Association of non-alcoholic fatty liver disease and COVID-19: A literature review of current evidence

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has swept through nations, crippled economies and caused millions of deaths worldwide. Many people diagnosed with COVID-19 infections are often found to develop liver injury, which, in a small portion of patients, progresses to severe liver disease. Liver injury in the form of elevated transaminases, hyperbilirubinemia and alterations in serum albumin has been observed to be higher in patients with severe forms of the disease. Those who already have insult to the liver from chronic disease, such as nonalcoholic fatty liver disease (NAFLD) may be at the greatest disadvantage. The severity of COVID-19 also seems to be driven by the presence of NAFLD and other co-morbidities. About 25% of the global population has NAFLD. With such a widespread prevalence of NAFLD, understanding the disease progression of COVID-19 and the occurrence of liver injury in this vulnerable population assumes great significance. In this review, we present an overview of COVID-19 infection in patients with NAFLD.

Keywords: SARS-CoV-2; Fatty liver; Mitochondria; Nitrosative stress; Oxidative stress; COVID-19; Metabolic associated fatty liver disease; Nonalcoholic fatty liver disease; Progressive liver disease; Nonalcoholic steatohepatitis

Core Tip: Liver injury in the form of elevated transaminases and hyperbilirubinemia in coronavirus disease 2019 (COVID-19) may be attributed to multiple factors, including the presence of pre-existing liver disease. The presence of nonalcoholic fatty liver disease (NAFLD) in patients with COVID-19 is likely to make them susceptible to severe forms of liver injury. Given the high prevalence of NAFLD worldwide, it is important to understand the implications of COVID-19 in such patients including role of comorbidities, disease progression, and the severity of COVID-19.