Fatty-Liver Disease Increases Risk Of COVID-19 Hospitalization But Majority Do Not Even Know They Have Fatty Liver Disease
COVID-19 And Fatty Liver Disease
: Researchers from the University of Minnesota and John Hopkins School of Medicine in a new observational study reveal that individuals with non-alcoholic fatty liver disease and steatohepatitis have increased odds of hospitalization due to coronavirus disease (COVID-19); conversely, metabolic surgery was found to be protective against the admission of infected individuals.
It should be noted that roughly 1 out of 4 individuals globally suffer from some sort of fatty liver disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909941/
However most people are unaware of the fact that they have the disease due to the lack of symptoms during the initial phases of the disease.
The study showing the correlation between fatty-live disease and COVID-19 hospitalization was published on a preprint server and is yet to be peer-reviewed. https://www.medrxiv.org/content/10.1101/2020.09.01.20185850v1
To date we already know the most critical risk groups for severe clinical presentations are the elderly, those living with diabetes, and those with other chronic conditions (such as heart and lung disease).
Interestingly hepatic steatosis (comprising non-alcoholic fatty liver disease and non-alcohol steatohepatitis) correlates well with visceral adiposity, developed metabolic disease, as well as overt and chronic inflammation process.
Considering that COVID-19's pathophysiology is tightly linked to inflammation, non-alcoholic fatty liver disease and steatohepatitis may also represent significant risk factors that put patients with the disease at higher risk of poor disease outcomes; nonetheless, the research on this and possible mitigating factors has been scarce.
Hence this is why the study team sought to appraise the risk of hospitalization for COVID-19 associated with non-alcoholic fatty liver disease and steatohepatitis.
This research represents the first in-depth assessment of hepatic steatosis as a risk factor for hospital admission of COVID-19 by analyzing an extensive database in the United States, as well as possible treatments for avoiding this scenario.
A detailed retrospective analysis of electronic medical records from 56 primary care clinics and 12 hospitals has been pursued. More specifically, over 6,700 adults with positive SARS-CoV-2 test results were included between March 1, 2020, and August 25, 2020.
The primary objective of the study was a precise quantification of hospitalization risk for COVID-19 based on the history of non-alcoholic fatty liver disease and steatohepatitis.
In addition the researchers also wanted to see how known treatments for metabolic disease modified this risk, as well as if there any gender or racial differences.
The study findings showed that the medical history of hepatic steatosis was associated with increased odds of admission to hospital due to COVID-19. Each additional year of having either non-alcoholic fatty liver disease or steatohepatitis was also linked to a significantly increased risk of being hospitalized for COVID-19.
Interestingly when demographic ch
aracteristics were appraised, it was revealed that hepatic steatosis increased the risk of hospitalization in both men and women, and significantly elevated the same risk within each racial subgroup with the largest rise seen among individuals who self-identified as black.
Corresponding author Dr Carolyn T. Bramante from the department of Medicine, University of Minnesota, Division of General Internal Medicine, Minneapolis, told Thailand Medical News, "Promisingly, we found that known treatments for metabolic syndrome and NAFLD/NASH greatly mitigated risks from COVID-19 those with home metformin or glucagon-like peptide-1 receptor agonists use had a nonsignificantly reduced odds of hospitalization, and those who had undergone bariatric surgery had a significant decrease in odds of hospitalization.”
Dr Bramante added, "Non-alcoholic fatty liver disease/steatohepatitis is a state of chronic inflammation due to visceral adiposity, is a significant risk factor for hospitalization for COVID-19, and appears to account for risk attributed to obesity.”
Though more research is needed to verify these findings, , patients with elevated body mass index can already be screened for hepatic steatosis and informed of all the risks associated with visceral adiposity and COVID-19, as well as opportunities as mentioned above to mitigate it.
In addition, the protective benefits of metformin, glucagon-like peptide-1 receptor agonists, and bariatric surgery are promising but more treatment options for non-alcoholic fatty liver disease/steatohepatitis are urgently needed.
Significantly weight loss is still the mainstay of treatment, and while breakthroughs in obesity medicine have enabled a sustainable approach to it, societal forces including the ongoing pandemic continue to foster an obesogenic environment. This is something further research endeavors also need to address specifically.
It should be noted also that most people are not aware about fatty liver diseases and it symptoms and also the screening procedures. More health education to the general population is also necessary.
NAFLD or Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of NAFLD is too much fat stored in liver cells.
Certain people with NAFLD can develop nonalcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This damage is similar to the damage caused by heavy alcohol use.
NAFLD usually causes no signs and symptoms. When it does, they may include:fatigue, pain or discomfort in the upper right abdomen
Possible signs and symptoms of NASH and advanced scarring (cirrhosis) include: Abdominal swelling (ascites), enlarged blood vessels just beneath the skin's surface, enlarged spleen, red palms and yellowing of the skin and eyes (jaundice).
NAFLD and NASH are both linked to the following:
-Overweight or obesity
-Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin
-High blood sugar (hyperglycemia), indicating prediabetes or type 2 diabetes
-High levels of fats, particularly triglycerides, in the blood
These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and NASH, which may lead to a buildup of scar tissue in the liver.
Risk factors Of Fatty Liver Disease:
-High levels of triglycerides in the blood
-Obesity, particularly when fat is concentrated in the abdomen
-Polycystic ovary syndrome
-Type 2 diabetes
-Underactive thyroid (hypothyroidism)
-Underactive pituitary gland (hypopituitarism)
NASH is more likely in these following groups: older elderly individuals, people with diabetes, individuals with body fat concentrated in the abdomen.
Often, it is difficult to distinguish NAFLD from NASH without further testing.
The main complication of NAFLD and NASH is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in NASH. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue.
If the process isn't interrupted, cirrhosis can lead to:
-Fluid buildup in the abdomen (ascites)
-Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed
-Confusion, drowsiness and slurred speech (hepatic encephalopathy)
-End-stage liver failure, which means the liver has stopped functioning
-Between 5% and 12% of people with NASH will progress to cirrhosis.
In order To reduce risk of NAFLD:
-Choose a healthy diet. Choose a healthy plant-based diet that's rich in fruits, vegetables, whole grains and healthy fats.
-Maintain a healthy weight. If you are overweight or obese, reduce the number of calories you eat each day and get more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.
-Exercise. Exercise most days of the week. Get an OK from your doctor first if you haven't been exercising regularly.
As NAFLD causes no symptoms in most cases, it frequently comes to medical attention when tests done for other reasons point to a liver problem. This can happen if your liver looks unusual on ultrasound or if you have an abnormal liver enzyme test.
Diagnostic tests done to pinpoint the diagnosis and determine disease severity include:
-Complete blood count
-Liver enzyme and liver function tests
-Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
-Celiac disease screening test
-Fasting blood sugar
-Hemoglobin A1C, which shows how stable your blood sugar is
-Lipid profile, which measures blood fats, such as cholesterol and triglycerides
Diagnostic Imaging procedures used to diagnose NAFLD include:
-Abdominal ultrasound, which is often the initial test when liver disease is suspected.
-Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) of the abdomen. These techniques lack the ability to distinguish NASH from NAFLD, but still may be used.
-Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
-Magnetic resonance elastography, works by combining MRI imaging with sound waves to create a visual map (elastogram) showing the stiffness of body tissues.
Should other tests are inconclusive, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring.
A liver biopsy can be uncomfortable, and it does have small risks that your doctor will review with you in detail. This procedure is performed by a needle insertion through the abdominal wall and into the liver.
The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. Losing weight addresses the conditions that contribute to NAFLD. Ideally, a loss of 10% of body weight is desirable, but improvement in risk factors can become apparent if you lose even 3% to 5% of your starting weight. Weight-loss surgery is also an option for those who need to lose a great deal of weight.
For those who have cirrhosis due to NASH, liver transplantation may be an option.
To date no drug treatment has been approved by the Food and Drug Administration for nonalcoholic fatty liver disease, but a few drugs are being studied with promising results.
Certain evidence suggests vitamin E supplements may be helpful for individuals with liver damage caused by nonalcoholic fatty liver disease. But vitamin E has been linked with increased risk of death and, in men, an increased risk of prostate cancer.
In research of individuals with nonalcoholic fatty liver disease, those who reported drinking two or more cups of coffee a day had less liver damage than those who drank little or no coffee. It's not yet clear how coffee may influence liver damage, but findings suggest it may contain certain compounds that may play a role in fighting inflammation.
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