Coronavirus disease 2019 severity in obesity:Metabolic dysfunctionassociated fatty liver disease in the spotlight

The coronavirus disease 2019(COVID-19)outbreak has drawn the scientific community's attention to pre-existing metabolic conditions that could aggravate the infection,causing extended viral shedding,prolonged hospitalization,and high death rates.Metabolic dysfunction-associated fatty liver disease(MAFLD)emerges as a surrogate for COVID-19 severity due to the constellation of metabolic alterations it entails.This review outlines the impact MAFLD exerts on COVID-19 severity in obese subjects,besides the possible mechanistic links to the poor outcomes.The data collected showed that MAFLD patients had poorer COVID-19 outcomes than non-MAFLD obese subjects.MAFLD is generally accompanied by impaired glycemic control and systemic arterial hypertension,both of which can decompensate during the COVID-19 clinical course.Also,MAFLD subjects had higher plasma inflammatory marker concentrations than non-MAFLD subjects,which might be related to an intensified cytokine storm syndrome frequently associated with the need for mechanical ventilation and death.In conclusion,MAFLD represents a higher risk than obesity for COVID-19 severity,resulting in poor outcomes and even progression to non-alcoholic steatohepatitis.Hepatologists should include MAFLD subjects in the high-risk group,intensify preventive measurements,and prioritize their vaccination.