Piacenza Liver Diagram

Fatty Liver, Obesity, and COVID-19

Sometimes, a health crisis serves to clear the mind and prompt scientific curiosity. In fact, we see that in a steady stream of new research building an understanding of how COVID-19 leaves some people unharmed and others devastated. A new paper in Obesity offers a fine example. Ming Deng and colleagues bring new insights to explain how fatty liver, obesity, and COVID-19 interact to raise the risk for poor outcomes in younger patients.

The science of the intersection between obesity and COVID-19 is becoming ever more clear. Now it’s time for medical care and health policy to catch up.

Liver Inflammation Meets an Inflammatory Response to the Coronavirus

Prior studies have shown it consistently. Age is the biggest risk factor for bad outcomes with this nasty virus. But for younger people, obesity and its complications are key. So Deng et al took a closer look at the mechanisms. They examined detailed data on 65 young patients at Zhongnan Hospital with moderate, severe, and critical cases of COVID-19. And thus, a multivariate logistic regression pointed to male gender, high BMI, elevated fasting glucose, and urinary protein as risk factors for severe disease.

Digging deeper, they examined the mechanism that linked obesity to poor outcomes. The authors wrote:

Our findings show that obesity is an important predictor of severe COVID-19 among young
patients. Further analysis found that obesity mainly affects the severity of COVID-19 through the
deposition of ectopic fat in multiple organs, which in turn damages the organ function. According
to our data, in young patients with severe COVID-19, the organs most likely to be affected were
the liver and kidneys.

A preprint analysis of data from the UK Biobank also points to the importance of fatty liver disease as a risk factor.

Catching Up with Science

Medical practice and health policy is having a hard time catching up with the understanding of obesity as a metabolic disease. People who should know better still think of obesity as a behavior, rather than a disease. They opine that fatty liver disease is a simple matter of malnutrition that shouldn’t be treated medically. Meanwhile, people living with obesity get little or no real care for the metabolic disease that afflicts them.

With a new editorial in Newsweek, Fatima Cody Stanford explains that this is unacceptable:

When we have more people – particularly people of color – battling obesity in the United States than anywhere else in the world, we can’t tolerate inaction by our leaders any longer. It’s time for Washington to treat obesity like the disease that it is, rather than the personal failing it is not, and do its part to protect the most vulnerable Americans with targeted legislation like the Treat and Reduce Obesity Act (TROA).

Wake up folks. Health systems that blame people for obesity and deny them treatment are making people sicker. They’re making us more vulnerable to COVID-19. At long last, it’s time to stop doing this to ourselves.

Click here for the paper from Deng et al and here for the preprint of UK Biobank data. For Stanford’s editorial, click here.

Piacenza Liver Diagram, illustration by Dbachmann / Wikimedia Commons

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July 2, 2020