Abbreviations:
- MAFLD : fatty liver disease associated with metabolic dysfunction
- NAFLD : nonalcoholic fatty liver disease
The coronavirus disease 2019 (COVID-19) outbreak in December 2019 spread rapidly around the world and was declared a global pandemic by the World Health Organization in March 2020. The Japanese government declared a state of emergency on the 7th. April 2020 due to a rapid increase in the number of patients affected by COVID-19. Under this statement, non-essential businesses, schools and recreational facilities were urged to close, while people were strongly encouraged to stay home except for essential activities.
The COVID-19 crisis forced changes in lifestyle, the so-called ’new normal’ . For example, many people now work from home and have little contact with people other than family members. These changes potentially led to less physical activity, altered rhythms of daily life, and unhealthy lifestyles.2 They may also have resulted in increases in body weight and body mass index (BMI), potentially increasing the incidence of obesity. and obesity-related disorders.
Due to widespread obesity , nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of liver disease worldwide. Currently, the prevalence of NAFLD worldwide is estimated to be approximately 25%. NAFLD comprises a broad spectrum of diseases ranging from nonalcoholic fatty liver to nonalcoholic steatohepatitis, including cirrhosis and/or hepatocellular carcinoma.
In 2020, an international consensus panel suggested that NAFLD should be renamed metabolic dysfunction-associated fatty liver disease (MAFLD) and proposed new information regarding its diagnosis.
The impact of “new normal” lifestyles on the incidence of MAFLD is unknown. We hypothesize that new lifestyles resulting from the COVID-19 pandemic affect the development of MAFLD. Therefore, we aimed to determine whether lifestyle changes associated with the COVID-19 pandemic increased the incidence of MAFLD and identify specific lifestyle changes associated with the development of MAFLD.
Background and Objectives
The coronavirus disease 2019 (COVID-19) pandemic precipitated lifestyle changes. We aimed to clarify whether COVID-19-induced lifestyle changes affected the development of metabolic dysfunction-associated fatty liver disease (MAFLD).
Methods
This retrospective longitudinal study included 973 participants who underwent health screenings between 2018 and 2020. We used data from the MedCity21 health screening registry.
The clinical characteristics and lifestyle habits of the participants were investigated. Independent lifestyle predictors of MAFLD development before the pandemic (2018-2019) and during the pandemic (2019-2020) were identified using logistic regression analysis.
Results
In 2018, 261 (27%) patients were diagnosed with MAFLD. Before the pandemic, 22 patients developed new MAFLD. During this time, routine nighttime eating was identified as an independent lifestyle predictor of the development of MAFLD (hazard ratio [HR] 2.54, 95% confidence interval [CI] 1.02-6.36 , P = 0.046). In contrast, 44 patients developed new MAFLD during the pandemic.
During this time, higher daily alcohol intake was identified as an independent lifestyle predictor of MAFLD development (HR 1.03, 95% CI 1.01-1.05, P = 0.008).
In participants younger than 60 years, daily alcohol intake and the proportion of participants eating twice a day were significantly higher in patients who developed MAFLD during the pandemic than in those who did not. In participants aged ≥60 years, no lifestyle was associated with the development of MAFLD before or during the pandemic.
Discussion
To our knowledge, there have been no previous reports of an increased incidence of MAFLD associated with lifestyle changes necessitated by the COVID-19 pandemic.In the current longitudinal study, we found that routine nighttime eating before the COVID-19 pandemic and increased daily alcohol intake during the COVID-19 pandemic were independent lifestyle predictors of the development of MAFLD in a Japanese population. .
Cases of fatty liver disease associated with metabolic dysfunction have increased since before the COVID pandemic with late-night eating before the pandemic and increased alcohol consumption mid-pandemic as predictors
Conclusions New diagnoses of MAFLD increased during the COVID-19 pandemic. Changes in lifestyle factors, particularly in those under 60 years of age, should be monitored and addressed as the pandemic continues. Key points
|
Comments
Liver disease increases as a result of lifestyle changes due to COVID-19, study reveals
Osaka City University reveals in a retrospective study that cases of fatty liver disease associated with metabolic dysfunction have increased since before the COVID pandemic and also show pre-pandemic night eating and an increase in alcohol consumption in the middle of the pandemic
Liver disease was negatively affected by lifestyle changes during the first year of the pandemic, according to a new study in the journal Liver International.
The retrospective study used health checkup data from 973 participants between 2018 and 2020 from MedCity21, an advanced preventive medicine medical center established by Osaka City University Hospital in 2014, and found that new diagnoses of liver disease increased Metabolic Dysfunction Associated Fat (MAFLD) from 22 before the COVID pandemic to 44 during the pandemic.
"Before the pandemic, we found that routine nighttime meals or eating dinner 2 hours before bedtime was an independent lifestyle predictor of developing MAFLD," says Hideki Fujii, first author of the study, "however, the analysis showed “Higher daily alcohol intake as an independent predictor of illness during the pandemic.”
Pre-pandemic
The researchers analyzed the lifestyle habits of the 22 patients who developed MAFLD between July 2018 and December 2019, which included alcohol intake, exercise, sleep duration, daytime meals, and nighttime meals.
Through a univariate and multivariate analysis of the data to control for possible risk factors such as age, sex, etc., they found that only the proportion of nighttime meals was significantly higher, marking it as an independent predictor of developing MAFLD.
During the pandemic
Between December 2019 and December 2020, in the additional 44 patients who developed MAFLD, the researchers found an increase in alcohol intake primarily among patients under 60 years of age.
“This represents a significant proportion of the working-age population,” says Dr. Fujii, “suggesting the need to more closely monitor and address this lifestyle change as the pandemic continues.” Additionally, the proportion of smokers and those who ate 2 meals a day instead of 3 was higher in those who developed MAFLD during the pandemic.
“Our data comes from people who, after undergoing an abdominal ultrasound in 2018, returned for routine follow-ups through 2020,” explains Dr. Fujii. While the research team is aware that this suggests that most participants were healthy enough to work and were health-conscious enough to voluntarily undergo medical checkups, "we were curious about the impact COVID-19 had." 19 and their associated “new normal” lifestyles on incidences of MAFLD,” continues Dr. Fujii, something that has remained unknown until now.
As the pandemic continues into 2022, these results are increasingly relevant for patient lifestyle counseling to prevent the increase in the number of people with MAFLD.
