The incidence of metabolic-associated fatty liver disease (MAFLD) rose during the first year of the COVID-19 pandemic, Japanese researchers report. While cases were previously attributed to late-night meals, increased alcohol consumption was responsible for the rise after the pandemic began, according to results published in Liver International.

Arising from the accumulation of fat in the liver, non-alcoholic fatty liver disease (NAFLD) and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for a growing proportion of advanced liver disease in the United States and worldwide. In many cases, fatty liver disease is associated with metabolic conditions, including obesity and diabetes, so it is sometimes referred to MAFLD. Fatty liver disease can lead to fibrosis, cirrhosis and even liver cancer. With no effective approved medical therapies, disease management is dependent on lifestyle changes such as weight loss and exercise.

Hideki Fujii, MD, PhD, of Osaka City University, in Japan, and colleagues sought to understand whether pandemic-related lifestyle factors influenced the development of MAFLD.

For this retrospective longitudinal study, the researchers recruited 973 individuals who received health checkups between 2018 and 2020. They used data from a health examination registry at MedCity21, a preventive medicine center at Osaka City University Hospital. They assessed the clinical features and lifestyles of participants.

In 2018, prior to the pandemic, 261 people (27%) were found to have MAFLD, including 22 with new cases. Between July 2018 and December 2019, the researchers assessed the lifestyle habits of these 22 individuals, including alcohol intake, exercise, sleep and diet. Regularly eating meals late at night was found to be an independent risk factor for MAFLD, more than doubling the risk.

“Before the pandemic, we found routine late-night meals, or dinner two hours before bedtime, as an independent lifestyle predictor of developing MAFLD,” Fujii said in a press release. “However, analysis showed higher daily alcohol intake as an independent predictor of the disease during the pandemic.”

During the pandemic, 44 more people developed MAFLD, with greater alcohol consumption linked to higher risk. For people over age  60, lifestyle habits were not linked to developing MAFLD. But among people younger than 60, those who developed fatty liver disease were more likely to report daily alcohol consumption and eating two meals a day instead of three.

“This represents a major proportion of the working-age population, suggesting a need to more closely monitor and address this lifestyle change as the pandemic continues,” said Fujii.

Click here to read the study in Liver International.
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