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World J Gastroenterol. Jun 14, 2021; 27(22): 3064-3072
Published online Jun 14, 2021. doi: 10.3748/wjg.v27.i22.3064
COVID-19 and pediatric fatty liver disease: Is there interplay?
Anna Di Sessa, Francesca Lanzaro, Sarah Zarrilli, Vittorio Picone, Stefano Guarino, Emanuele Miraglia del Giudice, Pierluigi Marzuillo
Anna Di Sessa, Francesca Lanzaro, Sarah Zarrilli, Vittorio Picone, Stefano Guarino, Emanuele Miraglia del Giudice, Pierluigi Marzuillo, Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
Author contributions: Di Sessa A wrote the manuscript; Miraglia del Giudice E, Di Sessa A, and Marzuillo P conceived the manuscript; Guarino S, Miraglia del Giudice E, and Marzuillo P supervised the manuscript drafting; Lanzaro F, Zarrilli S, and Picone V reviewed the literature data; Lanzaro F prepared the tables; Each author contributed important intellectual content during manuscript drafting or revision.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Di Sessa, MD, PhD, Research Fellow, Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Via l. de Crecchio, Naples 80138, Italy. anna.disessa@libero.it
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: March 14, 2021
Revised: March 27, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: June 14, 2021
Abstract

The rapid global spread of coronavirus disease 2019 (COVID-19) infection has become a major health issue with higher morbidity and mortality rates. Besides respiratory symptoms, a growing body of evidence indicates a variety of gastrointestinal manifestations including liver involvement. In this regard, several data supported an association between COVID-19 infection and liver injury in adults, while in children there is compelling but currently limited evidence. In particular, patients with COVID-19 have shown a higher risk of liver injury (mainly expressed as increased transaminase levels or hepatic steatosis). Conversely, a greater risk of more severe forms of COVID-19 infection has been observed in subjects with pre-existing chronic liver diseases. The dramatic interplay between COVID-19 and liver damage has been related to the inflammatory pathways chronically active in patients with nonalcoholic fatty liver disease and acutely in those affected by COVID-19, but other different pathogenic mechanisms have also been supposed. Of note, patients with previous metabolic comorbidities also had a higher risk of severe COVID-19 infection. This emphasizes the pathogenic interrelation of the inflammatory pathways with a dysregulated metabolic milieu in COVID-19 patients. Taking into account the prognostic role of fatty liver in COVID-19 patients and its intrinsic relationship with metabolic abnormalities even in childhood, a strict monitoring of this condition is recommended. We aimed to summarize the most recent evidence regarding the potential interplay between pediatric fatty liver and COVID-19.

Keywords: COVID-19, Children, Adults, Nonalcoholic fatty liver disease

Core Tip: Both adult and pediatric data recently reported a liver involvement in coronavirus disease 2019 (COVID-19). Although several pathogenic mechanisms have been proposed, inflammatory pathways seem to play a pivotal role in the pathophysiology of liver damage in this viral infection. In particular, a complex and bidirectional relationship has been highlighted between fatty liver and COVID-19. Several data suggested this intriguing interplay by underscoring the need for an early close monitoring of this liver condition with an intrinsic greater cardiometabolic burden.