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A MULTICENTER CLINICAL STUDY ON SARS-COV2 PANDEMIC CONFINEMENT: A FORCED IN VIVO TEST OF SHORT-TERM LIFESTYLE CHANGES AND THE INFLUENCE ON METABOLIC- (DYSFUNCTION) ASSOCIATED FATTY LIVER DISEASE (MAFLD) EVOLUTION

Mario Romeo 1, Rossella D'Onofrio 1, Marina Cipullo 1, Giuseppe Zagaria 1, Simone Olivieri 1, Marcello Dallio 1, Moris Sangineto 2, Gaetano Serviddio 2, Alessandro Federico 1

Affiliations

1 University of Campania Luigi Vanvitelli, Naples, Italy

2 University of Foggia, University Center for Liver Disease Research and Treatment (CURE), Liver Unit, Foggia, Italy

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Abstract

Introduction

A plethora of findings suggests the correlation between Metabolic-(Dysfunction)Associated Fatty Liver Disease (MAFLD) and long-term incorrect lifestyle behavior. The Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV2) pandemic lockdown represented a unique event forcing the entire population to suddenly change their lifestyle, favoring a drastic reduction in physical activity and an improper diet, with consequences on metabolic homeostasis never experienced before. In this study, we aimed to investigate the effects of the SARS-CoV-2 confinement and related lifestyle changes on MAFLD evolution.

Aims & Methods

A cohort of 222 MAFLD patients was followed two years before, two years during, and one year after the pandemic. At four time points [January 2018: T0; January 2020: T1; January 2022: T2; January 2023: T3], anthropometrical, biochemical, nutritional, bioelectrical impedance analysis (BIA) data, non-invasive tools for disease staging and hepatocellular carcinoma (HCC) occurrence were collected.

Results

At T2 an increase in fats and carbohydrate intake consistently with impaired weekly physical activity was demonstrated, associated with an increase in body mass index and waist-to-hip ratio (p<0.0001 for all), as well as a worsening in levels of total cholesterol, low/high-density lipoprotein, triglycerides, glucose, insulin, homeostatic model assessment for insulin resistance and transaminases (insulin: p=0.0003, glucose: p=0.0007; p<0.0001 for the others). Non-invasive tools assessments revealed a NAFLD fibrosis score, Liver Stiffness Measurement (LSM), and Controlled Attenuation Parameter impairment at T2 (p<0.0001 all). In comparison with T0 and T1, the BIA evidenced at T2 an increase in Fat Mass (FM) and a reduction of Free Fat Mass (FFM), Body Cell Mass (BCM), and Extracellular Mass (ECM). During the confinement period, the overall HCC and Milan-out staged HCC occurrence revealed HR:2.521, p=0.01, and HR:13.78, p=0.0009 respectively. Contrariwise to the modifications of the biochemical parameters, a significant association between body composition parameters modification during the study evaluations with HCC overall and HCC Milan-out criteria occurrence was highlighted (ΔFFM pre- vs during pandemic, OR: 0.704; ΔFM pre- vs during-pandemic, OR: 1.531; p <0.0001).
Receiving operator curve (ROC) analysis identified respectively -0.92 Kg (AUC:0.86) and -1.90 Kg (AUC:0.90) for FFM and +1.35 Kg (AUC:0.87) and +1.51 Kg (AUC:0.94) for FM as the best cut-off (BCO) variations (pre-pandemic vs pandemic) in the prediction of HCC overall and HCC Milan-out staged occurrence during the confinement. Time-to-time analysis revealed a higher incidence of HCC overall occurrence along the pandemic period in MAFLD patients presenting the following body modification composition “combined pattern” (BMCC) [BCO FFM decrease + BCO FM increase] in comparison to individuals presenting only one of two variations (p:0.025). At T3, compared to the pandemic period, simultaneously with improvement in physical activity as well as a decrease in fats and carbohydrate intake, the insulin levels, CAP, and FM were significantly decreased (p<0.001). Relevantly, a higher incidence of HCC overall occurrence even after the pandemic period in BMCC-MAFLD patients (p:0.048) was observed.

Conclusion

The confinement-related lifestyle changes impacted MAFLD evolution via body composition modifications, negatively influencing the HCC occurrence even after the pandemic period and the restoration of pre-existing life habits, as we are still observing the consequences of the confinement-induced "damages".

References

1. Taheri E, Bostick RM, Hatami B, et al. Dietary and Lifestyle Inflammation Scores Are Inversely Associated with Metabolic-Associated Fatty Liver Disease among Iranian Adults: A Nested Case-Control Study. J Nutr 2022;152:559-567.
2. Dallio M, Romeo M, Gravina AG, et al. Nutrigenomics and Nutrigenetics in Metabolic- (Dysfunction) Associated Fatty Liver Disease: Novel Insights and Future Perspectives. Nutrients 2021;13.
3. Ariya M, Koohpayeh F, Ghaemi A, et al. Assessment of the association between body composition and risk of non-alcoholic fatty liver. PLoS One 2021;16:e0249223.
4. Fujii H, Nakamura N, Fukumoto S, et al. Lifestyle changes during the coronavirus disease 2019 pandemic impact metabolic dysfunction-associated fatty liver disease. Liver Int 2022;42:995-1004.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

NAFLD: Risk, prevention and therapy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Abstract

Event

UEG Week Barcelona 2026

Topics

Neurogastroenterology & Motility Paediatrics

Session

What’s new in… Rome V?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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Eosinophilic GI disorders: Pathophysiology and beyond – are drugs for eosinophilia enough?

Antonio Di Sabatino 1, Albert J. Bredenoord 2

Affiliations

1 University of Pavia, Pavia, Italy

2 Amsterdam University Medical Center, Amsterdam, Netherlands

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Abstract

Event

UEG Week Barcelona 2026

Session

Eosinophilic gastrointestinal diseases: From basic to clinical practice

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Ariadna Aguilar 1

Affiliations

1 Hospital Universitari Vall d'Hebrón, Barcelona, Spain

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy Primary Care Neurogastroenterology & Motility

Session

Non-achalasia dysphagia: From symptoms to solution

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

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1 University of Bologna, Bologna, Italy

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Event

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Neurogastroenterology & Motility Primary Care

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1 Hospital General de Tomelloso, Madrid, Spain

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From guidelines to clinical practice: Digestive guidelines unplugged – what’s new, what’s next?

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