Recommendations and clinical guidance for children with metabolic-associated liver disease during the COVID-19 pandemic

Abstract

The outbreak of coronavirus disease-2019 (COVID-19), a new disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 affected most countries in the world within just a few months. By March 11, 2020, the Director-General at the World Health Organization (WHO) declared that COVID-19 can be considered a pandemic, and as of January 11, 2021, there were over 88.8 million cases of COVID-19 worldwide and 1.9 million deaths reported by WHO. In order to prevent the further spread of this epidemic outbreak, measures such as social distancing, stay-at-home orders, and school closure were executed in many countries. However, these measures also greatly reduced the opportunities for physical activity among children.1 Based on past experience, there are indications that an increased rate of weight gain occurs during summer school vacation for overweight children.2 Therefore, it is reasonable to speculate that under the influence of the COVID- 19 epidemic, long-term school closures may significantly increase the risk of weight gain in obese children. For children with metabolic-associated fatty liver disease (MAFLD),3,4 formerly known as nonalcoholic fatty liver disease, weight reduction through lifestyle changes (caloric restriction and physical activity) is considered as the first step in reversing disease progression, which makes managing MAFLD in children quite difficult during the ongoing COVID-19 pandemic. In addition, several studies found a significant correlation between a higher risk of severe illness from COVID-19 and metabolic disorders (e.g. diabetes, obesity, MAFLD).5-7 © 2021 Authors.