Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease

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6 Scopus citations


Background: SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. Objective: The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments. Setting: Retrospective analysis of electronic medical record data of 26,896 adults from a 12-hospital Midwest healthcare system with a positive COVID-19 polymerase chain reaction (PCR) test from March 1, 2020, to January 26, 2021. Methods: Variable selection was guided by the least absolute shrinkage and selection operator (LASSO) method, and multiple imputation was used to account for missing data. Multivariable logistic regression and competing risk models were used to assess the odds of being hospitalized within 45 days of a COVID-19 diagnosis. Analysis assessed the risk of hospitalization among patients with a prescription for metformin and statin use within the 3 months prior to the COVID-19 PCR result, history of home glucagon-like peptide 1 receptor agonist (GLP-1 RA) use, and history of metabolic and bariatric surgery (MBS). Interactions were assessed by sex and race. Results: A history of NAFLD/NASH was associated with increased odds of admission for COVID-19 (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.57–2.26; P < .001) and mortality (OR, 1.96; 95% CI, 1.45–2.67; P < .001). Each additional year of having NAFLD/NASH was associated with a significant increased risk of being hospitalized for COVID-19 (OR, 1.24; 95% CI, 1.14–1.35; P < .001). NAFLD/NASH increased the risk of hospitalization in men, but not women, and increased the risk of hospitalization in all multiracial/multiethnic subgroups. Medication treatments for metabolic syndrome were associated with significantly reduced risk of admission (OR, .81; 95% CI, .67–.99; P < .001 for home metformin use; OR, .71; 95% CI, .65–.83; P < .001 for home statin use). MBS was associated with a significant decreased risk of admission (OR, .48; 95% CI, .33–.69; P < .001). Conclusions: NAFLD/NASH is a significant risk factor for hospitalization for COVID-19 and appears to account for risk attributed to obesity. Other significant risks include factors associated with socioeconomic status and other co-morbidities, such as history of venous thromboembolism. Treatments for metabolic disease mitigated risks from NAFLD/NASH. More research is needed to confirm the risk associated with visceral adiposity, and patients should be screened for and informed of treatments for metabolic syndrome.

Original languageEnglish (US)
Pages (from-to)1780-1786
Number of pages7
JournalSurgery for Obesity and Related Diseases
Issue number10
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This research was supported by the Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute grant No. K12HS026379 (C.J.T.); the National Center for Advancing Translational Sciences grant Nos. KL2TR002492 and UL1TR002494 (C.T.B.); a COVID-19 Rapid Response Grant (No. UM 2020-2231); and the Minnesota Learning Health System Mentored Training Program (M Health Fairview Institutional Funds [C.T.B.]).

Publisher Copyright:
© 2021


  • COVID-19
  • fatty liver disease
  • metabolic and bariatric surgery
  • Bariatric Surgery
  • COVID-19 Testing
  • Humans
  • Liver
  • Male
  • Hospitalization
  • SARS-CoV-2
  • Non-alcoholic Fatty Liver Disease
  • Adult
  • Retrospective Studies

PubMed: MeSH publication types

  • Observational Study
  • Journal Article


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