COVID-19 and pediatric fatty liver disease: Is there interplay?

Table 2 Main findings regarding the association between fatty liver disease and coronavirus disease 2019 in children

Ref.	Study design	Population	NAFLD	Main findings
Qiu et al[36]	Cohort study. Three hospitals in Zhejiang Province, China	36 pediatric patients (aged 0-16 yr) with laboratory confirmed COVID-19 infection; mild cases (n = 17); moderate cases (n = 19) compared with adults with COVID-19 (n = 175); Children with SARS (n = 44); Children with H1N1 influenza (n = 167)	Increased liver enzymes	Elevated ALT in two patients (mild cases) and AST in three patients (two mild and one moderate case), 6% of cases with elevated liver enzymes, 18% of cases with elevated liver enzymes, 48% of cases with elevated liver enzymes, 17% of cases with elevated liver enzymes
Sun et al[37]	Retrospective analysis. Intensive Care Unit, Wuhan Children’s Hospital	8 severe or critically ill COVID-19 patients admitted to the ICU. Age: 2 mo-15 yr	Increased liver enzymes	Elevated ALT levels in 4 out of 8 patients. Total bilirubin level in all patients was normal
Wang et al[39]	Retrospective study. Children from six provinces (autonomous region) in northern China.	31 cases of COVID-19. Age: 6 mo-17 yr	Increased liver enzymes	Elevation of liver enzyme (22%)
Xia et al[38]	Retrospective study. Wuhan Children’s Hospital	20 COVID-19 pediatric patients. Age: 1 d-14 yr, 7 mo (median age: 2 yr and 1.5 mo)	No NAFLD screening. CT was performed for pneumonia	Elevated ALT (> 40 U/L) in 25% of cases
Jiehao et al[40]	Case series. Children’s Hospital in Shanghai, Hainan, Hefei in Anhui province, and Qingdao in Shandong province	10 patients aged 3-131 mo (mean: 74 mo). Male: female 1:1.5	No NAFLD screening. CT was performed for pneumonia	Median ALT: 18.5 U/L, AST: 27.7 U/L. One patient had ALT: 100 U/L and AST: 142 U/L
Tan et al[41]	Retrospective study. North Hospital of Changsha First Hospital	10 children with confirmed COVID-19 infection. Mean age of 7 yr (1-12 yr)	Increased liver enzymes	Elevated AST in two patients

ALT/AST: Alanine aminotransferase/aspartate aminotransferase; CT: Computed tomography; COVID-19: Coronavirus disease 2019; H1N1: Influenza A; ICU: Intensive care unit; NAFLD: Nonalcoholic fatty liver disease; SARS: Severe acute respiratory syndrome.