Rising NAFLD and metabolic severity during the Sars‐CoV‐2 pandemic among children with obesity in the United States

Abstract Objective Nonalcoholic fatty liver disease (NAFLD), the most common liver disease among youth with obesity, precedes more severe metabolic and liver diseases. However, the impact of the Sars‐CoV‐2 global pandemic on the prevalence and severity of NAFLD and the associated metabolic phenotype among youth with obesity is unknown. Methods Participants were recruited from the Yale Pediatric Obesity Clinic during the Sars‐CoV‐2 global pandemic (August 2020 to May 2022) and were compared with a frequency‐matched control group of youth with obesity studied before the Sars‐CoV‐2 global pandemic (January 2017 to November 2019). Glucose metabolism differences were assessed during an extended 180‐minute oral glucose tolerance test. Magnetic resonance imaging‐derived proton density fat fraction (PDFF) was used to determine intrahepatic fat content in those with NAFLD (PDFF ≥ 5.5). Results NAFLD prevalence increased in participants prior to (36.2%) versus during the Sars‐CoV‐2 pandemic (60.9%), with higher PDFF values observed in participants with NAFLD (PDFF ≥ 5.5%) during versus before the pandemic. An increase in visceral adipose tissue and a hyperresponsiveness in insulin secretion during the oral glucose tolerance test were also observed. Conclusions Hepatic health differences were likely exacerbated by environmental and behavioral changes associated with the pandemic, which are critically important for clinicians to consider when engaging in patient care to help minimize the future risk for metabolic perturbations.