key: cord-321997-3dkl6iha authors: Hussain, Abdulzahra; Vasas, Peter; EL-Hasani, Shamsi title: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease date: 2020-04-29 journal: Metabolism DOI: 10.1016/j.metabol.2020.154256 sha: doc_id: 321997 cord_uid: 3dkl6iha nan J o u r n a l P r e -p r o o f disease progression. Not only, NASH and NAFLD are important predictive factors for the outcomes in acute and chronic disease processes but also the obesity surgery and its complications [7] . We think that the authors had reached the correct conclusion indirectly, as obesity is the primary aetiology for the liver disease [NASH, NAFLED] and rarely considered as independent conditions. When they coexist, they do so because of obesity. Several other studies have reported obesity as a significant factor for mortality in Covid-19 patients [8-10].This subject is more important in the current Covid-19 crisis knowing the pandemic of obesity. In addition to the known defective immune system in the obesity, the virulence of Covid-19 and the differences in the incidence of obesity across the world, it is not clear what is the magnitude /severity of liver disease could add to production of critical illness like severe pneumonia. We believe more powerful studies are needed to confirm why obesity is a risk factor for critical illness and or mortality in Covid-19. This will help to reduce mortality in this vulnerable group of patients. Declaration: authors confirm no conflict of interest and no funding for this paper Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease Nonalcoholic Steatohepatitis: A Review Effect of Body Mass Index, Metabolic Health and Adipose Tissue Inflammation on the Severity of Non-alcoholic Fatty Liver Disease in Bariatric Surgical Patients: a Prospective Study Applying Non-Invasive Fibrosis Measurements in NAFLD/NASH: Progress to Date Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity Anand U 3 .Non-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations Nonalcoholic Steatohepatitis Is Associated With Increased Mortality in Obese Patients Undergoing Bariatric Surgery Obesity is associated with severe forms of COVID-19.Obesity (Silver Spring) Risk of COVID-19 for patients with obesity Lille Intensive Care COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation.Obesity (Silver Spring)