Impact of deterioration of lifestyle in nalfd patients during COVID-19 lockdown

Background: Quarantine measures during Corona Virus Disease 2019 (COVID-19) pandemic changed lifestyle habits. In Nonalcoholic fatty liver disease (NAFLD) weight gain and unhealthy diet, along with PNPLA3 gene, impact on metabolic and hepatic disease. Aim: to evaluate prevalence and predictors of weight gain and steatosis progression in NAFLD outpatients during COVID-19 lockdown. Methods: 357 NAFLD outpatients were evaluated before COVID-19 lockdown and 6 months apart. Anthropometric, metabolic (i.e. presence and therapy of type 2 diabetes-T2DM, hypertension, dyslipidemia), laboratory data (glycemia, lipids, transaminases) as well as ultrasound (US) grading of steatosis were collected pre and post lockdown. Worsening of metabolic alterations was assessed post lockdown as newonset comorbidity or introduction of new therapies. Patients were questioned about diet and physical activity at each visit. In 222 patients genotyping for PNPLA3 was available. Results: Mean age was 61 ±12 ys, with 67% male. After lockdown 28% of the cohort worsened US steatosis grade from mild to moderate or severe. Patients who worsened steatosis had a higher prevalence of T2DM (34% vs 12%, p=0.006) and higher BMI (28.6 ±3.9 vs 26.8 ±3.6 kg/m2, p=0.01) pre lockdown compared to those who did not. No impact of diet or physical activity was observed on steatosis progression. An increase in body weight was registered in 170 (48%) patients with a mean increase of 3.2 ±2.4 Kg. As expected, patients with weight gain compared to those without it had a significantly lower adherence to diet (45% vs 61%, p=0.005) and decreased physical activity (28% vs 45%, p=0.001) at post lockdown visit. However, deterioration of lifestyle was not significant in subjects with PNPLA3 homozygosity for the risk allele. In addition, no impact on weight gain of pre lockdown lifestyle (diet adhesion 60% vs 52%, p=0.15;physical activity 48% vs 40%, p=0.16) or metabolic comorbidities was found. In patients who gained weight a worse glycemic control was observed (7% vs 2%, p=0.04) with increase in glycemia (106 ± 25 vs 111 ± 30 mg/dl p<0.001) compared to pre lockdown. Conclusion: Lockdown led to a dramatic change in lifestyle with consequent weight gain in almost half of our cohort of NAFLD patients. Indeed, genetic factors seem to modulate this impact. Therefore, during pandemic emergencies should be highly important to monitor patients' lifestyle at home, possibly by new technologies such as telemedicine.