ABSTRACT
Objectives: Worldwide, the COVID-19 pandemic has resulted in lifestyle disruptions, with lockdowns and curtailed activities. This was acutely felt in Asia from February 2020 onwards. Such drastic changes in lifestyle habits may impact negatively on metabolic related diseases. We explored these changes and their effects in patients with metabolic associated fatty liver disease (MAFLD). Materials and Methods: The data of MAFLD patients who were prospectively enrolled from eleven Asian centres in a longitudinal cohort study were analyzed. The data from 1st January 2019 (pre- COVID-19), were compared with the data from 1st February 2020 onwards (during COVID-19). Patients were stratified by physical activity level and whether they met target recommendation of[ 150 min of moderate/vigorous exercise per week. Results: A total of 229 patients were evaluated. Mean age was 59 ± 9.6 years with 136 (59.4%) males. During the COVID-19 pandemic, 50 (21.8%) patients maintained moderate/vigorous exercise, while 28 (12.2%) and 33 (14.4%) patients started and stopped moderate/vigorous exercising respectively. 118 patients (51.5%) did not participate in moderate/vigorous exercise either before or during the pandemic. Seventy-eight (34.1%) patients achieved[150 min moderate/vigorous exercise per week at the last visit. With the onset of COVID-19, reduction of physical activity of any kind was demonstrated in the majority (65.9%) of patients. There was a reduction of any physical activity including walking amongst those who stopped moderate/vigorous exercise and those without moderate/ vigorous exercise throughout. No significant changes in BMI, waist or hip circumference were observed in any activity level group. In patients who stopped moderate/vigorous exercise, alanine transaminase and aspartate transaminase significantly increased by 18.5% and 14.8% respectively. Conclusion: Stoppage of moderate/vigorous exercise leads to worsening of liver enzymes in patients with MAFLD and may have deleterious effects long term. As we adapt to live with COVID endemicity, novel modified healthy lifestyle habits would be needed to manage MAFLD.