Covid-19 Mandates Associated with Increased Rate of Weight Gain and Liver Function Test Elevation in Children with Non-Alcoholic Fatty Liver Disease

ABSTRACT

Introduction: Weight management is currently the only established treatment of pediatric non-alcoholic fatty liver disease (NAFLD). Studies have shown improvements in liver histology, aminotransferase activity, and quality of life after weight loss in children with NAFLD.1 Recent studies demonstrate an accelerated rate of weight gain among children and adolescents during the COVID-19 pandemic that has been attributed to many factors, including the inability to be in a structured school setting and disruptions in family income.2,3 Objective: Our study aims to explore the effect of COVID-19 stay-at-home mandates and school closures on weight gain and liver function tests in children with NAFLD. Method(s) Following IRB approval (IRB 2021-4333), a retrospective chart review was performed on children aged 13-20 years who were seen at Lurie Children's Hospital (LCH) hepatology clinic for NAFLD and had two or more clinic visits at least three months apart during the pandemic period, defined as 3/1/20-9/1/21, and the pre-pandemic period, defined as before 3/1/20. The two most recent visits at least three months apart were the ones selected for the pre-pandemic period. Demographic and clinical data (race, ethnicity, age, BMI, height, weight, AST, ALT) were ed. Monthly BMI, AST, and ALT differences during the two periods were calculated for each patient. Paired-samples T-Tests were used to analyze differences between the two periods. Relative risks for an increase in BMI, AST, or ALT during the pandemic period compared to the pre-pandemic period were calculated. Result(s) Our cohort included 102 patients, with mean age of 14.5 (SD 1.6) during pre-pandemic period and 15.6 (SD 1.4) during pandemic period, 71 (70%) males, and 85 (83%) identifying as Hispanic or Latino. Mean BMI was 34.2 kg/m2 (SD 7.16) with mean Z-score of 2.16 (SD 0.56) during pre-pandemic period and mean BMI of 35.5 kg/m2 (SD 7.0) with mean Z-score of 2.21 (SD 0.56) during pandemic period. Seventy-seven (75%) children had a liver biopsy or other imaging consistent with their NAFLD diagnosis. There was a significant difference between monthly BMI differences during the pre-pandemic period (mean 0.0691 kg/m2/month, SD 0.271) and pandemic period (mean 0.161 kg/m2/month, SD 0.271);p=0.02. Of the 102 patients in our cohort, 75 had two or more ALT measurements at least three months apart during both time periods. There was a significant difference between monthly ALT differences during the pre-pandemic period (mean -2.39 IU/L, SD 8.67) and pandemic period (mean 1.70 IU/L, SD 11.3);p=0.01 (Figure 1). There was no significant difference between monthly AST differences during the two time periods. The relative risk of having an increase in BMI Z-score during the pandemic period compared to the pre-pandemic period was 1.37 (95% CI [1.09-1.72], p < 0.01, Figure 2). The relative risk of having an increase in ALT or AST during the pandemic period compared to the pre-pandemic period was not significant. Conclusion(s) Our cohort of children with NAFLD experienced an accelerated rate of BMI increases and ALT elevation during the COVID-19 pandemic. These findings underscore the importance of increasing access to resources for healthy behaviors during public health emergencies or extended school closures in facilitating the health and well-being of children with NAFLD.