Coronavirus Disease 2019 (COVID-19) is a pandemic disease caused by a new corona virus. COVID-19 affects different people in different ways. COVID-19 could affect the gastrointestinal system via gut microbiota impairment. Gut microbiota could affect lung health through a relationship between gut and lung microbiota, which is named gut-lung axis. Gut microbi- ota impairment plays a role in pathogenesis of various pulmonary disease states, so GI diseases were found to be associated with respiratory diseases. Moreover, most infected people will develop mild to moderate gastrointestinal (GI) symptoms such as diarrhea, vomiting, and stomachache, which is caused by impairment in gut microbiota. Therefore, the current study aimed to review potential role of gut microbiota in patients with COVID-19, its relation with lung axis, Central Nervous System (CNS) axis and improvement with probiotic therapy. Also, this review can be a guide for potential role of gut microbiota in patients with COVID-19.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19] quickly turned into a pandemic. Gastrointestinal involvement, especially liver diseases, is one of the main complications of COVID-19 patients. Objectives: The current study aimed to evaluate the high incidence of liver involvement in COVID-19 hospitalized patients and its association with mortality. Methods: A total of 560 hospitalized patients with a confirmed diagnosis of COVID-19 were included. Death was considered as the outcome. In addition to liver enzymes, demographic, clinical, and other laboratory data were also collected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels ≥ 40 were considered as abnormal. To investigate the association between abnormal levels of liver enzymes and death, multiple regression logistic was used. Results: According to the findings, 29.1% (95% CI = 25.3% - 32.9%) of patients had high levels (≥ 40 IU) of ALT, and 45.1% (95% CI = 40.9% - 49.3%) had high levels of AST (≥ 40 IU). The frequency (based on %) of high levels of AST (≥ 40 U/liter) was significantly higher in patients who died [67.3% (95% CI = 54.5% - 80.1%] of COVID-19 than those who survived [44.9% (95% CI = 39.7% - 50.0%)] (P-value < 0.001). No significant difference was detected in ALT between expired [29.1% (95% CI = 16.7% - 41.5%)] and survived patients [30.7% (95% CI = 25.9% - 35.5%] (P-value = 0.791). AST was found to have an independent association with death in multiple logistic regression (Wald = 4.429, OR (95% CI) = 1.014 (1.008 - 1.020), P-value = 0.035). Conclusions: Liver involvement is a common finding in COVID-19 hospitalized patients. Higher levels of AST were significantly associated with an increased mortality rate in COVID-19 patients.

Dietary modifications remain the mainstay in managing nonalcoholic fatty liver disease (NAFLD). Published data on the effect of overall dietary patterns on NAFLD is scarce. The present study aims to extract the dietary patterns and investigate their association to NAFLD by gender, using structural equation modeling, among adult participants in Amol, northern Iran. In this cross-sectional study, data from 3,149 participants in the Amol cohort study (55.3% men, n = 1,741) were analyzed. Usual dietary intake was assessed by a validated 168-items semiquantitative food frequency questionnaire. We classified major dietary patterns by explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). NAFLD diagnosis was based on ultrasound scanning, including increased hepatic echogenicity, abnormal appearance of hepatic arteries, and diaphragm in the absence of excessive alcohol consumption. Multivariable logistic regression and structural equation modeling (SEM) were used to explore the relationship between dietary patterns and NAFLD. Three distinct dietary patterns, including western, healthy, and traditional/mixed dietary patterns, were identified. Adult male who adhere to the western dietary pattern were more affected with NAFLD risk [Q1, Q2, Q3, Q4, odds ratio (OR) = 1, 1.16, 1.34, 1.39; 95% confidence interval (CI) = 0.83–1.61, 0.96–1.85, 0.98–1.96, ptrend = 0.04, respectively]. A full mediating effect of healthy dietary pattern, western dietary pattern, and traditional dietary pattern via dietary acid load (DAL) proxy (of dietary patterns to DAL: βstd = −0.35, p &lt; 0.006, βstd = 0.15, p = 0.009, and βstd = 0.08, p = 0.001, respectively), on NAFLD was found through mediation analysis using SEM. A western dietary pattern comprising frequent intake of salty and sweet snacks, soft drinks, refined grains, processed meats, cooked and fried potatoes, eggs, and coffee was associated with a higher odds of NAFLD in an Iranian male population. Additionally, our findings might provide a mechanistic explanation for the association between dietary patterns and NAFLD via DAL proxy. However, further prospective studies, including assessing acid-base biomarkers, are needed.