We read with great interest the article by Ji et al. on liver injury patterns and the clinical implications of metabolic-associated fatty liver disease (MAFLD) in patients with COVID-19.1 Metabolic and cardiovascular comorbidities like diabetes and hypertension aggravate the severity of COVID-19.2 Another comorbidity, MAFLD, also affects COVID-19 severity, as pointed out by Ji et al.1 Since excess liver fat is seen in up to a quarter of people,3 we hypothesized that its impact on severity might be modulated by age. We considered that disease severity of older patients with a greater burden of cardiac and respiratory illness would more likely be impacted by their comorbid conditions, than the presence of liver fat. In this study, we investigated the effects of MAFLD on COVID-19 severity in older vs. younger patients.