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Celiac disease increases risk of NAFLD

In study data published in the Journal of Hepatology, patients with celiac disease had an increased risk for developing nonalcoholic fatty liver disease vs. the general population.

“Celiac disease alters intestinal permeability and treatment with a gluten-free diet often causes weight gain, but so far there are few reports of non-alcoholic fatty liver disease in patients with celiac disease,” the researchers wrote. “In this population-based study, we aim to investigate the frequency with which NAFLD is identified among individuals with [celiac disease].”

Between 2006 and 2008, researchers collected and analyzed data from small intestinal biopsies of patients diagnosed with celiac disease from 28 pathology centers in Sweden performed between 1969 and 2008. The researchers performed a case-control study of 28,816 individuals with diagnosis of celiac disease in 1997 or later, and 130,051 matched controls. Hazard ratios were calculated for NAFLD using a Cox regression model.

Overall, the median age of celiac disease diagnosis was 28 years, with 42.8% diagnosed in childhood. Eighty-seven percent of patients diagnosed with celiac disease were diagnosed in 1990 or later and 97% were born in Nordic countries.

During 246,559 person-years of follow-up, 53 patients with celiac disease were diagnosed with NAFLD (21/100,000 person-years). Also, 85 controls were diagnosed with NAFLD during 1,488,413 person-years (6/100,000 person-years), according to the research, which correlated with a hazard ratio of 2.8 (95% CI, 2-3.8; P < .001), and the highest risk estimates seen in children (HR = 4.6; 95% CI, 2.3-9.1).

The hazard ratio for NAFLD risk in the first year after celiac disease diagnosis was 13.3 (95% CI, 3.5-50.3), but remained high beyond 15 years after the diagnosis of celiac disease (HR = 2.5; 95% CI, 1-5.9). Celiac disease was associated with a 4.2-fold increased risk of NAFLD in the first 5 years of diagnosis.

Post-hoc analysis showed that fewer patients with celiac disease and NAFLD had an alcohol-related liver disease compared with control patients with NAFLD (12% vs. 15%).

“Individuals with celiac disease seem to be at an increased risk of NAFLD compared to the general population, a risk that diminishes in magnitude, but persists over the long term,” the researchers concluded. “These findings should be confirmed in a population of NAFLD patients where excess alcohol intake has been ruled out and the diagnosis has been confirmed through liver biopsy.” – by Melinda Stevens

Disclosures: Reilly reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.