Patients with celiac disease who adhere to a gluten-free diet have nearly twice the risk of developing nonalcoholic fatty liver disease (NAFLD), according to research presented at the American College of Gastroenterology (ACG) 2021 Annual Meeting, held from October 22 to 27, 2021, in Las Vegas, Nevada and virtually.

Gluten-free diet can contribute to metabolic syndrome. Given that NAFLD is strongly associated with metabolic syndrome, researchers sought to determine the prevalence of NAFLD in patients with celiac disease before and after implementing a gluten-free diet, as well as the prevalence of celiac disease among patients with NAFLD.

In this systemic review and meta-analysis, 12 studies involving 4978 participants were included, of which 5 studies (1268 participants) assessed the prevalence of NAFLD in patients with celiac disease, and 7 studies (3710 participants) assessed the prevalence of celiac disease in patients with NAFLD. Only studies with ≥50 cases of celiac disease with most participants aged >15 years were included in the analysis. New diagnoses of serology- and histology-positive celiac disease were assessed.

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Researchers reported a pooled prevalence of NAFLD of 12.3% (95% CI, 5.6-24.7; I2 = 95%) and 21.4% (95% CI, 9.6-41.3; I2 = 97%) in patients with celiac disease before and after initiating a gluten-free diet, respectively. A significant increase in the odds of developing NAFLD after starting a gluten-free diet was observed (odds ratio [OR], 1.82; 95% CI, 1.24-2.66; P =.002).

A pooled prevalence of 5.3% (95% CI, 3.5-8.0; I2 = 76%) and 3.1% (95% CI, 1.7-5.6; I2 = 79%) was observed in patients with NAFLD with serology-positive and histology-positive celiac disease, respectively.

Researchers concluded, “Odds of developing NAFLD nearly double after initiation of [gluten-free diet] in [celiac disease] patients and close monitoring during follow-up might be reasonable. Given the long-term consequences of the [metabolic syndrome] and NAFLD, consideration should be given to screening protocols for NAFLD in patients with [celiac disease].”


Aggarwal M, Kumar P, Garg R, Lindenmeyer CC, Wakim-Fleming J, Rubio-Tapia A. Increased rate of nonalcoholic fatty liver disease after gluten free diet in celiac disease: a systematic review and meta-analysis. Presented at: ACG 2021 Annual Meeting; October 22-27, 2021; Las Vegas, NV and virtual. Abstract P0919.

This article originally appeared on Gastroenterology Advisor