Intest Res.  2021 Jan;19(1):106-114. 10.5217/ir.2019.00136.

Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver

• Agarwal A
• Singh A
• Mehtab W
• Gupta V
• Chauhan A
• Rajput MS
• Singh N
• Ahuja V
• Makharia GK

• KMID: 2512106
• DOI: http://doi.org/10.5217/ir.2019.00136

Abstract

Background/Aims
Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease.
Methods
Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan.
Results
In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively.
Conclusions
Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.

Keyword

Diabetes mellitus; Hyperlipidemia; Body mass index; Obesity; Fatty liver

Figure

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  Fig. 1. (A) Flowchart showing enrolment of newly diagnosed celiac disease patients and follow-up. (B) Flowchart showing enrolment of patients with celiac disease on gluten-free diet (GFD) for more than 1 year. UC, ulcerative colitis; CD, Crohn’s disease.

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  Fig. 2. (A) Comparison of body mass index (BMI) before and after gluten-free diet (GFD). (B) Individual criteria of metabolic syndrome before and after 1 year of GFD. aP-value for the BMI distribution before and after GFD.

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