Fatty Liver and Metabolic Syndrome in Patients With Celiac Disease: A Systematic Review

Document Type

Conference Proceeding

Publication Date

5-2023

Publication Title

Gastroenterology

Abstract

Introduction While celiac disease (CeD) is suspected primarily in patients with undernutrition, recent studies have recognized that patients with CeD can be normal or even overweight at the time of presentation. In recent years, patients with CeD have been reported to have a high prevalence of fatty liver and metabolic syndrome. We conducted a systematic review and meta-analysis to assess the prevalence of fatty liver and metabolic syndrome in patients with CeD and the effect of gluten-free diet (GFD) in them. Methods The PubMed, Embase, and the Cochrane Library databases were searched for original studies. We included fulltext articles published in the English language after 1990 that used well-defined criteria for CeD, fatty liver, and metabolic syndrome. We conducted the systematic review as per the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Of 350 studies identified, 11 studies (n=2,578) were included in the analysis. Statistical analysis was performed in STATA version 14.1. A random effects model was used to calculate pooled prevalence. The subgroup analysis was done to explore heterogeneity. Results On analysis of longitudinal studies (6 studies, n=869), the pooled prevalence of fatty liver in treatment naïve patients with CeD was 15.3% (95%CI 5.6-28.5%, I2 = 94.8%; figure 1A) which increased to 29.1% (95%CI 17.2-42.7%, I2 = 93.4%; figure 1B) after varying duration of GFD (figure 2A). Similarly, on analysis of longitudinal studies (7 studies, n=1239), the pooled prevalence of metabolic syndrome in treatment-naïve patients with CeD was 4.3% (95% CI 2.4-6.7%, I2 = 62.2%; figure 1C), which increased to 24.2% (95%CI 19.5-29.3%, I2 = 69.5%; figure 1D) after initiation of GFD (figure 2B). There was no difference in the prevalence of fatty liver and metabolic syndrome between low- vs high-income group countries, or between patients on GFD for ≤1 year vs >1 year. Conclusions Patients with CeD have a high prevalence of fatty liver and metabolic syndrome which increases further with the initiation of GFD and hence putting them at a higher risk of cardiovascular diseases and other metabolic complications. Patients with CeD should thus be screened and monitored for the development of fatty liver and metabolic syndrome. They should be counseled appropriately regarding their diet and the inclusion of physical activity in their lifestyle.

Volume

164

Issue

6 Suppl

First Page

S-1038

Comments

Digestive Disease Week, May 6-9, 2023, Chicago, IL

DOI

10.1016/S0016-5085(23)03411-X

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