E0491 - Prevalence and Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Patients With Celiac Disease

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Somtochukwu Onwuzo, MD

Cleveland Clinic Foundation
Cleveland, OH

Asif Hitawala, MD¹, Somtochukwu Onwuzo, MD², Ashraf Almomani, MD², Khaled Alsabbagh Alchirazi, MD³, Eduard Krishtopaytis, MD², Antoine Boustany, MD, MPH², Prabhat Kumar, MD², Dana Alshaikh, MD⁴, Osama Abu-Shawer, MD, MS³, Imad Assad, MD²
¹National Institutes of Health, Bethesda, MD; ²Cleveland Clinic Foundation, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴Mutah University, Amman, Al Karak, Jordan

Introduction: Celiac disease, also sometimes referred to as gluten-sensitive enteropathy, is an immune-mediated inflammatory disease affecting the small intestine and is caused by dietary gluten and other related protein sensitivity in individuals who are genetically predisposed. There have been several small studies suggesting an increased prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with celiac disease. However, large population-based studies are lacking. Further, it is unclear if the increased prevalence is secondary to celiac disease itself or due to some other associated factor(s). Hence, we decided to conduct a cross-sectional population-based study to identify the prevalence of NAFLD in patients with celiac disease and assess its risk factors.

Methods: Data were collected from a commercial database (Explorys, Inc, IBM Watson, Ohio). Adults with the diagnosis of “celiac disease,” based on the Systematized Nomenclature of Medicine–Clinical Terms, were included in the celiac disease group and the rest of the patients were included in the non-celiac disease group. The prevalence of NAFLD was compared in both groups. Age greater than 65 years, gender, Caucasian race, diabetes mellitus type 2 (T2DM), hypertension (HTN), dyslipidemia, obesity, and metabolic syndrome were considered as variables. Statistical univariate and multivariate analyses were performed using SPSS and R software.

Results: Out of 69,923,870 patients, a total of 137,010 patients were diagnosed with celiac disease (0.2%). Amongst celiac disease patients, NAFLD was present in 955 patients (0.7%) (Table 1). In univariate analysis, the odds of having NAFLD in patients with celiac disease, T2DM, obesity and metabolic syndrome were 7.92 (95% CI 7.43-8.45), 14.97 (95% CI 14.73-15.2), 16.86 (95% CI 16.6-17.13) and 25.63 (95% CI 24.9-26.39), respectively, as compared to patients without celiac disease. In multivariate analysis, the odds of having NAFLD amongst patients with celiac disease was 3.21 (95% CI 3.01-3.43). While the odds of having NAFLD decreased in patients greater than 65 years of age, they increased in all other variables (Figure 1).

Discussion: Patients with celiac disease have increased prevalence and odds of having NAFLD. The odds remained significant when controlled for common risk factors for NAFLD, suggesting that celiac disease may be a risk factor. Hence, these patients may benefit from surveillance for NAFLD, although the frequency, feasibility and costs require further research.

Figure: Prevalence of NAFLD in Celiac Disease- Multivariable Analysis

PARAMETER	CELIAC PATIENTS (n, % of total)	NON-CELIAC PATIENTS (n, % of total)
Age ≥ 65 years	39,550 (28.87%)	20,898,740 (29.89%) *
Female	103,045 (75.21%)	38,314,220 (54.79%) *
Caucasian	113,250 (82.66%)	37,734,150 (53.97%) *
T2DM	19,960 (14.57%)	5,569,340 (7.97%) *
HTN	45,795 (33.43%)	13,875,325 (19.84%) *
Dyslipidemia	51,150 (37.33%)	11,462,960 (16.39%) *
Obesity	33,500 (24.45%)	5,409,610 (7.74%) *
Metabolic Syndrome	2,740 (2%)	237,685 (0.34%) *
NAFLD	955 (0.7%)	61,910 (0.09%) *
TOTAL	137,010	69,923,870

Table: Table 1: Number of patients with NAFLD and its risk factors in celiac and non-celiac disease groups

T2DM: Diabetes mellitus type 2; HTN: Hypertension; NAFLD: Non-Alcoholic Fatty Liver Disease; ‘*’: p-value is <0.0001

Disclosures:

Asif Hitawala indicated no relevant financial relationships.

Somtochukwu Onwuzo indicated no relevant financial relationships.

Ashraf Almomani indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Eduard Krishtopaytis indicated no relevant financial relationships.

Antoine Boustany indicated no relevant financial relationships.

Prabhat Kumar indicated no relevant financial relationships.

Dana Alshaikh indicated no relevant financial relationships.

Osama Abu-Shawer indicated no relevant financial relationships.

Imad Assad indicated no relevant financial relationships.

Asif Hitawala, MD¹, Somtochukwu Onwuzo, MD², Ashraf Almomani, MD², Khaled Alsabbagh Alchirazi, MD³, Eduard Krishtopaytis, MD², Antoine Boustany, MD, MPH², Prabhat Kumar, MD², Dana Alshaikh, MD⁴, Osama Abu-Shawer, MD, MS³, Imad Assad, MD². E0491 - Prevalence and Risk Factors Associated With Non-Alcoholic Fatty Liver Disease in Patients With Celiac Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.