Increased risk of non-alcoholic fatty liver disease after diagnosis of celiac disease

  • Norelle R. Reilly
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Benjamin Lebwohl
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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  • Rolf Hultcrantz
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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  • Peter H.R. Green
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Jonas F. Ludvigsson
    Corresponding author. Address: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden. Tel.: +46 (0) 8 5248 2356; fax: +46 (0) 8 31 49 75.
    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
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Published:January 21, 2015DOI:

      Background & Aims

      Non-alcoholic fatty liver disease is a common cause of chronic liver disease. 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.


      Population-based cohort study. We compared the risk of non-alcoholic fatty liver disease diagnosed from 1997 to 2009 in individuals with celiac disease (n = 26,816) to matched reference individuals (n = 130,051). Patients with any liver disease prior to celiac disease were excluded, as were individuals with a lifetime diagnosis of alcohol-related disorder to minimize misclassification of non-alcoholic fatty liver disease. Cox regression estimated hazard ratios for non-alcoholic fatty liver disease were determined.


      During 246,559 person-years of follow-up, 53 individuals with celiac disease had a diagnosis of non-alcoholic fatty liver disease (21/100,000 person-years). In comparison, we identified 85 reference individuals diagnosed with non-alcoholic fatty liver disease during 1,488,413 person-years (6/100,000 person-years). This corresponded to a hazard ratio of 2.8 (95% CI 2.0–3.8), with the highest risk estimates seen in children (HR = 4.6; 95% CI 2.3–9.1). The risk increase in the first year after celiac disease diagnosis was 13.3 (95% CI 3.5–50.3) but remained significantly elevated even beyond 15 years after the diagnosis of celiac disease (HR = 2.5; 95% CI 1.0–5.9).


      Individuals with celiac disease are at increased risk of non-alcoholic fatty liver disease compared to the general population. Excess risks were highest in the first year after celiac disease diagnosis, but persisted through 15 years after diagnosis with celiac disease.


      CD (celiac disease), NAFLD (non-alcoholic fatty liver disease), NASH (non-alcoholic steatohepatitis), SIBO (small intestinal bacterial overgrowth), VA (villous atrophy), ICD (international classification of disease (codes)), CI (confidence Interval), HR (hazard ratio), OR (odds ratio), BMI (body mass index)


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