Prevalence of non-alcoholic fatty liver disease is not increased in patients with celiac disease: a cross-sectional study

Yıl 2024, Cilt: 16 Sayı: 2, 45 - 56, 27.08.2024

Ayşe Kefeli , Feyyaz Onayrılı , Ayşe Kevser Demir

Öz

Objective: Celiac disease (CD) is associated with liver diseases and could be associated Non-alcoholic fatty liver disease (NAFLD) due both diseases have same etiopathogenetic risk factors such as altered gut microbiota and intestinal permeability. Despite this tight association of these disease, there are few studies on this subject. Therefore, we aimed to determine the prevalence of NAFLD in patients with celiac disease.
Material and Methods: This cross sectional, was carried out in a tertiary health center. The aim of the study is to determine the frequency of NAFLD in CD patients treated with a gluten-free diet (GFD) for at least 6 months. The secondary aim was to assess the relative risk of NAFLD in CD patients treated with a GFD for at least 6 months. Patients with diagnosed CD and a GFD was initiated at least 6 months before were included the study as a group A. The control group (group B) was selected from the outpatients who applied to our polyclinic with dyspepsia. Hepatosteatosis was diagnosed by ultrasonographic examination.
Results: Group A and Group B were similar in terms of age, gender frequency, body mass index (BMI) and presence of diabetes mellitus. The frequency of NAFLD was 22.7% in Group A and 28.1 in Group B (P = 0.35). Advanced age, high BMI, high blood sugar, presence of DM was a risk factor for NAFLD.
Conclusion: Individuals with celiac disease are not at increased risk of nonalcoholic fatty liver disease compared to the general population.

Anahtar Kelimeler

Ultrasonography, non-alcoholic fatty liver disease, celiac disease

Çölyak hastalarında non-alkolik yağlı karaciğer hastalığı yaygınlığı artmıyor: Kesitsel çalışma

Öz

Amaç: Çölyak Hastalığı (CH), karaciğer hastalıklarıyla ilişkilidir. Her iki hastalıkta; bağırsak mikrobiyotasında değişiklik ve bağırsak geçirgenliği gibi aynı etiyopatogenetik risk faktörlerine sahip olması nedeniyle alkolik olmayan yağlı karaciğer hastalığı (AOYKH) ile ilişkilendirilebilir. Bu hastalıkların bu yakın lişkisine rağmen, bu konuda çok az çalışma yapılmıştır. Bu nedenle, biz çalışmamızda ÇH olan hastalarda AOYKH yaygınlığını belirlemeyi amaçladık.
Gereç ve Yöntem: Kesitsel nitelikte çalışmamız; üçüncü basamak bir sağlık merkezinde gerçekleştirildi. Çalışmanın ilk amacı, en az 6 ay boyunca glutensiz diyet ile tedavi edilen ÇH AOYKH sıklığını belirlemektir. İkincil olarak da; en az 6 ay boyunca glütensiz diyet ile tedavi edilen ÇH AOYKH’nın göreceli riskini değerlendirmektir. Tanısı konulmuş ÇH ve en az 6 ay önce glutensiz diyet başlatılmış hastalar çalışmaya Grup A olarak alındı. Kontrol grubu (Grup B), polikliniğimize dispepsi ile başvuran ayaktan hastalar arasından seçildi. Hepatosteatoz, ultrasonografik inceleme ile teşhis edildi.
Bulgular: Grup A ve Grup B, yaş, cinsiyet, vücut kitle indeksi (VKİ) ve diabetes mellitus (DM) varlığı açısından benzerdi. Alkolik olmayan yağlı karaciğer hastalığı sıklığı Grup A'da %22,7 iken, Grup B'de %28,1 idi (P = 0,35). İleri yaş, yüksek VKİ, yüksek kan şekeri, DM varlığı AOYKH için bir risk faktörüydü.
Sonuç: Çölyak hastalığı olan bireyler, genel popülasyona kıyasla alkolik olmayan yağlı karaciğer hastalığı açısından artmış risk altında değildir.

Anahtar Kelimeler

Ultrasonografi, alkolik olmayan yağlı karaciğer hastalığı, çölyak hastalığı

Kaynakça

• 1. Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int 2017;37:81–4.
• 2. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
• 3. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia. 2016;59(6):1121–40.
• 4. Glen J, Floros L, Day C, Pryke R. Guideline Development Group. Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance. BMJ. 2016;7:354:i4428.
• 5. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr (Practice Guideline). 2012;54 (1): 136–60.
• 6. Ludvigsson JF, Leffler DA, Bai JC, BiagiF, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62:43-52.
• 7. Freeman HJ. Hepatobiliary and pancreatic disorders in celiac disease. World J Gastroenterol 2006 March 14; 12(10): 1503-1508.
• 8. Capron JP, Sevenet F, Quenum C, Doutrellot C, Capron-Chivrac D, Delamarre J. Massive hepatic steatosis disclosing adult celiac disease. Study of a case and review of the literature. Gastroenterol Clin Biol 1983; 7: 256-260.
• 9. Naschitz JE, Yeshurun D, Zuckerman E, Arad E, Boss JH. Massive hepatic steatosis complicating adult celiac disease: report of a case and review of the literature. Am J Gastroenterol 1987; 82: 1186-1189.
• 10. Sood A, Midha V, Sood N. Nonalcoholic steatohepatitis, obesity and celiac disease. Indian J Gastroenterol 2003; 22: 156.
• 11. Reilly N, Lebwohl B, Hultcrantz R , Green PG, Ludvigsson JF. Increased Risk of Nonalcoholic Fatty Liver Disease After Diagnosis of Celiac Disease. J Hepatol. 2015; 62(6): 1405–1411.
• 12. Tovoli F, Negrini G, Farì R, Guidetti E, Faggiano C, Napoli L, et al. |Increased risk of nonalcoholic fatty liver disease in patients with coeliac disease on a gluten free diet: beyond traditional metabolic factors. Aliment Pharmacol Ther. 2018; 48:538–546.
• 13. Tortora R, Capone P, De Stefano G, Imperatore N, Gerbino N, Donett S, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther. 2015;41(4):352-9.
• 14. Agarwal A, Singh A, Mehtab W, Gupta V, Chauhan A, Rajput MS, et al. Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver. Intest Res. 2021;19(1):106-114.
• 15. Kalsch J, Bechmann LP, Manka P, Kahraman A, Schlattjan M, Marth T, et al. Non-alcoholic steatohepatitis occurs in celiac disease and is associated with cellular stress. Z Gastroenterol. 2013; 51:26–31.
• 16. Miele L, Valenza V, La Torre G, Montalto M, Cammarota G, Ricci R, et al. Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. Hepatology. 2009; 49:1877–1887.
• 17. Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut. 2001; 48:206–211.
• 18. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009; 43:157–161.
• 19. Mohler KM, Sleath PR, Fitzner JN, Cerretti DP, Alderson M, Kerwar SS, et al. Protection against a lethal dose of endotoxin by an inhibitor of tumour necrosis factor processing. Nature. 1994; 370:218–220.
• 20. Sezgin O, Akpınar H, Özer B, Törüner M, Bal K, Bor S. Population-based assessment of gastrointestinal symp- toms and diseases: Cappadocia Cohort, Turkey Turk J Gastroenterol. 2019;30(12):1009-1020.
• 21. Kaya E, Demir D, Alahdab YO, Yilmaz Y. Prevalence of hepatic steatosis in apparently healthy medical students: a transient elastography study on the basis of a controlled attenuation parameter. Eur J Gastroenterol Hepatol. 2016;28(11):1264-126.
• 22. Değertekin B, Tozun N, Demir F, Söylemez G, Parkan Ş, Gürtay E, et al.The Changing Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Turkey in the Last Decade. Turk J Gastroenterol 2021; 32: 302-312.
• 23. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a me- ta-analysis. Hepatology. 2011;54: 1082-1090.
• 24. Biagi F, Bianchi PI, Marchese A, Trotta L, Vattiato C, Balduzzi D, et al. A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life. Br J Nutr. 2012;108:1884-1888.