A pathogenetic link between non-alcoholic fatty liver disease and celiac disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) has recently been recognized as the leading cause of the abnormalities in the liver function tests in the Western countries. Celiac disease (CD) is a permanent immunological intolerance to gluten proteins in genetically predisposed individuals. CD has been reported in 4-13 % of the cases with steatohepatitis, although the pathogenesis of the liver steatosis in CD patients is unclear. Based on the literature data, it can be concluded that the inclusion of serological markers of CD should be a part of the general workup in the patients with steatosis when other causes of the liver disease are excluded and in the patients with NAFLD when metabolic risk factors are not evident.

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

“…[4, 5] Yet, data establishing whether individuals w i th CD may be at risk of NAFLD are nascent. [1, 6] Metabolic risks as well as those altering intestinal permeability are potential triggers for NAFLD which may be found in CD.…”

Non-Alcoholic Steatohepatitis Occurs in Celiac Disease and is Associated with Cellular Stress

“…Elevated liver enzymes with non-specific histological changes (i. e., steatosis) in liver biopsy are reported to be the most common hepatic presentation of CD [9]. NAFLD has recently been linked to CD in several studies [10,11]. Major histocompatibility complex class I-related chains A and B (MIC A/B) were suggested to play an important role in the progression of NASH [12].…”

Increasing Whole Grain Intake as Part of Prevention and Treatment of Nonalcoholic Fatty Liver Disease

“…Given that betaine reverses fatty liver in rodents on a choline-deficient diet, whole grains as a main source of dietary betaine and an ingredient that can alter gut microbiota, mean that several different but interlinked mechanisms for preventing fatty liver may potentially occur (Figure 1). Independent of whole grain intake, coeliac disease may be a risk factor for NAFLD, and elevated concentrations of transaminases are common in people with coeliac disease [119] though this could also be due to intestinal damage. The gluten-induced gastrointestinal inflammation is hypothesised to lead to increased gut leakage [91] and increased blood LPS, and people diagnosed with NAFLD and coeliac disease often improve after they are placed on a gluten-free diet.…”

“…The gluten-induced gastrointestinal inflammation is hypothesised to lead to increased gut leakage [91] and increased blood LPS, and people diagnosed with NAFLD and coeliac disease often improve after they are placed on a gluten-free diet. Monitoring coeliac disease is suggested for NAFLD patients, even when no other metabolic risk factor is present [119]. This being the case, it should be noted that cereals that form the basis of gluten-free diets (i.e., avoidance of wheat, rye, barley and oats) are generally very low in betaine ([19] and Table 1), with the exception of the South American pseudocereals amaranth and quinoa.…”