MAFLD and Celiac Disease in Children

Area of Science:

• Gastroenterology
• Hepatology
• Pediatrics

Background:

• Celiac disease (CD) is an immune-mediated disorder triggered by gluten, presenting with diverse symptoms, including malabsorption.
• Obesity is increasingly diagnosed alongside CD, raising concerns about associated metabolic disorders like metabolic associated fatty liver disease (MAFLD).
• The link between CD and MAFLD is complex, with potential roles for gluten-free diets (GFD) altering metabolism and gut-liver axis dysfunction.

Purpose of the Study:

• To review current knowledge on the factors contributing to hepatic steatosis (fatty liver) in pediatric patients with CD.
• To highlight the importance of considering CD in the differential diagnosis of pediatric fatty liver disease.

Main Methods:

• Literature review of studies investigating the relationship between celiac disease and hepatic steatosis in children.
• Analysis of proposed mechanisms linking gluten exposure, dietary changes, and liver fat accumulation.

Main Results:

• Gluten-free diets may alter metabolic profiles, potentially contributing to insulin resistance and fatty liver.
• Gut-liver axis alterations may play a role in liver fat accumulation and damage in CD patients.
• Serological screening for CD is crucial in pediatric patients with non-alcoholic fatty liver disease (NAFLD) without clear metabolic risk factors.

Conclusions:

• Celiac disease should be considered in the workup of pediatric patients with unexplained NAFLD.
• Anti-transglutaminase antibody testing for CD is recommended in asymptomatic children with NAFLD and in those with steatohepatitis when other causes are ruled out.