Hepatic Steatosis and Diet in Adult Celiac Disease: A Cross-Sectional Study

Background: Celiac disease (CD) is a chronic immune-mediated enteropathy that is treated exclusively with a lifelong gluten-free diet (GFD). Hepatic involvement, including hepatic steatosis (HS), is common in both newly diagnosed and long-term GFD-treated CD patients. Limited data exist regarding HS prevalence and risk factors in CD, and the effects of dietary patterns, including GFD and the Mediterranean diet (MD), remain unclear. Objective: This study investigated the prevalence and severity of HS in newly diagnosed, pre-GFD and GFD-treated CD patients compared to non-celiac control subjects, while assessing the influence of dietary adherence. Methods: In a nested cross-sectional study within the ARCTIC trial (NCT05530070), 290 Hungarian adults were enrolled (60 pre-GFD CD, 156 CD on GFD, and 74 control subjects). HS was assessed by ultrasonography, and dietary adherence was evaluated using the Standardized Dietitian Evaluation and Mediterranean Diet Score (MDS). Binary regression models were applied to identify predictors of HS. Results: HS was diagnosed in 34% of participants, most frequently in pre-GFD CD patients. BMI was the strongest predictor of HS both overall and within the CD cohort (OR = 1.27; 95% CI: 1.16, 1.42; p < 0.001). Neither adherence to GFD nor overall MD adherence significantly influenced the prevalence of HS. Severity of HS correlated with higher BMI, older age, and diabetes prevalence, while individual MD components, including olive oil consumption, were associated with milder HS. Conclusions: HS is more prevalent in CD patients, particularly pre-GFD patients, and is strongly associated with BMI. While overall dietary patterns did not significantly impact HS, certain diet components may modulate severity.