Prevalence and Risk Factors of Celiac Disease in Patients With Non-Alcoholic Fatty Liver Disease: A Meta-Analysis

Non-alcoholic fatty liver disease (NAFLD) has emerged as a significant public health issue due to its close association with metabolic abnormalities. Concurrently, celiac disease (CD), an autoimmune disorder triggered by gluten, has been increasingly investigated in connection with various chronic conditions. Given the potential link between these two conditions, this systematic review and meta-analysis aimed to determine the prevalence of CD in individuals diagnosed with NAFLD.

A comprehensive literature search was performed in multiple databases including PubMed, Scopus, Embase, and Web of Science. Studies were considered eligible if they reported clear data regarding CD prevalence among NAFLD populations.

Pooled data analysis revealed an overall CD prevalence of 3.8% (95% CI: 0.02-0.07) among NAFLD patients, with significant heterogeneity observed (I ² = 97.36%, p < 0.01). Further subgroup analyses demonstrated variations in CD prevalence related to disease characteristics; notably, the prevalence was higher among patients specifically evaluated for CD using serological and histological methods. Exploratory stratified analyses indicated that CD was more prevalent in patients with NAFLD who had lower body mass index (BMI), higher levels of aspartate aminotransferase (AST), lower hemoglobin (HB) concentrations, and reduced platelet (PLT) counts.

The findings from this meta-analysis suggest a higher-than-expected prevalence of CD among patients with NAFLD, though the substantial heterogeneity across studies limits the precision of this estimate. These findings indicate that clinicians may consider selective screening for CD, particularly in patients presenting with specific clinical features. However, given the exploratory nature of the subgroup analyses and the variability in diagnostic approaches across included studies, larger prospective studies with standardized diagnostic criteria are needed to confirm these observations and better elucidate the relationship between these two conditions.