Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 18;14(14):2942.
doi: 10.3390/nu14142942.

Hepatic Steatosis in Patients with Celiac Disease: The Role of Packaged Gluten-Free Foods

Alberto Raiteri  1   2 , Alessandro Granito  1   2 , Chiara Faggiano  1 , Alice Giamperoli  2 , Teresa Catenaro  2 , Giulia Negrini  2 , Francesco Tovoli  1   2
Affiliations

Hepatic Steatosis in Patients with Celiac Disease: The Role of Packaged Gluten-Free Foods

Alberto Raiteri et al. Nutrients. .

Abstract

Background: An increased risk of nonalcoholic fatty liver disease (NAFLD) in patients with celiac disease (CD) adhering to a gluten-free diet (GFD) was recently reported. The nutritional composition of packaged gluten-free foods (PGFF) has been proposed as a possible cause. This hypothesis has not been investigated further, since a systematic structural nutritional interview for all patients would be problematic in clinical practice. Methods: We administered a simple questionnaire based on a Recency, Frequency, and Monetary value (RFM) analysis (a cornerstone of direct marketing segmentation) to consecutive CD patients on a GFD for >6 months and verified its association with NAFLD. Subgroup analyses were performed to understand whether specific patterns of PGFF consumption were significantly associated with NAFLD. Results: Amongst 147 patients (female 82%, median age 42 years), 45 (30.6%) had NAFLD. Total RFM score (adjusted odds ratio = 1.223, 95% CI: 1.059−1.413, p = 0.006), body mass index, and total cholesterol and triglycerides were independently related to NAFLD, and “Bread and bakery” (p = 0.002), “salty convenience” (p = 0.005), and “sweet convenience” (p = 0.049) products were significantly related with NAFLD. Also, questions about the number of purchased PGFF in the last month (monetary value) and different categories of PGFF consumed in the last week (recency) were particularly able to identify NAFLD patients. Conclusions: The specific GFD dietary habits of CD patients were correlated with the degree of risk of NAFLD. Information was obtained through a questionnaire which could be used in clinical practice to favor a patient-tailored approach and in future studies to verify the reproducibility of our results in different geographical areas.

Keywords: celiac disease; gluten; gluten-free diet; non-alcoholic fatty liver disease; steatosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow chart. CD: celiac disease; GFD: gluten-free diet.
Figure 2
Figure 2
Distribution of the Recency, Frequency, Monetary value (RFM) score in the whole study population (n = 147).
Figure 3
Figure 3
Recency (R), frequency (F), and monetary value (M) scores of bread/bakery (G2), salty (G7a), and sweet convenience products (G7b) in patients with and without nonalcoholic fatty liver disease (the latter category defined as “normal”).
See this image and copyright information in PMC

References

    1. Ludvigsson J.F., Leffler D.A., Bai J.C., Biagi F., Fasano A., Green P.H.R., Hadjivassiliou M., Kaukinen K., Kelly C.P., Leonard J.N., et al. The Oslo Definitions for Coeliac Disease and Related Terms. Gut. 2013;62:43–52. doi: 10.1136/gutjnl-2011-301346. - DOI - PMC - PubMed
    1. Reilly N.R., Aguilar K., Hassid B.G., Cheng J., Defelice A.R., Kazlow P., Bhagat G., Green P.H. Celiac Disease in Normal-Weight and Overweight Children: Clinical Features and Growth Outcomes Following a Gluten-Free Diet. J. Pediatr. Gastroenterol. Nutr. 2011;53:528–531. doi: 10.1097/MPG.0b013e3182276d5e. - DOI - PubMed
    1. Valletta E., Fornaro M., Cipolli M., Conte S., Bissolo F., Danchielli C. Celiac Disease and Obesity: Need for Nutritional Follow-up after Diagnosis. Eur. J. Clin. Nutr. 2010;64:1371–1372. doi: 10.1038/ejcn.2010.161. - DOI - PubMed
    1. Norsa L., Shamir R., Zevit N., Verduci E., Hartman C., Ghisleni D., Riva E., Giovannini M. Cardiovascular Disease Risk Factor Profiles in Children with Celiac Disease on Gluten-Free Diets. World J. Gastroenterol. 2013;19:5658–5664. doi: 10.3748/wjg.v19.i34.5658. - DOI - PMC - PubMed
    1. Reilly N.R., Lebwohl B., Hultcrantz R., Green P.H.R., Ludvigsson J.F. Increased Risk of Non-Alcoholic Fatty Liver Disease after Diagnosis of Celiac Disease. J. Hepatol. 2015;62:1405–1411. doi: 10.1016/j.jhep.2015.01.013. - DOI - PMC - PubMed