Celiac Disease (CeD) has been associated with elevated risk of metabolic dysfunction-associated steatotic liver disease (MASLD). Prior studies in smaller populations have suggested that this risk is disproportionately present in lean patients (Tovoli et al). This study aims to explore this relationship in a large, real-world population.
We utilized the TriNetX US Collaborative Network to identify adults with CeD (n = 174882) and propensity-score matched controls without CeD (matched on age, sex, BMI, T2DM, HTN, and HLT), with our initial analysis notable for a 49% increased risk of MASLD in CeD patients (RR 1.485, 95% CI 1.436-1.536). We have now further explored this relationship to assess if the risk of developing MASLD in CeD patients is BMI-dependent. We stratified CeD patients into 2 cohorts by BMI: lean (BMI < 25 kg/m^2) vs. overweight (BMI > 25 kg/m^2) with matched controls. We then compared incidence of MASLD or MASH (ICD10 K76.0 or K75.81) after the index date in lean CeD patients vs. matched controls, as well as in overweight CeD patients vs. matched controls.
We found that MASLD risk was significantly elevated in both the lean (RR 1.435, 95% CI 1.319-1.562) and overweight (RR 1.414, 95% CI 1.361-1.468) subgroups, with the overlapping confidence intervals suggesting a similar relative risk for both lean CeD patients and overweight CeD patients.
This study is the largest US propensity-score matched analysis to characterize CeD as an independent risk factor for MASLD. Our analysis found a similar risk of incident MASLD in CeD patients across BMI range, unlike prior studies suggesting that lean CeD patients were at disproportionate risk. These findings suggest that clinicians should be screening celiac patients for MASLD regardless of BMI.