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.
