Prevalence of autoimmune, cholestatic and nonalcoholic fatty liver disease in celiac disease

Abstract

Background While there is higher prevalence of autoimmune, cholestatic and fatty liver disease in celiac disease (CeD), most data is from small-scale studies. We evaluated the prevalence and risk factors of the same using large cohort data. Methods A population-based cross-sectional study was conducted using Explorys, a multi-institutional database. Prevalence and risk factors of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and nonalcoholic fatty liver disease (NAFLD) in CeD were assessed. Results Out of 70 352 325 subjects, 136 735 had CeD (0.19%). The prevalence of AIH (0.32%), PBC (0.15%), PSC (0.004%) and NAFLD (0.7%) were high in CeD. After adjusting for age, gender, Caucasian race and anti-tissue transglutaminase antibody (anti-TTG), CeD subjects had higher odds of AIH [adjusted odds ratio (aOR) 7.06, 95% confidence interval (CI) 6.32–7.89] and PBC (aOR 4.16, 95% CI 3.46–5.0). Even after adjusting for CeD, anti-TTG positivity concurred with higher odds of AIH (aOR 4.79, 95% CI 3.88–5.92) and PBC (aOR 9.22, 95% CI 7.03–12.1). After adjusting for age, gender, Caucasian race, diabetes mellitus (DM), obesity, hypothyroidism and metabolic syndrome, there was higher prevalence of NAFLD in CeD, with the aOR in the presence of DM type 1 being 2.1 (95% CI 1.96–2.25), and in the presence of DM type 2 being 2.92 (95% CI 2.72–3.14). Conclusion Subjects with CeD are more likely to have AIH, PBC, PSC and NAFLD. AIH and PBC have higher odds in the presence of anti-TTG. The odds of NAFLD in CeD are high regardless of type of DM.

Global incidence and prevalence of autoimmune hepatitis, 1970–2022: a systematic review and meta-analysis

“…A total of 26 studies were included in our systematic review to estimate the global pooled prevalence of AIH, found to be 15.65 cases per 100,000 inhabitants (95% CI, 13.42–18.24; I 2 = 99.75%) with a 95% prediction interval of 7.00–35.00 ( Table 3 ). 9 , 10 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 41 , 42 , 43 , 44 , 50 , 51 , 52 Table E7 shows the subgroup differences in prevalence of AIH in this study. The pooled prevalence of AIH was higher in countries with HDI >0.92 9 , 10 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 28 31 , 32 , 35 , 37 , 38 , 42 , 43 , 44 , 50 , 51 compared with countries with HDI <0.92, 30 , 34 , 41 with 19.97 (95% CI, 17.00–23.44) versus 9.15 (95% CI, 6.11–13.72) cases per 100,000 inhabitants, respectively.…”

“… 9 , 10 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 41 , 42 , 43 , 44 , 50 , 51 , 52 Table E7 shows the subgroup differences in prevalence of AIH in this study. The pooled prevalence of AIH was higher in countries with HDI >0.92 9 , 10 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 28 31 , 32 , 35 , 37 , 38 , 42 , 43 , 44 , 50 , 51 compared with countries with HDI <0.92, 30 , 34 , 41 with 19.97 (95% CI, 17.00–23.44) versus 9.15 (95% CI, 6.11–13.72) cases per 100,000 inhabitants, respectively. The positive correlation was shown between increasing HDI and the prevalence of AIH (Pearson's R = 0.341, P < 0.05) ( Figure E2 ).…”

“…The positive correlation was shown between increasing HDI and the prevalence of AIH (Pearson's R = 0.341, P < 0.05) ( Figure E2 ). The pooled prevalence of AIH was higher in females 17 , 18 , 19 , 23 , 25 , 26 , 28 , 32 , 34 , 35 , 38 , 41 , 50 than in males 17 , 18 , 19 , 23 , 25 , 26 , 28 , 32 , 34 , 35 , 38 , 41 , 50 (28.04 [95% CI, 21.31–36.89] versus 8.05 [95% CI, 5.87–11.04] cases per 100,000 inhabitants). The OR for AIH in females compared with males was 3.48 (95% CI, 2.29–5.29).…”

“…After evaluating 91 studies, 54 were excluded for reasons such as insufficient data on disease incidence, convenience sampling data, inappropriate study design, lack of population-based studies, and data duplication. Eventually, 37 studies (k = 37 9 , 10 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ; researcher-validated studies, k = 21 9 , 21 , 26 , 27 , 28 , 30 , 31 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 ) were deemed eligible, involving 239,345,726 participants (approximately 2.9% of the global population) and 55,839 patients with AIH from 18 different countries (Argentina, Canada, Denmark, Finland, France, Iceland, Israel, Japan, New Zealand, Norway, Singapore, South Korea, Spain, Sweden, Taiwan, the Netherlands, the United Kingdom, and the United States [by country, 10.9% of the global population]) across five continents. Search strategy results are summarized in…”

“…All studies were conducted in a single country and included population-based studies on patients with AIH from 1970 to 2022. Twenty studies included both children and adults, 9 , 10 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 30 , 32 , 35 , 36 , 37 , 38 , 42 , 45 , 46 , 47 , 51 14 studies included only adults, 17 , 27 , 28 , 31 , 34 , 39 , 40 , 41 , 43 , 44 , 48 , 49 , 50 and 4 studies included only children. 24 , 29 , 33 , 52 Table 1 shows detailed characteristics of all the studies that met the inclusion criteria.…”