In 85 non-diabetic adults, 32.5% of long-term gluten-free-diet (GFD) patients with celiac disease had CAP-defined liver steatosis (≥248 dB/m) versus 18.5% of newly diagnosed patients and 33.3% of non-celiac controls. Ultrasound steatosis showed the same pattern (37.5% vs 25.9%). GFD patients had higher BMI (24.5 vs 21.9 kg/m²), while liver stiffness was similar (4.3-4.9 kPa). In a 10-patient longitudinal subset, median CAP rose from 182.5 to 217 dB/m (p=0.047). None of the prevalence differences reached statistical significance.
The headline here is restraint: the data do not show that a GFD causes fatty liver. The most plausible reading is weight regain. Untreated celiac disease causes malabsorption and leanness, so healing the gut and eating more palatable, often calorie-dense gluten-free substitutes pushes BMI toward normal, and liver fat follows. Notably, GFD patients were no more steatotic than controls, which fits that story. Larger celiac cohorts have reported mixed results, and the hepatic benefit of gluten removal on transaminases is well documented, so this adds nuance rather than reversal. Limits are substantial: cross-sectional design, only 27-40 per celiac arm, self-reported adherence, no independent association after adjustment, and a longitudinal analysis of ten people. For adults with celiac disease, the practical takeaway is modest: the GFD remains essential, but monitor weight, lipids and liver health after diagnosis and favour whole foods over processed gluten-free products. Incremental and hypothesis-generating, not practice-changing.