Imperatore N, et al. – Researchers carried out this study to assess the predictive factors for metabolic syndrome (MS) and hepatic steatosis (HS) in coeliac disease (CD) after 1 year of a gluten–free diet (GFD). For patients with CD on GFD, proton pump inhibitors (PPI) exposure added the further risk of occurrence of MS and HS. The use of PPI had to be limited to strict indications in patients with CD on GFD.

• The researchers enrolled all consecutive newly diagnosed CD patients.
• Data was prospectively collected about BMI; waist circumference; blood pressure; cholesterol; triglycerides, glucose, and insulin blood levels; insulin resistance (through the homeostatic model assessment HOMA-IR) and treatment with proton pump inhibitors (PPI).
• In accordance with current guidelines, diagnosis of MS was made and HS was diagnosed by ultrasonography.
• They re-assessed the prevalence of MS and HS after 1 year of GFD.
• They performed a logistic regression analysis to identify risk factors for MS and HS occurrence after 1 year of GFD.

• Among 301 patients with newly diagnosed CD, 4.3% met criteria for diagnosis of MS and 25.9% presented with HS at the time of CD diagnosis; 99 subjects (32.8%) had long-term exposure to PPI during the study period.
• 72 (23.9%) patients had developed MS (4.3 vs 23.9%; p < 0.001, OR 6.9) and 112 (37.2%) had developed HS (25.9 vs 37.2%; p < 0.01, OR 1.69) after 1 year.
• At multivariate analysis, the only factors associated with the occurrence of MS were high BMI at diagnosis (OR 10.8; p < 0.001) and PPI exposure (OR 22.9; p < 0.001).
• And, the only factors associated with the occurrence of HS were HOMA-IR (OR 9.7; p < 0.001) and PPI exposure (OR 9.2; p < 0.001).