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Published in:

01-03-2019 | Original Article

Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population

Authors: Ju Young Jung, Jae-Jun Shim, Sung Keun Park, Jae-Hong Ryoo, Joong-Myung Choi, In-Hwan Oh, Kyu-Won Jung, Hyunsoon Cho, Moran Ki, Young-Joo Won, Chang-Mo Oh

Published in: Hepatology International | Issue 2/2019

Abstract

Background

Elevation of serum ferritin levels is frequently observed in non-alcoholic fatty liver disease (NAFLD) patients. Our study aims to examine the association between serum ferritin levels and NAFLD in Korean population.

Methods and results

A total of 25,597 participants were selected from Korean National Health and Nutritional Examination Surveys 2007–2012. The NAFLD liver fat score (NLFS) was used to define NAFLD. Elevation of ALT levels was defined as ALT level > 40 IU/L for male and ALT level > 31 IU/L for female. Multiple logistic regression was used to examine the association of serum ferritin levels and NAFLD by sex. After adjusting for multiple covariates, the ORs (95% CI) of the elevated ALT levels were 1.56 (95% CI: 1.17–2.07), 1.84 (95% CI: 1.39–2.45), and 4.08 (95% CI: 3.08–5.40) for the second, third and fourth serum ferritin quartiles in male (p for trend < 0.01), 1.67 (95% CI: 1.24–2.23), 2.23 (95% CI: 1.68–2.96), and 5.72 (95% CI: 4.32–7.60) for the second, third and fourth serum ferritin quartiles in female (p for trend < 0.01). Serum ferritin levels were also significantly associated with NAFLD and liver fibrosis both in male and female.

Conclusions

Elevation of serum ferritin level is significantly associated with NAFLD and blood ALT elevation in Korean general population.

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Fan JG, Farrell GC. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol 2009;50:204–210CrossRef

Ascha MS, Hanouneh IA, Lopez R, et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 2010;51:1972–1878CrossRef

Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol 2008;49:608–612CrossRefPubMed

Yamada T, Fukatsu M, Suzuki S, et al. Fatty liver predicts impaired fasting glucose and type 2 diabetes mellitus in Japanese undergoing a health checkup. J Gastroenterol Hepatol 2010;25:352–356CrossRefPubMed

Targher G, Bertolini L, Padovani R, et al. Relations between carotid artery wall thickness and liver histology in subjects with nonalcoholic fatty liver disease. Diabetes Care 2006;29:1325–1330CrossRefPubMed

Targher G, Bertolini L, Padovani R, et al. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 2007;30:1212–1218CrossRef

Lazo M, Hernaez R, Eberhardt MS, et al. Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 2013;178:38–45CrossRefPubMedPubMedCentral

Park SH, Jeon WK, Kim SH, et al. Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults. J Gastroenterol Hepatol 2006;21:138–143CrossRefPubMed

Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013;10:686–690CrossRef

10.

Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011;9:524–530CrossRef

11.

Valenti L, Dongiovanni P, Fracanzani AL, et al. Increased susceptibility to nonalcoholic fatty liver disease in heterozygotes for the mutation responsible for hereditary hemochromatosis. Dig Liver Dis 2003;35:172–178CrossRefPubMed

12.

Nelson JE, Bhattacharya R, Lindor KD, et al. HFE C282Y mutations are associated with advanced hepatic fibrosis in Caucasians with nonalcoholic steatohepatitis. Hepatology 2007;46:723–729CrossRefPubMed

13.

Kim CW, Chang Y, Sung E, et al. Serum ferritin levels predict incident non-alcoholic fatty liver disease in healthy Korean men. Metabolism 2012;61:1182–1188CrossRefPubMed

14.

Kowdley KV, Belt P, Wilson LA, et al. Serum ferritin is an independent predictor of histologic severity and advanced fibrosis in patients with nonalcoholic fatty liver disease. Hepatology 2012;55:77–85CrossRefPubMed

15.

Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of nonalcoholic steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease and low visceral adiposity. J Hepatol 2011;54:1244–1249CrossRefPubMed

16.

Oh CM, Oh IH, Lee JK, et al. Blood cadmium levels are associated with a decline in lung function in males. Environ Res 2014;132:119–125CrossRefPubMed

17.

Ryu SY, Crespi CM, Maxwell AE. Drinking patterns among Korean adults: results of the 2009 Korean community health survey. J Prev Med Public Health 2013;46:183–191CrossRefPubMedPubMedCentral

18.

Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116:1081–1093CrossRefPubMed

19.

Fleming RE, Ponka P. Iron overload in human disease. N Engl J Med 2012;366:348–359CrossRefPubMed

20.

Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735–2752CrossRef

21.

Oh SW. Obesity and metabolic syndrome in Korea. Diabetes Metab J 2011;35:561–566CrossRefPubMedPubMedCentral

22.

Kotronen A, Peltonen M, Hakkarainen A, et al. Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors. Gastroenterology 2009;137:865–872CrossRefPubMed

23.

Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis 2010;42:503–508CrossRefPubMed

24.

Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317–1325CrossRefPubMed

25.

Eguchi Y, Hyogo H, Ono M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol 2012;47:586–595CrossRefPubMed

26.

Cleophas TJ, Zwinderman AH. Statistics applied to clinical studies. 5th ed. New York: Springer; 2012. p. 313–318CrossRef

27.

Park SK, Ryoo JH, Kim MG, et al. Association of serum ferritin and the development of metabolic syndrome in middle-aged Korean men: a 5-year follow-up study. Diabetes Care 2012;35:2521–2526CrossRefPubMedPubMedCentral

28.

Kim CH, Kim HK, Bae SJ, et al. Association of elevated serum ferritin concentration with insulin resistance and impaired glucose metabolism in Korean men and women. Metabolism 2011;60:414–420CrossRefPubMed

29.

Utzschneider KM, Kahn SE. Review: the role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2006;91:4753–4761CrossRefPubMed

30.

Ling JC, Mohamed MN, Jalaludin MY, et al. Determinants of high fasting insulin and insulin resistance among overweight/obese adolescents. Sci Rep 2016;6:36270CrossRefPubMedPubMedCentral

31.

O’Malley G, Santoro N, Northrup V, et al. High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation. Diabetologia 2010;53:1199–1209CrossRefPubMed

32.

Alam F, Memon AS, Fatima SS. Increased body mass index may lead to hyperferritinemia irrespective of body iron stores. Pak J Med Sci 2015;31:1521–1526PubMedPubMedCentral

Title: Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population
Authors: Ju Young Jung
Jae-Jun Shim
Sung Keun Park
Jae-Hong Ryoo
Joong-Myung Choi
In-Hwan Oh
Kyu-Won Jung
Hyunsoon Cho
Moran Ki
Young-Joo Won
Chang-Mo Oh
Publication date: 01-03-2019
Publisher: Springer India
Published in: Hepatology International / Issue 2/2019
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI: https://doi.org/10.1007/s12072-018-9892-8

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