Association between serum ferritin level and the various stages of non-alcoholic fatty liver disease: A systematic review

Abstract

IntroductionNon-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder across the world, and non-invasive evaluation approaches are in need to assess NAFLD disease progression. Serum ferritin has been proposed as one of the biomarkers for NAFLD diagnosis in previous studies. This systematic review aims to identify, report, and synthesize studies that investigated the association of serum ferritin level with the various stages of NAFLD among the adult population.MethodsThree databases – MEDLINE, EMBASE, and Scopus – were systematically searched to obtain potentially relevant publications before July 2022. No restrictions were applied to geographical region, study design, publication type and language. The association between serum ferritin level or different ferritin categories and the various stages of NAFLD was the primary outcome of interest. Title and abstract screenings, data extraction and coding, and quality assessment were independently completed by two authors with discrepancies resolved through discussion with a third author.ResultsThirty-two studies were included and heterogeneity was considerable. The associations between serum ferritin level and the stages of hepatic steatosis, fibrosis, inflammation and ballooning and the occurrence of non-alcoholic steatohepatitis (NASH) were investigated but inconsistent associations were reported. Most studies identified serum ferritin to be a predictor of advanced NAFLD, while several revealed the opposite end.ConclusionsSerum ferritin could be considered to act as a non-invasive biomarker for assessing various stages of NAFLD. Nevertheless, further studies are still in need to confirm its predictive value since this study reported inconsistent associations based on the qualitative synthesis.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021275630.

Prevalence and Characteristics of Metabolic Hyperferritinemia in a Population-Based Central-European Cohort

“…Of all subjects with MASLD (n = 2669) in our cohort, 24% (n = 636) had HF, which again supports previous estimates of HF prevalence in MASLD [32]. We also observed a higher prevalence of MASLD of 57% in subjects with HF and a further increase in MASLD prevalence along with the severity of HF [29,[33][34][35]. A relationship between intravenous iron therapy and worsening of hepatic fat was also shown in the setting of dialysis [36] and recently a relationship between liver iron and MASLD was proposed by Mendelian randomization analysis [37].…”

“…Later, the definition of dysmetabolic iron overload (DIOS) was refined as HF with normal or mildly increased transferrin saturation, metabolic abnormalities and a specific amount of hepatic iron excess with liver biopsy or MR imaging [12]. Many reports followed describing the underlying pathophysiology, metabolic alterations [22][23][24][25][26][27][28], the impact of DHF on liver damage [29], or the controversial therapeutic effect of venesection [30]. However, so far, different definitions and criteria for MHF have been used, making comparisons difficult.…”

Metabolic Associated Fatty Liver Disease (MAFLD) and COVID-19 Infection: An Independent Predictor of Poor Disease Outcome?

“…Kowdley et al showed an independent association between ferritin level and increased risk for liver fibrosis in patients with NAFLD [ 48 ]. On the contrary, two large retrospective studies concluded that even though ferritin was associated with liver steatosis, it was a poor predictor of fibrosis stage and disease progression [ 49 ]. This was in keeping with our results.…”

Association between serum ferritin and uric acid levels and nonalcoholic fatty liver disease in the Chinese population

“…Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the world. It is characterized by excess intracellular fat in the absence of excessive alcohol consumption ( Wang et al, 2022 ; Jung et al, 2019 ). NAFLD is a disease that progresses in stages starting with simple fatty liver (steatosis), nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, which can lead to liver failure or even hepatocellular carcinoma ( Yang et al, 2022 ; Rostoker et al, 2019 ).…”

“…However, there is still uncertainty about its association with NAFLD ( Modares Mousavi et al, 2018 ; Du et al, 2017 ) therefore, its role should be investigated in a large-scale study ( Yang et al, 2022 ; Giacomazzi et al, 2022 ). Many previous studies have suggested that hyperferritinemia is not only associated with NAFLD and systemic inflammation, but also correlates with the histologic severity of NAFLD and with the presence of NASH ( Wang et al, 2022 ).…”