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Hepatology International

, Volume 13, Issue 2, pp 222–233 | Cite as

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

  • 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 OhEmail author
Original Article
  • 250 Downloads

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.

Keywords

Iron Alanine aminotransferase Non-alcoholic fatty liver disease 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BMI

Body mass index

HSI

Hepatic steatosis index

KNHANES

Korean National Health and Nutritional Examination Survey

NAFLD

Non-alcoholic fatty liver disease

NLFS

Non-alcoholic fatty liver disease liver fat score

WC

Waist circumference

Notes

Acknowledgements

The data used in this study were obtained from the 4th and 5th Korean National Health and Nutrition Examination Survey database (Available from: https://knhanes.cdc.go.kr/knhanes/index.do).

Funding

This work was supported by the National Cancer Center Grant (Grant numbers NCC-1610170) and Kyung Hee University in 2017 (Grant: KHU-20170835). The funding organization had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

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 and Chang-Mo Oh have declared that no competing interests exist.

Ethics approval

Ethics approval for the research protocol was obtained by the institutional review board (IRB) of the Kyung Hee University (IRB No: KHSIRB-17-073, Seoul, Korea).

Informed consent

Written informed consents were obtained from study participants before the KNHANES survey started.

Supplementary material

12072_2018_9892_MOESM1_ESM.docx (24 kb)
Supplementary material 1 Association between serum ferritin and blood ALT level in Korean male. The generalized additive model was used to examine the non-linear dose-response relationship between serum ferritin levels and blood ALT levels. The generalized additive model fit a linear additive model with a continuous serum ALT against serum ferritin level after adjusting for all covariates. The natural spline smoothing function for serum ferritin levels was chosen to yield four degrees of freedom (DOCX 24 kb)
12072_2018_9892_MOESM2_ESM.tiff (1.1 mb)
Supplementary material 2 Association between serum ferritin and blood ALT level in Korean female. The generalized additive model was used to examine the non-linear dose-response relationship between serum ferritin levels and blood ALT levels. The generalized additive model fit a linear additive model with a continuous serum ALT against serum ferritin level after adjusting for all covariates. The natural spline smoothing function for serum ferritin levels was chosen to yield four degrees of freedom (TIFF 1168 kb)
12072_2018_9892_MOESM3_ESM.tiff (1.1 mb)
Supplementary material 3 (TIFF 1168 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  • Ju Young Jung
    • 1
  • Jae-Jun Shim
    • 2
  • Sung Keun Park
    • 1
  • Jae-Hong Ryoo
    • 3
  • Joong-Myung Choi
    • 4
  • In-Hwan Oh
    • 4
  • Kyu-Won Jung
    • 5
  • Hyunsoon Cho
    • 5
    • 6
  • Moran Ki
    • 6
  • Young-Joo Won
    • 5
    • 6
  • Chang-Mo Oh
    • 4
    Email author
  1. 1.Total Healthcare CenterKangbuk Samsung Hospital, Sungkyunkwan University, School of MedicineSeoulRepublic of Korea
  2. 2.Departments of Internal Medicine, School of MedicineKyung Hee UniversitySeoulRepublic of Korea
  3. 3.Departments of Occupation and Environmental medicine, School of MedicineKyung Hee UniversitySeoulRepublic of Korea
  4. 4.Departments of Preventive Medicine, School of MedicineKyung Hee UniversitySeoulRepublic of Korea
  5. 5.Cancer Registration and Statistic Branch, National Cancer Control InstituteNational Cancer CenterGoyangRepublic of Korea
  6. 6.Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and PolicyNational Cancer CenterGoyangRepublic of Korea

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