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Associations of Serum Iron Status with MAFLD and Liver Fibrosis in the USA: a Nationwide Cross-Section Study

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Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new terminology characterized by liver steatosis. Iron status is related to many metabolic diseases. However, the researches on the associations of serum iron status with MAFLD are limited. The objective of this study was to investigate the associations of serum iron status biomarkers with MAFLD and liver fibrosis. A total of 5892 adults were enrolled in the current cross-sectional study using the 2017-March 2020 National Health and Nutrition Examination Survey. Liver steatosis and liver fibrosis were defined by the median values of controlled attenuation parameter ≥ 274 dB/m and liver stiffness measurement ≥ 8 kPa, respectively. The multivariable logistic/linear regression and restricted cubic spline analysis were conducted. After adjusting for potential confounders, higher ferritin levels were associated with higher odds of MAFLD (OR 4.655; 95% CI 2.301, 9.418) and liver fibrosis (OR 7.013; 95% CI 3.910, 12.577). Lower iron levels were associated with a higher prevalence of MAFLD (OR 0.622; 95% CI 0.458, 0.844) and liver fibrosis (OR 0.722; 95% CI 0.536, 0.974). Lower transferrin saturation (TSAT) was associated with a higher prevalence of MAFLD (OR 0.981; 95% CI 0.970, 0.991) and liver fibrosis (OR 0.988; 95% CI 0.979, 0.998). Higher ferritin levels, lower iron levels, and TSAT were associated with a higher prevalence of MAFLD and liver fibrosis. This study extended the knowledge of modifying iron status to prevent MAFLD and liver fibrosis. More prospective and mechanism studies were warranted to confirm the conclusions.

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Data Availability

The data that support the findings of this study are available from NHANES, which is available publicly at https://www.cdc.gov/nchs/nhanes/.

Abbreviations

NHANES:

National Health and Nutrition Examination Surveys

NCHS:

National Center for Health Statistics

MEC:

Mobile examination center

MAFLD:

Metabolic-associated fatty liver disease

NAFLD:

Non-alcoholic fatty liver disease

VCTE:

Vibration-controlled transient elastography

CAP:

Controlled attenuation parameter

LSM:

Liver stiffness measurement

BMI:

Body mass index

HOMA-IR:

Homeostasis model assessment-insulin resistance

T2DM:

Type 2 diabetes mellitus

OR:

Odds ratio

FPG:

Fasting plasma glucose

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

TSAT:

Transferrin saturation

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Acknowledgements

The authors thank all team members and participants in the NHANES study.

Funding

This research is supported by the National Natural Science Foundation of China (82170800), Guangdong Basic and Applied Basic Research Foundation (2021A1515110682), and Research Initiation Project of Shunde Hospital of Southern Medical University (SRSP2021001).

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Author notes

  1. Heng Wan and Jie Shen have contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, 528300, Guangdong Province, China

    Genfeng Yu, Lan Liu, Yaosheng Luo, Cheng Song, Xingying Chen, Hualin Duan, Yuqi Jiang, Huixian Zeng, Heng Wan & Jie Shen

  2. Department of Ultrasound, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, 528300, Guangdong Province, China

    Tao Qin

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  1. Genfeng Yu
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Contributions

Study concept and design: GY, LL, YL, and CS.

Literature searches and data collection: XC, HD, HZ, and YJ.

Statistical analysis: GY, LL, and TQ.

Drafting of the manuscript: GY, LL, and TQ.

Critical revision: JS and HW.

Study supervision: JS and HW.

All authors contributed to the manuscript for important intellectual content and approved the submission.

Corresponding authors

Correspondence to Heng Wan or Jie Shen.

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Ethics Approval

The original survey was approved by the NCHS Research Ethics Review Board, and informed consent for data collection and storage was obtained from all participants.

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Genfeng Yu, Lan Liu, and Tao Qin contributed equally to this manuscript and shared their first authorship.

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Yu, G., Liu, L., Qin, T. et al. Associations of Serum Iron Status with MAFLD and Liver Fibrosis in the USA: a Nationwide Cross-Section Study. Biol Trace Elem Res 202, 87–98 (2024). https://doi.org/10.1007/s12011-023-03666-4

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