Serum ferritin as an independent predictor of non-alcohol fatty liver disease in general adults: the TCLSIH cohort study

Abstract

Background Serum ferritin is an important iron storage protein in the human body, which indicates iron storage and the body’s nutritional status, and is associated with a variety of chronic diseases. Few prospective studies have assessed the association between serum ferritin levels and non-alcoholic fatty liver disease (NAFLD). This prospective cohort study aimed to explore whether serum ferritin levels were associated with the incidence of NAFLD in a large-scale adult population. Methods A total of 15,748 participants without baseline NAFLD were enrolled in the cohort study (1-9 years follow-up periods, median: 4.5 years). Serum ferritin levels were determined by protein chip-chemiluminescence method, and NAFLD was diagnosed by abdominal ultrasonography. Multivariable Cox proportional hazards regression models were used to assess the association between baseline serum ferritin levels and the risk of NAFLD. Results During the follow-up period, 3,374 new NAFLD cases were observed, and the incidence rate of NAFLD was 83.4 per 1000 person-years. In the fully adjusted model, the hazards ratios (95% confidence interval) for incident NAFLD across serum ferritin levels quartiles were 1.06 (0.94-1.19), 1.25 (1.11-1.41), and 1.52 (1.28-1.79) (P for trend <0.0001). Receiver operating characteristic (ROC) analysis showed that the optimal cut-off values were 55.9 mg/dl for serum ferritin levels (Area under the ROC curve (AUC)=0.61) Conclusion Increased serum ferritin level was independently associated with a higher risk of incident NAFLD in a large-scale general population. It is suggested that serum ferritin levels can be useful for the early detection of subjects at high risk of developing NAFLD.