Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population (original) (raw)

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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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

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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.

Author information

Authors and Affiliations

  1. Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
    Ju Young Jung & Sung Keun Park
  2. Departments of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
    Jae-Jun Shim
  3. Departments of Occupation and Environmental medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
    Jae-Hong Ryoo
  4. Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
    Joong-Myung Choi, In-Hwan Oh & Chang-Mo Oh
  5. Cancer Registration and Statistic Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
    Kyu-Won Jung, Hyunsoon Cho & Young-Joo Won
  6. Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
    Hyunsoon Cho, Moran Ki & Young-Joo Won

Authors

  1. Ju Young Jung
  2. Jae-Jun Shim
  3. Sung Keun Park
  4. Jae-Hong Ryoo
  5. Joong-Myung Choi
  6. In-Hwan Oh
  7. Kyu-Won Jung
  8. Hyunsoon Cho
  9. Moran Ki
  10. Young-Joo Won
  11. Chang-Mo Oh

Corresponding author

Correspondence toChang-Mo Oh.

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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).

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

12072_2018_9892_MOESM1_ESM.docx

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

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)

Supplementary material 3 (TIFF 1168 kb)

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Jung, J.Y., Shim, JJ., Park, S.K. et al. Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population.Hepatol Int 13, 222–233 (2019). https://doi.org/10.1007/s12072-018-9892-8

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