Ferritin as a key risk factor for nonalcoholic fatty liver disease in children with obesity

Associations of Ultrasound Findings with Serum Iron and Ferritin Levels in Children with Obesity

The nutritional status of children is always a concern for medical professionals. Increasingly, obesogenic factors have created a new global epidemic. Obesity is characterized by persistent inflammation, which can have detrimental effects on the growth and development of children. Iron and ferritin are both important factors to consider when evaluating these children due to their role in the pathophysiology of chronic inflammation. Recently, ultrasonographic evaluation seems to be an increasingly used method in pediatric clinical practice. In this study, we included 98 children aged 6-14 years, 72 of whom were obese and 26 had normal weight. The data obtained indicated that there was an association between low iron and increased ferritin levels, aspects of non-alcoholic fatty liver visualized by ultrasonography, and the degree of fibrosis assessed elastographically. Ultrasonography can help us identify liver damage, but the possibility of identifying an association with other paraclinical investigations such as iron and ferritin levels can be cumulative. In this way, the assessment can be more complex, as the child benefits from comprehensive evaluation and management. The results drew attention to non-invasive, easy-to-perform, and low-cost methods of assessing obese children in terms of iron metabolism and structural liver changes.

Iron status and non-alcoholic fatty liver disease: A Mendelian randomization study

OBJECTIVES

The aim of this study was to assess the association of genetically determined iron status with the risk for non-alcoholic fatty liver disease (NAFLD) using two-sample Mendelian randomization (MR) analysis.

METHODS

We applied single nucleotide polymorphisms (SNPs) associated at genome-wide significance with iron status proxied by serum iron, ferritin, transferrin, and transferrin saturation from the Genetics of Iron status Consortium (N = 48 793), in a genome-wide association study of 1664 NAFLD cases and 400 055 controls from the United Kingdom Biobank. A SNP associated with multiple markers of iron status was only applied to one marker with the strongest association in the main analysis. Their effects on NAFLD were calculated using inverse variance weighting after excluding SNPs associated with alkaline phosphatase and lipid metabolism.

RESULTS

The risk for NAFLD is negatively associated with genetically predicted serum transferrin level with a 20% reduction in NAFLD risk per SD (0.65g/L) increase in transferrin (95% confidence interval [CI], 0.66-0.97), and trending positive association with transferrin saturation (odds ratio [OR], 1.50; 95% CI, 0.96-2.35) but it was not associated with serum iron (OR, 0.90; 95% CI, 0.63-1.29) and ferritin (OR, 1.33; 95% CI, 0.54-3.30).

CONCLUSIONS

MR analysis provided evidence that genetically predicted higher serum transferrin, indicating lower iron status, may be protective against NAFLD, whereas higher transferrin saturation, indicating higher iron status, might increase the risk for NAFLD and its pathogenesis.

Analysis of risk factors for non-alcoholic fatty liver disease in hospitalized children with obesity before the late puberty stage

Objective

This study aimed to determine the clinical characteristics of obese pediatric non-alcoholic fatty liver disease (NAFLD) in central China and verify the applicability of some known risk factors for pediatric NAFLD before late puberty.

Methods

This was a retrospective case-control study. A total of 1,029 inpatients at Wuhan Children's Hospital before the late puberty stage were enrolled in the study, including 815 children with obesity (non-NAFLD group) and 214 children with obesity and NAFLD (NAFLD group) diagnosed by liver ultrasound. Subgroup analyses were performed according to sex and puberty. The anthropometric indices and laboratory test data of these 1,029 children were sorted. After intergroup comparison, a logistic regression model was used to determine the risk factors for pediatric NAFLD. Significant risk factors for NAFLD were further tested using receiver operating characteristic (ROC) curves to evaluate their ability to predict an early diagnosis of NAFLD.

Results

The NAFLD group had a mean age of 11.03 ± 1.66, with 11.18 ± 1.66 and 10.27 ± 1.45 years for male and female children, respectively (p < 0.05 and p < 0.01, respectively). Even subdivided by both sex and puberty, raised body mass index (BMI), homeostatic model-insulin resistance, triglycerides, alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (γ-GT) were still found in the non-NAFLD and NAFLD groups (p < 0.05 and p < 0.01, respectively). The results of logistic regression analysis showed that BMI (odds ratio [OR], 1.468;95% confidence interval [CI], 1.356-1.590; p<0.001) and ALT (OR, 1.073;95%CI, 1.060-1.087; P<0.001) were two most independent risk factors for NAFLD. The maximal OR for BMI was 1.721 (95% CI, 1.336-2.217). In the female group, the maximal OR of ALT was found to be 1.104 (95% CI, 1.061-1.148). Age and thyroid-stimulating hormone (TSH) and γ-GT levels were also risk factors, but they appeared only in some groups. The results of the ROC analysis showed that ALT was a better predictor of pediatric NAFLD than BMI. The maximum area under the ROC curve in six of the nine groups belongs to ALT.

Conclusions

BMI, ALT, and age are risk factors for NAFLD in children with obesity before late puberty. BMI had the greatest exposure risk for NAFLD, and ALT had the highest predictive value for the diagnosis of NAFLD. At the stratified level, for exposure risk, age was specific to the male sex, TSH was specific to the early puberty stage, and γ-GT was specific to the female sex plus the prepuberty stage. On a stratified level, for the female sex, even with age stratification, BMI rather than ALT has a better ability for the diagnosis of NAFLD.

Prolactin is a Key Factor for Nonalcoholic Fatty Liver Disease in Obese Children

This study investigates whether serum prolactin (PRL) is a key factor for nonalcoholic fatty liver disease (NAFLD) in children. A total of 691 obese childred participated in this study and were divided into a NAFLD group (n=366) and simple obesity (SOB) group (n=325) according to the hepatic ultrasound results. The two groups were matched for gender, age, pubertal development, and body mass index (BMI). All patients underwent an OGTT test, and fasting blood samples were collected to measure prolactin. Stepwise logistic regression was performed to identify significant predictors of NAFLD. Serum prolactin levels were significantly lower in NAFLD subjects than in the SOB subjects [82.4 (56.36, 118.70) vs. 99.78 (63.89, 153.82), p<0.001] (mIU/l). NAFLD was strongly associated with insulin resistance (HOMA-IR) and prolactin, with lower levels of prolactin increasing the risk of NAFLD (adjusted ORs=1.741; 95% CI: 1.059-2.860) across the prolactin concentration tertiles after adjustment for confounders. Low serum prolactin levels are associated with the presence of NAFLD; thus, increased circulating prolactin might be a compensatory response for obesity in children.

Serum Ferritin Levels Are Associated with Adipose Tissue Dysfunction-Related Indices in Obese Adults

Iron overload is associated with type 2 diabetes and metabolic syndrome. However, little is known about the role of iron status on adipose tissue. We aimed to investigate the association of iron metabolism markers with adipose tissue dysfunction-related indices in obese individuals. A total of 226 obese adults with body mass index (BMI) ≥ 30 kg/m² were recruited into the study. Hemoglobin, serum ferritin, iron, soluble transferrin receptor (sTfR), total iron-binding capacity (TIBC), transferrin saturation (TSAT), and other clinical parameters were measured. Adipose tissue dysfunction was assessed by adipose tissue insulin resistance (adipose-IR), visceral adiposity index (VAI), and lipid accumulation product (LAP) index. Serum ferritin levels, adipose-IR, and VAI progressively increased from class I to class III obesity and significantly higher in class III obesity. Correlation analysis suggested that only serum ferritin levels were positively correlated with adipose-IR (r = 0.284, P < 0.001), VAI (r = 0.209, P = 0.002), and LAP (r = 0.324, P < 0.001). Moreover, further logistic regression analysis revealed serum ferritin was significantly associated with elevated adipose-IR, VAI, and LAP. After adjustment for potential confounders, serum ferritin levels remained independently associated with elevated adipose-IR (OR = 1.004, 95% CI 1.000-1.009, P < 0.05) and VAI (OR = 1.005, 95% CI 1.001-1.009, P < 0.05). Serum ferritin was associated with elevated adipose-IR, VAI, and LAP, suggesting that ferritin could be an important early indicator for the risk of developing adipose tissue dysfunction in obese individuals.

Percent Body Fat-Related Disparities of Serum Ferritin on the Risk of Lipid Metabolism Abnormalities in Children and Adolescents

OBJECTIVE

This study examined the association between serum ferritin and dyslipidemia in children and adolescents with different degrees of obesity.

METHOD

In this multi-stage, stratified, randomized, sampling cross-section cohort study, demographic data were collected by questionnaire from 4320 children and adolescents (aged 6-17 years) in Shanghai, China. Anthropometric measures and percent body fat (PBF) were recorded. Serum lipid parameters were detected by an automatic biochemical method, and ferritin levels were measured by an automatic immunoassay.

RESULTS

Our results showed 70.6%, 13.9%, and 15.5% of participants had a healthy body fat, low fat, and overweight/obese, respectively. Increasing ferritin quartiles were independently associated with a greater hazard of dyslipidemia, especially in overweight/obese participants, and the OR (95% CI) was 3.01 (1.29-7.00), 3.58 (1.59-8.04), and 5.66 (2.57-12.46) across the ferritin quartiles after adjustment for confounders. Ferritin was only a predictive value for dyslipidemia in overweight/obese participants (AUC = 0.64) and was consistent in boys (AUC = 0.61) and girls (AUC = 0.68). The significant positive correlation between ferritin value and lipid abnormalities profiles (except for low HDL-C) mainly appeared in the overweight/obesity group.

CONCLUSION

The results showed that serum ferritin can be considered an independent risk factor for dyslipidemia in children and adolescents with obesity.

HIGHLIGHTS

Ferritin overload had a greater risk of dyslipidemia, especially in children and adolescents with overweight/obesity.

The association between non-alcoholic fatty liver disease and serum ferritin levels in American adults

BACKGROUND

Elevated serum ferritin levels (SFLs) was previously reported to be related with hepatic histologic severity and advanced liver fibrosis among non-alcoholic fatty liver disease (NAFLD) patients. However, whether NAFLD influences SFLs remains uncertain and needs more clinical evidences. This study explored the differences of SFLs in US adults with or without NAFLD.

METHODS

We conducted a cross-sectional study of 3689 participants aged 18-80 years using the National Health and Nutrition Examination Survey (NHANES) 2017-2018 cycle. NAFLD status was confirmed based on controlled attenuation parameter (CAP) values ≥274 dB/m through vibration controlled and transient elastography (VCTE). We performed weighted multivariable logistic regression models to evaluate the associations between NAFLD and SFLs in different age and gender.

RESULTS

There was a positive association between NAFLD and SFLs in all three models (model 1:β = 23.07, 95% CI: 10.32, 35.81; model 2:β = 23.68, 95% CI: 10.86, 36.50; model 3:β = 13.86, 95% CI: 0.29, 27.43). After adjusting for the covariates, this positive association persisted in females (β = 16.22, 95% CI: 2.81, 29.62). Further, relationships between NAFLD and SFLs were significantly different in various age groups. In the subgroup stratified by gender, their associations further differed. In males, the positive association was more prominent in 50-64 age group (β = 70.89, 95% CI: 25.14, 116.64). In females, this positive association was more prominent in 18-34 age group (β = 20.72, 95% CI: 7.45, 33.99). However, no correlations between severe steatosis, significant fibrosis, advanced fibrosis, cirrhosis, and SFLs in adults with NAFLD were found.

CONCLUSION

This study indicated that US adults suffered with NAFLD had significantly higher SFLs compared with their counterparts in non-NAFLD group. Moreover, the associations between NAFLD and SFLs further differed by age and gender.

Composition of Dietary Fatty Acids and Health Risks in Japanese Youths

In the overall composition of dietary fatty acids (FAs), the quantity of each FA is interrelated with that of others. We examined the associations between dietary FA composition and cardiometabolic risk in Japanese youths. Risk factors (anthropometric characteristics, serum lipid and liver enzyme levels, and blood pressure) were measured in 5485 junior-high-school students. Dietary intake was assessed using a food frequency questionnaire. The mean saturated FA (SFA), monounsaturated FA (MUFA), omega-6 polyunsaturated FAs (PUFAs), and omega-3 PUFAs intake were 9.6%E, 10.3%E, 6.3%E, and 1.1%E, respectively. In compositional regression analysis controlled for confounders, a high intake of omega-6 PUFAs relative to others was associated with low low-density-lipoprotein cholesterol levels (LDL-C; p = 0.003), and relative SFA intake was associated with high levels of gamma-glutamyl transpeptidase (p = 0.019). Relative omega-3 PUFAs intake was associated with low blood pressure (p = 0.005–0.034) but had unfavorable effects on adiposity and alanine transaminase. Substitutional models showed similar results for omega-6 PUFAs on LDL-C, but MUFA had inconsistent effects on risk factors. The results from the compositional data analysis were consistent with previous studies and clinical practice/knowledge. Focusing on increasing omega-6 PUFAs in Japanese youths could have favorable consequences in the long term.

Ferritin as a key risk factor for nonalcoholic fatty liver disease in children with obesity

Background

The association between serum ferritin and nonalcoholic fatty liver disease (NAFLD) in children with obesity is not clear. This study was designed to investigate whether serum ferritin can be an independent predictor for NAFLD.

Methods

According to the hepatic ultrasound results, a total of 347 children with obesity were enrolled in this study. Among them, 95 patients with NAFLD and 95 without NAFLD were matched for gender, age, blood pressure and body mass index, the odds ratios (OR) and 95% confidence intervals (CI) for the association of ferritin and the risk of NAFLD were analyzed.

Results

After propensity score matching, ferritin values of the patients with NAFLD were significantly higher than those without NAFLD group. Alanine aminotransferase and ferritin were strongly associated with NAFLD in multivariate stepwise logistic regression analysis. The medium and high levels of ferritin increased risk of NAFLD, and the adjusted ORs were 3.298 (95% CI:1.326‐8.204), 7.322 (95% CI:2.725‐19.574) across the ferritin concentration tertiles after adjustment for confounders. Ferritin was shown to be the best predictor for NAFLD with sensitivity and specificity of 60.0% and 77.9%, respectively, area under the curve was 0.733.

Conclusion

The results show that serum ferritin can usefully be considered as a predictor of NAFLD in children with obesity.