Serum Ferritin in Patients with Nonalcoholic Fatty Liver Disease: Evaluation of Ferritin to Adiponectin Ratio and Ferritin by Homeostatic Model of Assessment Insulin Resistance Product as Non-Invasive Markers

Aims: Serum ferritin and insulin resistance increase and adiponectin decreases with the severity of nonalcoholic fatty liver disease (NAFLD). The aims of this pilot study were: the evaluation of serum iron and ferritin, and ferritin/adiponectin ratio and ferritin by homeostatic model of assessment insulin resistance (HOMA-IR) product; ferritin relationship with adiponectin and HOMA- IR in NAFLD patients. Methods: Thirty patients with biopsy-proven NAFLD (15 with simple nonalcoholic fatty liver (NAFL), 15 with nonalcoholic steatohepatitis (NASH)) and 24 matched controls were recruited. Serum samples for ferritin, adiponectin and standard biochemical tests were obtained after overnight fasting. Results: Serum ferritin (ng/mL), ferritin/adiponectin ratio and ferritin by HOMA-IR product were higher in NAFL patients (96.9±12.4, 26.7±4.4, 245±50, respectively) than controls (58.3±11.0, 13.6±4.6, 92±31, respectively), and even higher in NASH patients (124.5±21.8, 35.5±9.6, 725±217, respectively). Serum ferritin was higher in more severe portal inflammation, without independently predicting it. However, both ferritin/adiponectin ratio (p=0.027) and ferritin by HOMA-IR product (p=0.017) could independent predict portal inflammation. Serum iron was similar irrespectively of the histological category. Serum ferritin (but not iron) correlated positively with HOMA-IR (rs=0.563; p<0.001) and inversely with serum adiponectin (rs= -0.504; p<0.001). Conclusion: Serum ferritin, ferritin/adiponectin ratio and ferritin by HOMA-IR product escalade from controls to NAFL and NASH patients. Ferritin/adiponectin ratio and ferritin by HOMA-IR product may be promising in noninvasive assessment of portal inflammation in NAFLD, but further validation is needed. Immunogastroenterology 2012; 1:119-125