Association between serum ferritin and non-alcoholic fatty liver disease among middle-aged and elderly Chinese with normal weight

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) in normal-weight population is becoming an important health issue. This study aimed to assess the association between serum ferritin (SF) and NAFLD among middle-aged and elderly Chinese with normal weight. Methods and Study Design: A total of 2029 Chinese adults aged 35-70 years with normal weight were involved in this cross-sectional study. General information, lifestyle factors and laboratory characteristics were collected. The concentrations of serum alanine aminotransferase (ALT) and SF were recorded. Receiver operating characteristic (ROC) was applied to assess predictive performance of SF for NAFLD. Logistic regression analysis was conducted to evaluate the associations of SF with NAFLD and elevated ALT. Results: Compared with controls, subjects with NAFLD had higher SF concentrations (p<0.001). In multivariate logistic regression analyses, the odds ratios (ORs) with 95% confidence intervals (CIs) of NAFLD were 3.19 (2.07-4.92) for the highest versus lowest quartile of SF. ROC analysis revealed a predictive ability of SF for NAFLD with an area under the curve of 0.660 (95% CI, 0.63-0.69). In addition, higher SF was significantly associated with increased risk of elevated ALT (OR=1.84, 95% CI: 1.32-2.55). In stratified analyses by gender and age, the positive associations of SF with the risk of NAFLD and elevated ALT were only observed in women and 35 similar to 49y group. Conclusions: SF was positively associated with the risk of NAFLD and elevated ALT among normal-weight Chinese adults. ROC analysis suggested that SF may serve as an indicator of predicting NAFLD.