Cristina Galarregui, Bertha Araceli Marin-Alejandre, Nuria Perez-Diaz-Del-Campo, Irene Cantero1, J. Ignacio Monreal, Mariana Elorz, Alberto Benito-Boillos, José Ignacio Herrero, Josep A. Tur, J Alfredo Martínez, M Angeles Zulet1, Itziar Abete
Background and objective: Non alcoholic fatty liver disease (NAFLD) is a major cause of liver morbidity. The identification of affordable and reproducible non-invasive biomarkers for the diagnosis and characterization of NAFLD as feasible alternative to liver biopsy is a major challenge for the research community. This study aimed to explore the usefulness of ferritin as a proxy biomarker of NAFLD condition, alone or in combination with other routine biochemical parameters.
Methods: Subjects with overweight/obesity and ultrasound-confirmed liver steatosis (n=112) from the Fatty Liver in Obesity (FLiO) study were assessed. Hepatic evaluation considered magnetic resonance imaging (MRI), ultrasonography and credited routine blood liver biomarkers. Anthropometry and body composition, dietary intake (by means of a validated 137-item food frequency questionnaire) and specific biochemical markers of nutritional status were also determined. Serum ferritin levels were analyzed using a Chemiluminescent Microparticle Immunoassay (CMIA) kit.
Results: Lower serum ferritin concentrations were associated with a general better liver health and nutritional status. The evaluation of ferritin as a surrogate of liver damage by means of quantile regression analyses showed a positive association with alanine aminotransferase (ALT) (β=19.21; p=<0.001), liver fat content (β=8.70; p=0.008) and hepatic iron by MRI (β=3.76; p=<0.001), after adjusting for potential confounders. In ROC analyses, the panel combination of blood ferritin, glucose and ALT showed the best prediction for liver fat mass (AUC 0.82).On the other hand, a combination of ferritin and ALT showed the higher predictive ability for estimating liver iron content (AUC 0.73).
Conclusion: This investigation demonstrated the association of serum ferritin with liver health as well as with glucose and lipid metabolism markers in subjects with NAFLD. Current findings led to the identification of ferritin as a potential non-invasive predictive biomarker of NAFLD, whose surrogate value increased when combined with other routine biochemical measurements such as glucose/ALT.