Relationship among biomarkers of iron metabolism and severity of underlying nonalcoholic steatohepatitis (NASH)

Background: In obese subjects with nonalcoholic steatohepatitis (NASH), hepatic iron load may be associated with the risk of toxicity, acting as a comorbidity factor involved in fibrogenesis and carcinogenesis. To evaluate the relationship among biomarkers of iron metabolism and the severity of NASH in adult obese subjects. Methods: Eighty-eight adult subjects with histological diagnosis of non-alcoholic fatty liver disease (NAFLD) were evaluated in a prospective study for the biomarkers of iron metabolism: serum iron, transferrin and ferritin, as well as transferrin saturation index (TSI). Iron deposition in the liver, the intensity of steatosis and fibrosis were assessed in liver biopsies. Results: Increased serum levels of ferritin were found in 31/88 (35.2%) subjects and 12/88 (13.6%) had values of TSI above 45%. Histological evaluation of liver biopsies showed the presence of fibrosis in 48/88 cases (54.5%) being 23.8% mild and 30.7% moderate/severe. Analysis of stainable iron in liver biopsies by Perls method, demonstrated fine granular deposits in the cytoplasm of hepatocytes in 17/88 biopsies (19.3%). There was no association between the presence of iron deposits in the liver parenchyma and the intensity of fibrosis. Multiple logistic regression analysis identified type 2 diabetes mellitus (T2DM) or fasting glucose >100 mg/dL and dyslipidemia as factors independently associated with fibrosis. Conclusions: The findings from our study did not confirm the association between the presence of iron in the hepatic parenchyma and the severity of NASH in obese subjects.