Abstract：
OBJECTIVE: Iron metabolism and insulin resistance (IR) are closely related to non-alcoholic fatty liver disease (NAFLD). However, the interplay between them on the occurrence and progression of NAFLD is not fully understood. We aimed to disentangle the crosstalk between iron metabolism and IR and explore its impact on NAFLD.
METHODS: We analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017-2018 to evaluate the association between serum iron metabolism indicators (ferritin, serum iron, unsaturated iron-binding capacity [UIBC], total iron-binding capacity [TIBC], transferrin saturation, and transferrin receptor) and NAFLD/non-alcoholic steatohepatitis (NASH). Mediation analysis was conducted to explore the role of IR played in these relationship.
RESULTS: A total of 4812 participants were included, among whom 43.7% were diagnosed with NAFLD and 13.2% were further diagnosed with NASH. After adjusting the covariates, the risk of NAFLD increases with increasing serum ferritin (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.37-2.14), UIBC (aOR 1.45, 95% CI 1.17-1.79), and TIBC (aOR 1.36, 95% CI 1.11-1.68). Higher levels of serum ferritin (aOR 3.70, 95% CI 2.25-6.19) and TIBC (aOR 1.69, 95% CI 1.13-2.56) were also positively associated with NASH. Participants with IR were more likely to have NAFLD/NASH. Moreover, IR-mediated efficacy accounted for 85.85% and 64.51% between ferritin and NAFLD and NASH, respectively.
CONCLUSIONS: Higher levels of serum ferritin and TIBC are closely associated with the occurrence of NAFLD and NASH. IR may be considered a possible link between NAFLD or NASH and increased serum ferritin levels.
METHODS: We analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017-2018 to evaluate the association between serum iron metabolism indicators (ferritin, serum iron, unsaturated iron-binding capacity [UIBC], total iron-binding capacity [TIBC], transferrin saturation, and transferrin receptor) and NAFLD/non-alcoholic steatohepatitis (NASH). Mediation analysis was conducted to explore the role of IR played in these relationship.
RESULTS: A total of 4812 participants were included, among whom 43.7% were diagnosed with NAFLD and 13.2% were further diagnosed with NASH. After adjusting the covariates, the risk of NAFLD increases with increasing serum ferritin (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.37-2.14), UIBC (aOR 1.45, 95% CI 1.17-1.79), and TIBC (aOR 1.36, 95% CI 1.11-1.68). Higher levels of serum ferritin (aOR 3.70, 95% CI 2.25-6.19) and TIBC (aOR 1.69, 95% CI 1.13-2.56) were also positively associated with NASH. Participants with IR were more likely to have NAFLD/NASH. Moreover, IR-mediated efficacy accounted for 85.85% and 64.51% between ferritin and NAFLD and NASH, respectively.
CONCLUSIONS: Higher levels of serum ferritin and TIBC are closely associated with the occurrence of NAFLD and NASH. IR may be considered a possible link between NAFLD or NASH and increased serum ferritin levels.
摘要：
目的：铁代谢和胰岛素抵抗（IR）与非酒精性脂肪性肝病（NAFLD）密切相关。然而,它们对NAFLD发生和进展的相互作用尚不完全清楚.我们旨在解开铁代谢与IR之间的串扰，并探讨其对NAFLD的影响。
方法：我们分析了2017-2018年国家健康和营养检查调查（NHANES）的数据，以评估血清铁代谢指标（铁蛋白，血清铁,不饱和铁结合能力[UIBC]，总铁结合能力[TIBC]，转铁蛋白饱和度，和转铁蛋白受体）和NAFLD/非酒精性脂肪性肝炎（NASH）。进行中介分析以探讨IR在这些关系中的作用。
结果：共包括4812名参与者，其中43.7%诊断为NAFLD,13.2%进一步诊断为NASH.调整协变量后，NAFLD的风险随着血清铁蛋白的增加而增加（调整比值比[aOR]1.71，95％置信区间[CI]1.37-2.14），UIBC（aOR1.45，95%CI1.17-1.79），和TIBC（aOR1.36，95%CI1.11-1.68）。血清铁蛋白水平（aOR3.70，95%CI2.25-6.19）和TIBC（aOR1.69，95%CI1.13-2.56）也与NASH呈正相关。患有IR的参与者更有可能患有NAFLD/NASH。此外，IR介导的疗效在铁蛋白与NAFLD和NASH之间分别占85.85%和64.51%,分别。
结论：血清铁蛋白和TIBC水平升高与NAFLD和NASH的发生密切相关。IR可能被认为是NAFLD或NASH与血清铁蛋白水平升高之间的可能联系。
方法：我们分析了2017-2018年国家健康和营养检查调查（NHANES）的数据，以评估血清铁代谢指标（铁蛋白，血清铁,不饱和铁结合能力[UIBC]，总铁结合能力[TIBC]，转铁蛋白饱和度，和转铁蛋白受体）和NAFLD/非酒精性脂肪性肝炎（NASH）。进行中介分析以探讨IR在这些关系中的作用。
结果：共包括4812名参与者，其中43.7%诊断为NAFLD,13.2%进一步诊断为NASH.调整协变量后，NAFLD的风险随着血清铁蛋白的增加而增加（调整比值比[aOR]1.71，95％置信区间[CI]1.37-2.14），UIBC（aOR1.45，95%CI1.17-1.79），和TIBC（aOR1.36，95%CI1.11-1.68）。血清铁蛋白水平（aOR3.70，95%CI2.25-6.19）和TIBC（aOR1.69，95%CI1.13-2.56）也与NASH呈正相关。患有IR的参与者更有可能患有NAFLD/NASH。此外，IR介导的疗效在铁蛋白与NAFLD和NASH之间分别占85.85%和64.51%,分别。
结论：血清铁蛋白和TIBC水平升高与NAFLD和NASH的发生密切相关。IR可能被认为是NAFLD或NASH与血清铁蛋白水平升高之间的可能联系。
