IRON METABOLISM DISTURBANCES ARE ASSOCIATED WITH LIVER FIBROSIS SEVERITY IN MASLD: A CROSS-SECTIONAL STUDY USING NON-INVASIVE TOOLS

Abstract

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Disturbances in iron metabolism—particularly hyperferritinemia—may play a role in fibrosis progression through mechanisms involving oxidative stress and chronic inflammation.

To describe iron metabolism parameters in patients with MASLD and analyze their association with liver disease severity using non-invasive tools.

Materials and Methods

We conducted a cross-sectional study including 199 adult patients with MASLD followed at a specialized hepatology clinic (2022–2024). Clinical, anthropometric, and biochemical variables were collected, including serum ferritin, transferrin, serum iron, and transferrin saturation index (TSI). Liver fibrosis was evaluated by FIB-4 score and transient elastography (FibroScan®); steatosis was assessed by controlled attenuation parameter (CAP). Non-parametric statistical tests were applied (Spearman correlation, Kruskal–Wallis, chi-square).

Results

The mean age was 57 ± 12 years; 58.3% were women and 39.7% had type 2 diabetes. The mean BMI was 33.8 ± 6.3 kg/m². Hyperferritinemia was observed in 43.4% of patients. Elevated ferritin, serum iron, and TSI were significantly associated with higher FIB-4 scores (p < 0.05). Ferritin levels were also significantly associated with liver stiffness measured by FibroScan® (p < 0.05). No significant association was found between iron metabolism parameters and the degree of steatosis assessed by CAP.

Conclusions

Iron metabolism disturbances, particularly hyperferritinemia, are frequent in MASLD and associated with greater risk of liver fibrosis, but not with steatosis. These findings support the potential utility of iron biomarkers as adjunctive non-invasive indicators of disease progression.