Iron Deficiency in Patients With Nonalcoholic Fatty Liver Disease Is Associated With Obesity, Female Gender, and Low Serum Hepcidin

Background & Aims Irondeficiency is often observed in obese individuals. The ironregulatory hormone hepcidinis regulated by ironand cytokines interleukin (IL) 6 and IL1β. We examine the relationship between obesity, circulating levels of hepcidin, and IL6 and IL1β, and other risk factors in patients with nonalcoholic fatty liver disease(NAFLD) with irondeficiency. Methods We collected data on 675 adult subjects (>18 years old) enrolled in the Nonalcoholic SteatohepatitisClinical Research Network. Subjects with transferrin saturationResults One-third of patients (231 of 675; 34%) were irondeficient. Obesity, diabetes, and metabolic syndrome were more common in subjects with irondeficiency ( P P P ≤ .018), and increased levels of IL6 and IL1β (6.6 vs 4.8 for ironnormal, P ≤ .0001; and 0.45 vs 0.32 for ironnormal, P ≤ .005). Conclusions Irondeficiency is prevalent in patients with NAFLD and associated with female gender, increased body mass index, and nonwhite race. Serum levels of hepcidinwere lower in iron-deficient subjects, reflecting an appropriate physiologic response to decreased circulating levels of iron, rather than a primary cause of irondeficiency in the setting of obesity and NAFLD.