A HOMEOSTASE FÉRRICA EM ADULTOS COM EXCESSO DE PESO E SUA RELAÇÃO COM COMPLICAÇÕES METABÓLICAS E HEPÁTICAS

Abstract

Introduction: Alterations in iron homeostasis, evidenced by elevated serum ferritin (SF) levels, are present in individuals with excess weight and negatively affect insulin sensitivity as well as glucose and lipid homeostasis. These imbalances increase the risk of Metabolic Syndrome (MetS) and Metabolic-Associated Steatotic Liver Disease (MASLD). Factors such as adiposity, sex, diet, and metabolic parameters influence both SF concentrations and the severity of MASLD. However, the relationship among these factors remains poorly understood in the adult population of Paraná, Brazil. Objective: To evaluate the association between SF concentrations and changes in adiposity, nutritional status, metabolic status, and hepatic complications in adult residents of Paraná. Methods: This was a quantitative, descriptive, cross-sectional study with non-probabilistic consecutive sampling, approved by an institutional Research Ethics Committee. Data were collected at a Nutrition outpatient clinic in Southwestern Paraná between 2023 and 2024. A total of 163 adults were evaluated, with collection of socioeconomic data (age, sex, education, income), lifestyle factors (physical activity, alcohol consumption, smoking), anthropometric measurements (weight, height, and adiposity), laboratory tests (glucose, lipid profile, hepatic parameters, SF, complete blood count, inflammatory markers), and dietary information (food frequency questionnaire and 24-hour dietary recall). The prevalence of MetS, the Hepatic Steatosis Index (HSI), and the Fibrosis-4 Index (FIB-4) were also calculated. Results: In the first stage, 79 adults were analyzed, with a median age of 34 (25–44) years. Among them, 67.09% were overweight, which was associated with greater visceral adiposity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance, resulting in a higher prevalence of MetS (30.39%) and increased cardiovascular risk (54.43%) compared to individuals without excess weight (p<0.05). Significant hematological alterations were also identified (p<0.05), including increased hemoglobin, erythrocytes, hematocrit, leukocytes, and platelets, as well as reduced mean corpuscular volume and mean corpuscular hemoglobin. Principal component analysis showed a significant association between visceral adiposity, metabolic and hematological alterations, and elevated SF concentrations in overweight individuals (p<0.05). In the second stage, 113 adults (>18 years) were evaluated and categorized into normal SF and high SF groups. Individuals with high SF were predominantly male (47.4%), married or in a stable union (65.7%), had lower educational attainment (42.1%), higher obesity prevalence (55.3%), and alterations in glycemic, lipid, and blood pressure parameters (p<0.05). Hepatic findings showed that adults with high SF had increased alanine aminotransferase (21.6%), uric acid (29%), and HSI (67.6%) (p<0.05). Logistic regression indicated a higher likelihood of elevated SF among men (OR=16.82) and individuals with high adiposity (OR=7.5). Diet did not influence SF concentrations. PERMANOVA analysis confirmed that adults with high SF present a distinct sociodemographic profile, greater adiposity, and more metabolic and hepatic complications, with no dietary impact. Conclusions: Adults from Paraná with excess weight, high visceral adiposity, and metabolic complications exhibited higher SF concentrations, particularly men. SF appears to be a potential marker of health status and risk of hepatic complications.