Hyperferritinemia is Related to Higher Adiposity, Metabolic Syndrome, and Hepatic Dysfunction, Mainly Affecting Men: A Study in Southern Brazil

Objectives: To compare body composition, metabolic profile, liver alterations, and dietary patterns in adults stratified by serum ferritin (SF) levels (normal vs. high). Methods: A cross-sectional study was conducted using secondary data from 113 adults (>18 years) of both sexes, who attended a nutrition outpatient clinic in southern Brazil between March 2023 and October 2024. Socioeconomic, anthropometric, blood pressure, dietary, biochemical, and liver parameters were assessed. Statistical analyses included Student's t-test or Mann–Whitney U test, chi-square test, logistic regression, PERMANOVA, and PCoA, with significance set at 5%. Results: Participants with high SF were more frequently male (p< 0.0001), married or in stable relationships (p=0.012), and had lower educational levels (p=0.009). They exhibited higher rates of obesity (p=0.003), cardiovascular risk (p=0.004), and increased body fat percentage (BF%) (p=0.002). Metabolic disturbances included elevated glucose (p=0.023), triglycerides (p=0.003), insulin resistance (p=0.027), hypertension (p=0.001), and metabolic syndrome (MS) (p=0.001). Liver-related findings comprised increased ALT (p=0.008), uric acid (p=0.016), and steatosis indicators (p=0.022). Dietary evaluation showed greater carbohydrate intake (p=0.024). Logistic regression demonstrated a higher likelihood of elevated SF among men (OR=16.82) and individuals with increased BF% (OR=7.5). PCoA analysis distinguished groups according to adiposity, metabolic, and sociodemographic factors. Conclusions: Adults with elevated SF were predominantly obese men with excess adiposity, insulin resistance, and metabolic and hepatic dysfunctions, conditions that increase the risk of MS and liver injury. These findings suggest that SF and other iron biomarkers may serve as valuable tools for diagnosing metabolic dysfunctions and obesity-related liver diseases, particularly Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD).