Hepatic iron and nonalcoholic fatty liver disease

Increased iron is suspected to enhance hepatic injury associated with nonal coholic fatty liver disease (NAFL). We evaluated the impact of iron accumul ation on the outcome of NAFL. Patients with NAFL were identified from our d atabase. Twenty-two clinicodemographic and 19 pathological features were av ailable for each patient. Histological staining (Perls' Prussian blue), hep atic iron concentration (HIC), and hepatic iron index (HII) were determined . Data on follow-up, mortality, and cause of death were analyzed. In 65 pat ients with available liver biopsy blocks, HIC and HII were 1,171 +/- 717 mu g/g dry weight and 0.43 +/- 0.30 mu mol/g/yr, respectively. Males had more iron accumulation (HIC: 1,514 +/- 836 vs. 859 +/- 389, P =.0001; and HII: 0.58 +/- 0.35 vs. 0.29 +/- 0.16, P =.0001). In type II diabetics, both HIC (977 +/- 769 vs. 1,301 +/- 659; P <.05) and HII (0.30 +/- 0.23 vs. 0.52 =/- 0.32; P <.05) were lower. Iron accumulation was not related to other varia bles analyzed. Increased iron was not seen in those with higher grades of f ibrosis or other pathological features associated with the aggressive form of NAFL (hepatocyte necrosis, fibrosis, ballooning degeneration, and Mallor y hyaline). Iron accumulation was not associated with increased overall mor tality, liver-related mortality, or development of cirrhosis. In summary, i n most patients with NAFL, significant iron accumulation is not seen. Addit ionally, in our series of patients with NAFL, iron is not associated with p oor clinical or pathological outcomes.