Objective To investigate the association of serum 25-hydroxyvitamin D [25(OH)D] and serum ferritin (SF) with metabolic associated fatty liver disease (MAFLD) and fibrosis-4 (FIB-4) index.Methods A retrospective analysis was performed for the clinical data of 595 patients who were hospitalized in Department of Gastroenterology, Wuhan Hankou Hospital, from August 2020 to December 2021. Clinical features were compared between 242 patients with MAFLD and 353 patients without MAFLD, and the prevalence rate of MAFLD and SF level were compared between the groups with different 25(OH)D levels. The non-normally distributed continuous data were expressed as M(P25-P75), and the Mann-Whitney U test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to investigate the correlation between serum 25(OH)D and SF in different populations; a binary logistic regression analysis was used to investigate the association of 25(OH)D and SF with the risk of MAFLD and FIB-4 index; the receiver operating characteristic (ROC) curves were used to assess the value of 25(OH)D and SF in the diagnosis of liver fibrosis in patients with MAFLD.Results Compared with the non-MAFLD patients, the MAFLD patients had a significant reduction in serum 25(OH)D level [15.35(11.26-20.02) vs 21.71(15.39-27.84), Z=-9.761, P < 0.05] and a significant increase in SF level [365.50(251.75-525.00) vs 205.00(112.50-275.00), Z=-13.317, P < 0.05]. The prevalence rate of MAFLD and SF level tended to increase with the reduction in serum 25(OH)D level (Z=75.512, P < 0.05). Serum 25(OH)D level was significantly negatively correlated with SF in MAFLD patients (r=-0.460, P < 0.05). The logistic regression analysis showed that the reduction in serum 25(OH)D level (odds ratio [OR]=0.934, 95% confidence interval [CI]: 0.879-0.992, P=0.028) and the increase in SF level (OR=1.009, 95%CI: 1.006-1.013, P < 0.001) were independent risk factors for MAFLD, and the reduction in serum 25(OH)D level (OR=0.852, 95%CI: 0.752-0.965, P=0.012) was also an independent risk factor for elevated FIB-4 index (> 2.67) in MAFLD patients. The ROC curve analysis showed that serum 25(OH)D, SF, and their combination had an area under the ROC curve of 0.793, 0.829, and 0.851, respectively, in predicting elevated FIB-4 index (> 2.67) in MAFLD patients (all P < 0.05).Conclusion Serum 25(OH)D is negatively correlated with SF, and the reduction in serum 25(OH)D and the increase in SF are associated with the risk of MAFLD and elevated FIB-4 index. Serum 25(OH)D and SF levels have a certain value in predicting liver fibrosis in patients with MAFLD.
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