Abstract
Objectives: Serum ferritin (SF) reflects iron homeostasis, in addition to being an acute phase reactant protein. Since its levels are altered in the obesity state, we compared body composition, metabolic profile, liver alterations, and dietary patterns in adults stratified by SF levels (normal vs. high). Methods: A cross-sectional study was conducted using secondary data from 113 adults (≥18 years) of both sexes, attended at an outpatient nutrition clinic in southern Brazil and categorized for normal or high SF. Socioeconomic, anthropometric, blood pressure, dietary, biochemical, and liver parameters were assessed and statistical analyses performed. Results: Participants with high SF were more frequently male (p < 0.0001), married or in a civil union (p = 0.012), and had lower educational levels (p = 0.009). Moreover, higher rates of obesity (p = 0.003), cardiovascular risk (p = 0.004), increased body fat percentage (BF%; p = 0.002) and metabolic disturbances such as 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) were noted in this group. Liver-related findings comprised increased ALT (p = 0.008), uric acid (p = 0.016), and indicators of steatosis (p = 0.022). Logistic regression demonstrated a higher likelihood of elevated SF among men (OR = 16.82) and individuals with increased BF% (OR = 7.5), without significant influence of diet. 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).