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Kim and colleagues¹ evaluated the metabolic factors associated with nonalcoholic fatty liver disease (NAFLD). However, they did not consider serum ferritin levels. There is a growing body of evidence that serum ferritin, a good indicator of body iron stores, is associated with both metabolic syndrome² and NAFLD.³ Although a potential beneficial role of iron depletion is questionable,⁴ it might be wise advising patients with NAFLD to modify their diets^5-6 by minimizing consumption of red meat (a rich source of heme iron) and alcohol, avoiding iron supplementation and restricting their intake of vitamin C (an enhancer of nonheme iron absorption).

AUTHOR INFORMATION
Correspondence: Dr Mascitelli, 34 Via Manzoni, Tricesimo (UD) 33019, Italy (lumasci@libero.it)

Luca Mascitelli, MD; Francesca Pezzetta, MD

1. Kim HJ, Kim HJ, Lee KE, et al. Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults. Arch Intern Med. 2004;164:2169-2175. FREE FULL TEXT 2. Jehn M, Clark JM, Guallar E. Serum ferritin and risk of the metabolic syndrome in U.S. adults. Diabetes Care. 2004;27:2422-2428. FREE FULL TEXT 3. Hsiao TJ, Chen JC, Wang JD. Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients. Int J Obes Relat Metab Disord. 2004;28:167-172. FULL TEXT | ISI | PUBMED 4. Bugianesi E, Manzini P, D’Antico S, et al. Relative contribution of iron burden, HFE mutations, and insulin resistance to fibrosis in nonalcoholic fatty liver. Hepatology. 2004;39:179-187. FULL TEXT | ISI | PUBMED 5. Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341:1986-1995. FREE FULL TEXT 6. Fleming DJ, Tucker KL, Jacques PF, Dallal GE, Wilson PWF, Wood RJ. Dietary factors associated with the risk of high iron stores in the elderly Framingham Heart Study cohort. Am J Clin Nutr. 2002;76:1375-1384. FREE FULL TEXT

Arch Intern Med. 2005;165:1070.

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