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This study aims to investigate whether serum iron is associated with nonalcoholic fatty liver disease (NAFLD) and advanced hepatic fibrosis (AHF). Cross-sectional data for adults aged\u2009\u2265\u200918\u00a0years who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were analyzed. Odds ratio (ORs) and 95% confidence intervals (CIs) of NAFLD and AHF associated with serum iron were estimated using multivariable logistic regression models. A total of 18,031 males and 18,989 females were included in the analysis. After multivariable adjustment for potential confounders, serum iron was significantly and inversely associated with NAFLD in both genders (<jats:italic>P-trend<\/jats:italic>\u2009&lt;\u20090.001) and AHF in females (<jats:italic>P-trend<\/jats:italic>\u2009=\u20090.018). Compared to the bottom quartile, those in higher quartiles of serum iron had no significant ORs for AHF in males, but the trend across the quartiles was significant (<jats:italic>P-trend<\/jats:italic>\u2009=\u20090.046). In conclusion, higher serum iron level was associated with lower risk of NAFLD in males and females, and with lower risk of AHF in females but not in males. No significant racial\/ethnical differences in these associations were observed.<\/jats:p>","DOI":"10.1038\/s41598-021-89991-x","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T10:04:53Z","timestamp":1621245893000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Serum iron and risk of nonalcoholic fatty liver disease and advanced hepatic fibrosis in US adults"],"prefix":"10.1038","volume":"11","author":[{"given":"Huan-Huan","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Chong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-Ming","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Hua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Ying","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Qiang","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"89991_CR1","first-page":"164","volume":"19","author":"N Abbaspour","year":"2014","unstructured":"Abbaspour, N., Hurrell, R. & Kelishadi, R. 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