{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T16:40:58Z","timestamp":1790527258451,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013831","name":"Utility of antioxidants in the prevention, monitoring and treatment of non-alcoholic fatty liver disease in children with established PNPLA3 genotype","doi-asserted-by":"publisher","award":["26\/11C\/13 July 2021"],"award-info":[{"award-number":["26\/11C\/13 July 2021"]}],"id":[{"id":"10.13039\/501100013831","id-type":"DOI","asserted-by":"publisher"}]},{"award":["26\/11C\/13 July 2021"],"award-info":[{"award-number":["26\/11C\/13 July 2021"]}],"id":[{"id":"https:\/\/ror.org\/01p2t4k13","id-type":"ROR","asserted-by":"publisher"}]},{"name":"University of Medicine and Pharmacy of Craiova, Romania"},{"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Metabolic abnormalities are frequently associated with hepatic steatosis and low-grade inflammation, yet the contributions of iron metabolism and genetic susceptibility are not fully understood. We aimed to investigate the relationship between serum ferritin, hepatic steatosis, metabolic risk clustering, and the PNPLA3 rs738409 gene variant in children. A total of 68 children aged 6\u201314 years underwent anthropometric, biochemical, imaging, and genetic assessment. Hepatic steatosis was present in 72.1% of participants, with fibrosis greater than F1 in 42.6%. Serum ferritin showed a strong correlation with echographic liver steatosis severity (\u03c1 = 0.804, p &lt; 0.001) and a moderate correlation with the number of metabolic risk components (\u03c1 = 0.482, p &lt; 0.001). The highest metabolic burden occurred in children with low iron and elevated ferritin. While PNPLA3 status did not independently predict ferritin levels, carriers had a significantly higher prevalence of hypertension (50.0% vs. 25.0%, p = 0.038) and a non-significant trend toward low HDL-C (65.0% vs. 42.9%, p = 0.070). Ferritin was associated with metabolic clustering and ultrasound-defined hepatic steatosis, acting as a nonspecific marker of combined metabolic and hepatic alterations. PNPLA3 genotype was not independently related to ferritin or fibrosis in early pediatric disease. Given the cross-sectional design and the relatively small sample size, these findings should be interpreted as exploratory and further studies including larger populations and direct inflammatory markers should be conducted.<\/jats:p>","DOI":"10.3390\/ijms27073044","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:32:47Z","timestamp":1774611167000},"page":"3044","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ferritin and Liver Steatosis in Children: Interactions Between Metabolic Clustering and PNPLA3 Variants"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9259-8806","authenticated-orcid":false,"given":"Mihaela-Andreea","family":"Podeanu","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Infant Care, Pediatrics and Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8707-9768","authenticated-orcid":false,"given":"Raluca Elena","family":"Sandu","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7801-5646","authenticated-orcid":false,"given":"Bianca \u0218tef\u0103ni\u021ba","family":"Vintilescu","sequence":"additional","affiliation":[{"name":"Department of Infant Care, Pediatrics and Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5675-1741","authenticated-orcid":false,"given":"Claudiu Marinel","family":"Ionele","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-098X","authenticated-orcid":false,"given":"Ion","family":"Rogoveanu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Strea\u021b\u0103","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Elena","family":"Niculescu","sequence":"additional","affiliation":[{"name":"Department of Infant Care, Pediatrics and Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan Nicolae","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-7683","authenticated-orcid":false,"given":"Sergiu-Marian","family":"Cazacu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0218tefania Cornelia","family":"Andrei","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina Maria","family":"Barbu","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4095-6846","authenticated-orcid":false,"given":"Mioara Desdemona","family":"Stepan","sequence":"additional","affiliation":[{"name":"Department of Infant Care, Pediatrics and Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e13535","DOI":"10.1111\/obr.13535","article-title":"Economic Burden of Childhood Overweight and Obesity: A Systematic Review and Meta-Analysis","volume":"24","author":"Ling","year":"2023","journal-title":"Obes. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Biazzi Leal, D., Altenburg de Assis, M.A., Hinnig, P.d.F., Schmitt, J., Soares Lobo, A., Bellisle, F., Di Pietro, P., Vieira, F., De Moura Araujo, P.H., and De Andrade, D. (2017). Changes in Dietary Patterns from Childhood to Adolescence and Associated Body Adiposity Status. Nutrients, 9.","DOI":"10.3390\/nu9101098"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S2213-8587(22)00047-X","article-title":"Obesity in Children and Adolescents: Epidemiology, Causes, Assessment, and Management","volume":"10","author":"Jebeile","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100164","DOI":"10.1016\/j.obpill.2025.100164","article-title":"Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Children with Obesity: An Obesity Medicine Association (OMA) and Expert Joint Perspective 2025","volume":"14","author":"Panganiban","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2553610","DOI":"10.1001\/jamanetworkopen.2025.53610","article-title":"Characteristics and Outcomes of Adults Hospitalized with Childhood-Onset Complex Chronic Conditions","volume":"9","author":"Malecki","year":"2026","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cura\u2013Esquivel, I., Perales-Quintana, M.M., Torres-Gonz\u00e1lez, L., Guzm\u00e1n-Avil\u00e1n, K., Mu\u00f1oz-Espinosa, L., and Cordero-P\u00e9rez, P. (2023). Metabolic, Inflammatory and Adipokine Differences on Overweight\/Obese Children with and without Metabolic Syndrome: A Cross-Sectional Study. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0281381"},{"key":"ref_7","first-page":"101717","article-title":"Pediatric MASLD in China: Epidemiology, Screening, Diagnosis, and Management","volume":"64","author":"Li","year":"2025","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e70132","DOI":"10.1002\/edm2.70132","article-title":"Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Mechanisms, Clinical Implications and Therapeutic Advances","volume":"8","author":"Miller","year":"2025","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Moreira, A.C., Mesquita, G., and Gomes, M.S. (2020). Ferritin: An Inflammatory Player Keeping Iron at the Core of Pathogen-Host Interactions. Microorganisms, 8.","DOI":"10.3390\/microorganisms8040589"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Fonseca, \u00d3., Ramos, A.S., Gomes, L.T.S., Gomes, M.S., and Moreira, A.C. (2023). New Perspectives on Circulating Ferritin: Its Role in Health and Disease. Molecules, 28.","DOI":"10.3390\/molecules28237707"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"319","DOI":"10.3390\/pathophysiology29020023","article-title":"Serum Ferritin in Metabolic Syndrome\u2014Mechanisms and Clinical Applications","volume":"29","author":"Srivastav","year":"2022","journal-title":"Pathophysiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.numecd.2018.11.008","article-title":"Ferritin Levels throughout Childhood and Metabolic Syndrome in Adolescent Stage","volume":"29","author":"Blanco","year":"2019","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Stepan, M.D., Vintilescu, \u0218.B., Ionele, C.M., Dumitra, G.G., Podeanu, M.A., Bigea, C.C., Sacerdo\u021bianu, V.M., Anastasescu, C.M., and Florescu, D.N. (2024). Associations of Ultrasound Findings with Serum Iron and Ferritin Levels in Children with Obesity. Life, 14.","DOI":"10.3390\/life14040484"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.15584\/ejcem.2023.1.1","article-title":"Role of Genetic Modification of the PNPLA3 Gene in Predicting Metabolically Unhealthy Obesity and Metabolic Associated Fatty Liver Disease in Children","volume":"21","author":"Abaturov","year":"2023","journal-title":"Eur. J. Clin. Exp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/hep.23946","article-title":"Patatin-Like Phospholipase Domain-Containing 3 and the Pathogenesis and Progression of Pediatric Nonalcoholic Fatty Liver Disease","volume":"52","author":"Browning","year":"2010","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/j.numecd.2020.05.012","article-title":"PNPLA3 Gene Polymorphism Is Associated with Liver Steatosis in Children with Down Syndrome","volume":"30","author":"Valentini","year":"2020","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_17","first-page":"74","article-title":"Clinical Significance of Serum IL-6 and TNF-\u03b1 Levels in Patients with Metabolic Syndrome","volume":"6","author":"Mohammadi","year":"2017","journal-title":"Rep. Biochem. Mol. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zong, X., Kelishadi, R., Kim, H.S., Schwandt, P., Matsha, T.E., Mill, J.G., Caserta, C.A., Medeiros, C.C.M., Kollias, A., and Whincup, P.H. (2024). A Proposed Simplified Definition of Metabolic Syndrome in Children and Adolescents: A Global Perspective. BMC Med., 22.","DOI":"10.1186\/s12916-024-03406-y"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s12020-023-03642-x","article-title":"Mechanisms and Risk Factors of Metabolic Syndrome in Children and Adolescents","volume":"84","author":"Codazzi","year":"2024","journal-title":"Endocrine"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Stepan, M.D., Vintilescu, \u0218.B., Strea\u021b\u0103, I., Podeanu, M.A., and Florescu, D.N. (2023). The Role of Vitamin D in Obese Children with Non-Alcoholic Fatty Liver Disease and Associated Metabolic Syndrome. Nutrients, 15.","DOI":"10.3390\/nu15092113"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Talebi Anaraki, K., Heidari-Beni, M., Arefian, M., and Kelishadi, R. (2025). Managing Pediatric Metabolic Syndrome: A Systematic Review of Current Approaches. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-05759-6"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"de Lamas, C., Kal\u00e9n, A., Anguita-Ruiz, A., P\u00e9rez-Ferreir\u00f3s, A., Pic\u00e1ns-Leis, R., Flores, K., Moreno, L.A., Bueno, G., Gil, \u00c1., and Gil-Campos, M. (2022). Progression of Metabolic Syndrome and Associated Cardiometabolic Risk Factors from Prepuberty to Puberty in Children: The PUBMEP Study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1082684"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Jia, S., Ye, X., Wu, T., Wang, Z., and Wu, J. (2025). Global Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in Children and Adolescents with Overweight and Obesity: A Systematic Review and Meta-Analysis. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-04314-y"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.cgh.2020.06.048","article-title":"Prevalence of Liver Steatosis and Fibrosis Detected by Transient Elastography in Adolescents in the 2017\u20132018 National Health and Nutrition Examination Survey","volume":"19","author":"Ciardullo","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.4103\/ijem.ijem_150_24","article-title":"Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Children with Overweight and Obesity by Transient Elastography","volume":"29","author":"Fajrudheen","year":"2025","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Jin, H.Y., Noh, E.S., Jeong, H., and Hwang, I.T. (2024). Prediction of Hepatic Fibrosis Using the Aspartate Transaminase-to-Platelet Ratio Index in Children and Adolescents with Metabolic Dysfunction-Associated Steatotic Liver Disease. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-05263-3"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"433","DOI":"10.15403\/jgld-506","article-title":"PNPLA3 I148M Polymorphism in Patients with Nonalcoholic Fatty Liver Disease, Obesity and Prediabetes","volume":"28","author":"Karamfilova","year":"2019","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Stasinou, E., Emmanouilidou-Fotoulaki, E., Kavga, M., Sotiriadou, F., Lambropoulos, A.F., Fotoulaki, M., and Papadopoulou-Legbelou, K. (2022). Association of Rs738409 Polymorphism in Adiponutrin Gene with Liver Steatosis and Atherosclerosis Risk Factors in Greek Children and Adolescents. Nutrients, 14.","DOI":"10.3390\/nu14173452"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tang, S., Zhang, J., Mei, T.T., Guo, H.Q., Wei, X.H., Zhang, W.Y., Liu, Y.L., Liang, S., Fan, Z.P., and Ma, L.X. (2020). Association of PNPLA3 Rs738409 G\/C Gene Polymorphism with Nonalcoholic Fatty Liver Disease in Children: A Meta-Analysis. BMC Med. Genet., 21.","DOI":"10.1186\/s12881-020-01098-8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1002\/hep.23832","article-title":"A Common Variant in the Patatin-Like Phospholipase 3 Gene (PNPLA3) Is Associated with Fatty Liver Disease in Obese Children and Adolescents","volume":"52","author":"Santoro","year":"2010","journal-title":"Hepatology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/hep.30625","article-title":"Relationship Between PNPLA3 Rs738409 Polymorphism and Decreased Kidney Function in Children With NAFLD","volume":"70","author":"Targher","year":"2019","journal-title":"Hepatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/liv.14251","article-title":"PNPLA3 Rs738409 Is Associated with Renal Glomerular and Tubular Injury in NAFLD Patients with Persistently Normal ALT Levels","volume":"40","author":"Sun","year":"2020","journal-title":"Liver Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.2337\/db10-0554","article-title":"Effects of PNPLA3 on Liver Fat and Metabolic Profile in Hispanic Children and Adolescents","volume":"59","author":"Goran","year":"2010","journal-title":"Diabetes"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/apt.13521","article-title":"I148M Variant of PNPLA3 Increases the Susceptibility to Non-Alcoholic Fatty Liver Disease Caused by Obesity and Metabolic Disorders","volume":"43","author":"Xia","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6969","DOI":"10.3748\/wjg.v19.i41.6969","article-title":"PNPLA3 I148M Polymorphism and Progressive Liver Disease","volume":"19","author":"Dongiovanni","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"501","DOI":"10.5223\/pghn.2019.22.6.501","article-title":"New Perspectives in Pediatric Nonalcoholic Fatty Liver Disease: Epidemiology, Genetics, Diagnosis, and Natural History","volume":"22","author":"Ko","year":"2019","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.cld.2017.08.002","article-title":"The Genetics of Pediatric Nonalcoholic Fatty Liver Disease (NAFLD)","volume":"22","author":"Goyal","year":"2017","journal-title":"Clin. Liver Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"252","DOI":"10.52547\/ibj.3647","article-title":"Update on Non-Alcoholic Fatty Liver Disease-Associated Single Nucleotide Polymorphisms and Their Involvement in Liver Steatosis, Inflammation, and Fibrosis: A Narrative Review","volume":"26","author":"Astarini","year":"2022","journal-title":"Iran. Biomed. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"41","DOI":"10.47162\/RJME.64.1.05","article-title":"Assessment of Tumoral and Peritumoral Inflammatory Reaction in Cutaneous Malignant Melanomas","volume":"64","author":"Bakri","year":"2023","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Podeanu, M.-A., Vintilescu, \u0218.B., Sandu, R.E., Ionele, C.M., Niculescu, C.E., Florescu, M.-M., \u0218elaru, E.-L., and Stepan, M.D. (2025). Ferritin as an Inflammatory Marker in Pediatric Metabolic Syndrome: Links to Obesity and Liver Ultrasound Alterations. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26083793"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Crasan, I.-M., Tanase, M., Delia, C.E., Gradisteanu-Pircalabioru, G., Cimpean, A., and Ionica, E. (2025). Metaflammation\u2019s Role in Systemic Dysfunction in Obesity: A Comprehensive Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110445"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Masenga, S.K., Kabwe, L.S., Chakulya, M., and Kirabo, A. (2023). Mechanisms of Oxidative Stress in Metabolic Syndrome. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24097898"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.atherosclerosis.2018.05.043","article-title":"Ferritin, Metabolic Syndrome and Its Components: A Systematic Review and Meta-Analysis","volume":"275","author":"Shi","year":"2018","journal-title":"Atherosclerosis"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Abril-Ulloa, V., Flores-Mateo, G., Sol\u00e0-Alberich, R., Manuel-y-Keenoy, B., and Arija, V. (2014). Ferritin Levels and Risk of Metabolic Syndrome: Meta-Analysis of Observational Studies. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-483"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zhang, H., Wang, L., Li, S., Liu, X., Li, Y., He, Y., Man, Q., and Yang, L. (2020). Association of Iron Storage Markers with Metabolic Syndrome and Its Components in Chinese Rural 6\u201312 Years Old Children: The 2010\u20132012 China National Nutrition and Health Survey. Nutrients, 12.","DOI":"10.3390\/nu12051486"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Podeanu, M.-A., Ionele, C.M., Sandu, R.E., Rogoveanu, I., Stepan, M.D., Niculescu, C.E., Cazacu, S.-M., and Vintilescu, \u0218.B. (2026). Obesity, Metabolic Syndrome and MASLD in Children: Inflammation as the Missing Link\u2014A Short Narrative Review. Life, 16.","DOI":"10.3390\/life16020310"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e23602","DOI":"10.1002\/jcla.23602","article-title":"Ferritin as a Key Risk Factor for Nonalcoholic Fatty Liver Disease in Children with Obesity","volume":"35","author":"Zhang","year":"2021","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3782","DOI":"10.3748\/wjg.v18.i29.3782","article-title":"Diagnostic and Therapeutic Implications of the Association between Ferritin Level and Severity of Nonalcoholic Fatty Liver Disease","volume":"18","author":"Valenti","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1159\/000295112","article-title":"Evaluation of the Overweight\/Obese Child\u2014Practical Tips for the Primary Health Care Provider: Recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity","volume":"3","author":"Baker","year":"2010","journal-title":"Obes. Facts"},{"key":"ref_51","unstructured":"MSD Manuals (2026, January 02). Professional Version. Blood Pressure Percentiles for Boys (2\u201317 Years). Available online: https:\/\/www.msdmanuals.com\/professional\/multimedia\/clinical-calculator\/blood-pressure-percentiles-for-boys-2-17-years."},{"key":"ref_52","unstructured":"MSD Manuals (2026, January 02). Professional Version. Blood Pressure Percentiles for Girls (2\u201317 Years). Available online: https:\/\/www.msdmanuals.com\/professional\/multimedia\/clinical-calculator\/blood-pressure-percentiles-for-girls-2-17-years."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Di Martino, M., Koryukova, K., Bezzi, M., and Catalano, C. (2017). Imaging Features of Non-Alcoholic Fatty Liver Disease in Children and Adolescents. Children, 4.","DOI":"10.3390\/children4080073"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Zeng, J., Zhang, X., Sun, C., Pan, Q., Lu, W.-Y., Chen, Q., Huang, L.-S., and Fan, J.-G. (2019). Feasibility Study and Reference Values of FibroScan 502 with M Probe in Healthy Preschool Children Aged 5 Years. BMC Pediatr., 19.","DOI":"10.1186\/s12887-019-1487-6"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00431-019-03561-y","article-title":"Utility and Accuracy of Transient Elastography in Determining Liver Fibrosis: A Case-Control Study","volume":"179","author":"Jain","year":"2020","journal-title":"Eur. J. Pediatr."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/7\/3044\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:48:18Z","timestamp":1775058498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/7\/3044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":55,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijms27073044"],"URL":"https:\/\/doi.org\/10.3390\/ijms27073044","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}