PFLPhysiological Fitness Landscape

Biomarkers · Inflammation

Serum Ferritin

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 9% higher risk of death. We found the same pattern in NHANES

Serum Ferritin and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.09×95% CI 1.04–1.15 · 19,200 adults, 2,567 deaths
Published risk of death1.50×ferritin >=600 vs <200 ug/L (95% CI 1.20–1.80) · Copenhagen City Heart Study, Danish general population
Value of the measurement+0.008gain in concordance within age bands; rank 45 of 56 · all tests

Serum Ferritin by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table
Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (ug/L), from the survey named in the row. Not a reference range or a target.
SexAge5th25thMedian75th95thnCycle / source
All20-3911.038.187.31663731,439NHANES 2017-2018
All40-5914.664.01182154391,571NHANES 2017-2018
All60+23.763.61141954781,914NHANES 2017-2018
Allall15.152.21061914154,924NHANES 2017-2018
Men20-3939.7103160232457691NHANES 2017-2018
Men40-5944.9112184293527736NHANES 2017-2018
Men60+23.074.0143246591969NHANES 2017-2018
Menall35.296.61612675252,396NHANES 2017-2018
Women20-397.9322.242.472.4139748NHANES 2017-2018
Women40-5910.337.474.1129287835NHANES 2017-2018
Women60+24.453.595.7158384945NHANES 2017-2018
Womenall10.933.968.61202772,528NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in Serum Ferritin, study by study

3 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
TypeInterventionReported effectEvidenceSource
behavioralTherapeutic phlebotomy / Blood donation in iron overload statesWeekly phlebotomy lowered ferritin from median 504 ng/mL to <100 ng/mL after a median 7.5 phlebotomies (66.5 days)RCTInfanti L, et al. Blood donation for iron removal in individuals with HFE…
clinicalTherapeutic phlebotomy / venesection (RCT in NAFLD)Phlebotomy lowered ferritin by 148 ng/mL over 6 months vs 38 ng/mL in controls (P < 0.001)RCTAdams LA, et al. The impact of phlebotomy in nonalcoholic fatty liver disease…
dietDietary restriction of heme iron and red meat intakeRed meat >=7 vs <=4 servings/wk associated with higher odds of high iron stores (OR 3.61; 95% CI 1.57, 8.27); observationalcross-sectionalFleming DJ, et al. Am J Clin Nutr. 2002;76:1375-1384.
dietIndividual dietary counselling to eat more flesh foods/heme iron and vitamin C, cook in cast iron, and cut phytate and calcium intake, for 16 weeks in young women with non-anaemic iron deficiencySerum ferritin 26% higher than placebo after 16 weeks of dietary change (P=0.068), vs +59% with 50 mg/day iron amino-acid chelateRCTHeath AL, Skeaff CM, O'Brien SM, et al. Can dietary treatment of non-anemic…
nutraceuticalOral iron supplementation (athletes; greatest effect from iron-deficient baseline)Increased serum ferritin vs control (SMD 1.27, 95% CI 0.44-2.10); effect evident when baseline ferritin ≤ 12 µg/lmeta-analysisŠmid AN, et al. Effects of Oral Iron Supplementation on Blood Iron Status in…
pharmacologicLuspatercept 1.00-1.25 mg/kg for at least 48 weeks plus best supportive care in adults with transfusion-dependent beta-thalassaemia (BELIEVE)Least-squares mean serum ferritin 348 ug/L lower than placebo at week 48 (95% CI 179-517) through reduced transfusion burdenRCTCappellini MD, Viprakasit V, Taher AT, et al. A Phase 3 Trial of Luspatercept…

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
TypeCondition or exposureReported effectEvidenceSource
clinicalGenetic Hemochromatosis (HFE C282Y mutation homozygosity)Most C282Y homozygotes have elevated serum ferritin; male homozygotes with ferritin of 1000 ug/L or more reported more fatigue and liver diseaseprospective cohortAllen KJ, et al. Iron-overload-related disease in HFE hereditary…
nutraceuticalChronic iron supplementation (30 mg/day or more) in older adultsSupplemental iron of 30 mg/d or more associated with higher risk of high iron stores (serum ferritin >300 ug/L men, >200 ug/L women) vs nonusers (OR 4.32) in adults aged 68-93cross-sectionalFleming DJ, et al. Am J Clin Nutr. 2002;76:1375-1384.

What else moves this marker

They describe those study groups, not an individual, and an association is not a cause.

Diseases and conditions

Each row is one study: what it compared and the change it reported in this marker.
WhatEffect on the markerComparison · populationSource
↑ Polycystic ovary syndrome · Serum ferritin in women with PCOS vs healthy womenSMD +1.05 (95% CI 0.25 to 1.86)PCOS vs healthy controls · 21 cross-sectional/case-control studies; 2,173 women with PCOS and 1,897 healthy women (all elements)meta analysis · PMID 33042025

Sources

Map Serum Ferritin against another biomarker.

Related markers: Alpha-1-Antichymotrypsin (AACT) · Alpha-1-Antitrypsin (AAT) · Antinuclear Antibodies (ANA) · CD4:CD8 T-Cell Ratio · CD8+ T-Cell Count · Erythrocyte Sedimentation Rate (ESR) · Fibrinogen · Growth Differentiation Factor-15 (GDF-15)

Map Serum Ferritin against another marker