TNF and metabolic dysfunction-associated steatotic liver disease: Ferritin-related bacterial families are strongly correlated with liver iron-related genes, and such iron metabolism-related microbiome characteristics may be correlated with liver fat accumulation through liver glucose metabolism.32 Serum ferritin elevation in NAFLD patients is mainly related to chronic liver inflammation, β-cell dysfunction, and insulin resistance.33 Kim et al13 found that serum ferritin could generate hydroxyl-free radicals through an iron-catalyzed peroxide reaction, thus increasing tumor necrosis factor and enhancing oxidative stress.