Background: We sought to determine the association of dysmetabolic iron overload syndrome (DIOS)
with metabolic syndrome (MetS).
Methods: Several studies have shown that DIOS is associated with Mets, mainly through the pathogenesis of its
components: type 2 diabetes mellitus (T2DM), essential hypertension, non-alcoholic fatty liver disease (NAFLD)
and polycystic ovary syndrome (POS).
Results: Serum ferritin levels increase proportionally according to the degree of insulin resistance (IR) and the
number of components of Mets. Moreover, DIOS predicts the onset of T2DM and NAFLD. Dysregulation of iron
metabolism in DIOS is due to a multifactorial and dynamic process triggered by an unhealthy diet, facilitated by
environmental and genetic cofactors, and resulting in a bidirectional relation between the liver and visceral adipose
tissue (VAT). Iron removal combined with a healthy diet improved both insulin sensitivity and beta-cell function,
but had no significant effect on blood glucose; however, phlebotomy therapy might be considered with
Conclusion: Iron overload is closely associated with metabolic syndrome and its components; however, it remains
under-appreciated in everyday clinical practice. Diet and lifestyle modification offer some clinical benefit;
however, it is not adequate for successful management of the disease. The results of phlebotomy remain controversial,
underlying the necessity of further efforts in this field.