Venesection in iron overload and concurrent non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a condition where excess fat builds up in the liver, and it affects a large and growing proportion of the population — particularly those with obesity, diabetes, or metabolic syndrome. When iron also accumulates in the liver alongside the fat, the combination may accelerate liver damage. Venesection (therapeutic blood removal, like donating blood) is already used to reduce iron overload in conditions like haemochromatosis — but its potential role in treating NAFLD with concurrent iron overload has not been properly studied. This study will enrol patients with confirmed NAFLD and high liver iron on biopsy, and ask them to undergo venesection (blood removal) every four weeks for up to 10 months. A liver biopsy will be performed before and after to directly measure changes in both fat and iron content in the liver. You may be eligible if you are aged 18–70, have NAFLD confirmed by imaging or biopsy, have a serum ferritin above 600, and have iron overload confirmed on a liver biopsy. People who are anaemic, have hereditary haemochromatosis, drink excessively, have heart failure, or have advanced liver cirrhosis are not eligible. This is an important and practical study — venesection is a simple, low-cost therapy that, if proven effective, could help a large number of people with a condition for which effective treatments remain limited.