We examined the relationships among serum ferritin, alanine aminotransferase (ALT) levels, and cardiovascular risk factors of metabolic syndrome in Korean postmenopausal women. We conducted a cross-sectional study of 959 postmenopausal women without an apparent cause of liver disease. Metabolic syndrome was defined as the presence of at least 3 of the following: elevated blood pressure, low high-density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Serum ferritin and ALT levels were found to be correlated (r = 0.374, P <.001) and to be associated with the components of metabolic syndrome. Subjects with metabolic syndrome showed significantly higher serum ferritin (74.7 +/- 2.0 vs 59.6 +/- 2.0 ng/mL, P <.001) and ALT levels (21.3 +/- 1.6 vs 18.7 +/- 1.5 IU/L, P <.001). Moreover, the greater the number of metabolic syndrome components present, the higher were the serum ferritin and ALT levels (P <.001). Multiple regression analysis showed that serum ALT levels are significantly associated with serum ferritin levels, waist circumference, fasting blood glucose, age, and white blood cell count (adjusted R-2 = 0.147). Elevated iron stores were positively associated with serum ALT levels and metabolic syndrome in Korean postmenopausal women. (c) 2005 Elsevier Inc. All rights reserved.