Serum Ferratin Concentrations Predict Incidence of Type 2 Diabetes

by | Dec 15, 2020 | 2020, Diabetes, Iron, Minerals

Written by Angeline A. De Leon, Staff Writer. Italian study participants with higher levels of serum ferritin (SF) at baseline had an increased risk of developing type 2 diabetes.

diabetesAccording to recent estimates, the prevalence of type 2 diabetes among adults is projected to reach over 7% worldwide by 2030 1. Although risk of diabetes has typically been attributed to broad sociodemographic and lifestyle factors such as smoking 2, a less known predictor of diabetes appears to be iron overload, with newer studies reporting an association between incident diabetes and iron-related biomarkers 3,4. Serum ferratin (SF, indicator of iron stores in the body) specifically has been linked to type 2 diabetes 5. Although the pathophysiology underlying the relationship between SF and diabetes is still under study, researchers hypothesize that the pro-oxidative property of iron may be involved in the activation of stress pathways which can disturb the insulin signaling process 6. Among individuals with genetic factors affecting their risk of iron overload (mutations of hemochromatosis-associated genes leading to iron buildup in the body) 7, the prevalence of type 2 diabetes may be especially elevated. Given the scarcity of epidemiological data on the association between iron status and type 2 diabetes in Mediterranean regions which follow distinct dietary and lifestyle habits 8, a recent study 9 published in Nutrients (2020) conducted a large-scale population study to examine the relationship between SF levels and incidence of type 2 diabetes among healthcare patients in Catalonia.

A longitudinal cohort study was conducted with a total of 206,115 individuals (mean age = 50.9 years) who were clinically free of type 2 diabetes at the time of enrollment and who had registered SF values with the Information System for Research in Primary Care database. Eligible subjects also provided information regarding sociodemographic characteristics and clinical and lifestyle factors (anthropometric measures, smoking status, alcohol use, etc.) at baseline. Incident cases of type 2 diabetes were ascertained over a median follow-up period of 8.4 years using the International Classification of Diseases, 10th Edition. Hazard Ratios (HRs) were then computed for incident type 2 diabetes based on SF quartiles (the lowest quartile used as reference).

Over the course of the follow-up period, a total of 12,371 incident cases of type 2 diabetes were identified. Relative to non-diabetic individuals, those who developed type 2 diabetes had higher SF concentrations at baseline (107.0 μg/L vs. 60.3 μg/L, respectively) and were also older, had a higher body mass index (BMI), and were more likely to present with obesity, hypertension, dyslipidemia and/or other comorbidities (p < 0.001 for all). After adjusting for confounding variables, regression analyses showed a relationship between increasing SF quartiles and elevated risk of type 2 diabetes: relative to reference Quartile 1, HR for Quartile 2 = 0.95 (95% Confidence Interval: 0.85 to 1.06); HR for Quartile 3 = 1.18 (95% CI: 1.65 to 1.31); and HR for Quartile 4 = 1.51 (95% CI: 1.36 to 1.65) (all Ptrend < 0.001). In this adjusted model, each one standard deviation increase in log-transformed SF concentration was also associated with a 26% increase in risk of type 2 diabetes (HR = 1.26, 95% CI: 1.21 to 1.32).

Results from this large-scale study validate the hypothesized relationship between higher iron status, based on SF levels, and increased risk of type 2 diabetes among Europeans. Although other demographic and clinical factors at baseline were significantly linked to the onset of diabetes (age, BMI, existing comorbidities), SF concentration was found to be a key independent predictor of type 2 diabetes. A robust graded relationship was observed between SF concentrations and incident type 2 diabetes such that increasing levels of SF were associated with higher risk of diabetes. Thus, based on study results, one potential strategy for improving management and diagnosis of diabetes may involve monitoring iron statuses of patients, perhaps even implementing dietary changes and/or introducing iron supplementation. One limitation of the present study relates to the measurement of SF at only one timepoint. Future studies will need to examine how changing levels of SF concentrations relates to diabetes management over time.

Source: Diaz-Lopez A, Iglesias-Vazquez L, Palleja-Millan M, et al. Association between iron status and incident type 2 diabetes: a population-based cohort study. Nutrients. 2020; 12: 3249. DOI: 10.3390/nu12113249.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

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Posted December 15, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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