JAMA. 2004 Feb 11;291(6):711-7. Related Articles, Links
Body iron stores in relation to risk of type 2 diabetes in apparently healthy women.
Jiang R, Manson JE, Meigs JB, Ma J, Rifai N, Hu FB.
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
[email hidden]
CONTEXT: Type 2 diabetes is a common manifestation of hemochromatosis, a disease of iron overload.
However, it is not clear whether higher iron stores predict the development of type 2 diabetes in a
healthy population. OBJECTIVE: To examine plasma ferritin concentration and the ratio of the
concentrations of transferrin receptors to ferritin in relation to risk of type 2 diabetes. DESIGN,
SETTING, AND PARTICIPANTS: Prospective nested case-control study within the Nurses' Health Study
cohort. Of the 32 826 women who provided blood samples during 1989-1990 and were free of diagnosed
diabetes, cardiovascular disease, and cancer, 698 developed diabetes during 10 years of follow-up.
The controls (n = 716) were matched to cases on age, race, and fasting status; and on body mass
index (BMI) for cases in the top BMI decile. MAIN OUTCOME MEASURE: Incident cases of type 2
diabetes. RESULTS: Among cases, the mean (SD) concentration of ferritin was significantly higher
(109 [105] vs 71.5 [68.7] ng/mL for controls; P<.001 for difference) and the mean (SD) ratio of
transferrin receptors to ferritin was significantly lower (102 [205] vs 141
[340], respectively; P =.01). In conditional logistic regression stratified on the matching factors
and controlled for BMI and other diabetes risk factors, the multivariate relative risks [RRs]
of incident type 2 diabetes across increasing quintiles of ferritin were 1.00, 1.09 (95%
confidence interval [CI], .70-1.70), 1.26 (95% CI, 0.82-1.95), 1.30 (95% CI, 0.83-2.04), and
2.68 (95% CI, 1.75-4.11) (P<.001 for trend). The RRs across increasing quintiles of transferrin
receptors to ferritin ratio were 2.44 (95% CI, 1.61-3.71), 1.00 (95% CI, 0.64-1.56), 1.13 (95%
CI, 0.73-1.74), 0.99 (95% CI, 0.64-1.53), and
340.1 (A=.01 for trend). Further adjustment for an inflammatory marker (C-reactive protein) did not
change the results appreciably. The associations persisted within strata defined by levels
of BMI, menopausal status, alcohol consumption, and C-reactive protein. CONCLUSION: Higher
iron stores (reflected by an elevated ferritin concentration and a lower ratio of
transferrin receptors to ferritin) are associated with an increased risk of type 2 diabetes
in healthy women independent of known diabetes risk factors.
PMID: 14871914 [PubMed - in process]
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