High ferritin and low transferrin saturation are associated with pre-diabetes among a national representative sample of U.S. adults

Summary Background & aims Iron overload is known to cause diabetes. However, the underlying mechanism is poorly understood. We therefore studied the association of different markers of iron metabolism, namely ferritin, erythrocyte protoporphyrin and transferrin saturation (TSAT, as defined by a...

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Published in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-12, Vol.32 (6), p.1055-1060
Main Authors: Cheung, Ching-Lung, Cheung, Tommy T, Lam, Karen S.L, Cheung, Bernard M.Y
Format: Article
Language:English
Subjects:
Adult
adults
alanine transaminase
albumins
anemia
aspartate transaminase
Biological and medical sciences
Biomarkers - blood
blood glucose
Blood Glucose - metabolism
Cholesterol - blood
diabetes
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
erythrocytes
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Fasting
Feeding. Feeding behavior
Female
Ferritin
Ferritins - blood
Fundamental and applied biological sciences. Psychology
Gastroenterology and Hepatology
glucose
Glycated Hemoglobin A - metabolism
glycosylation
hemoglobin
high density lipoprotein cholesterol
homeostasis
Humans
Inflammation
insulin
Insulin - blood
Insulin Resistance
Iron
iron overload
Iron, Dietary - administration & dosage
Iron, Dietary - blood
kidney diseases
liver
Logistic Models
Male
Medical sciences
metabolism
Middle Aged
National Health and Nutrition Examination Survey
nutrient deficiencies
Nutrition Surveys
pathophysiology
physical activity
Pre-diabetes
Prediabetic State - blood
Prediabetic State - diagnosis
Prediabetic State - epidemiology
protoporphyrin
Protoporphyrins - blood
regression analysis
risk
sociodemographic characteristics
transferrin
Transferrin - metabolism
Transferrin saturation
triacylglycerols
Triglycerides - blood
United States - epidemiology
Vertebrates: anatomy and physiology, studies on body, several organs or systems
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Summary:Summary Background & aims Iron overload is known to cause diabetes. However, the underlying mechanism is poorly understood. We therefore studied the association of different markers of iron metabolism, namely ferritin, erythrocyte protoporphyrin and transferrin saturation (TSAT, as defined by a percentage of transferrin that is saturated with iron) with pre-diabetes (preDM) in US adults without chronic kidney disease, anemia, and iron deficiency. Methods Data on 2575 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2002 who were free of diabetes, chronic kidney disease, iron deficiency, and anemia were analyzed. Data on 3876 participants of the NHANES III (1988–1994) were used as replication. Homeostasis model assessment of insulin resistance (HOMA-IR), blood glycosylated hemoglobin level (HbA1C), fasting glucose, insulin, and preDM (defined as a fasting plasma glucose 100–125 mg/dl or an HBA1C value 5.7–6.4%) were measured as the outcomes. Results Logistic regression analyses indicated independent associations of high ferritin ( Ptrend  = 0.028) and low TSAT ( Ptrend  = 0.029) with preDM after adjusting for sociodemographics, physical activity (active/sedementary), metabolic and inflammatory markers (triglycerides, total cholesterol, HDL cholesterol, mean arterial pressure, CRP, white cell count, and albumin), and liver enzymes (GGT, Alk phos, AST, and ALT). The NHANES III data showed similar associations. Combining the results showed a more significant association for high ferritin ( Pmeta  = 0.016) and low TSAT ( Pmeta  = 0.002). Moreover, TSAT was associated with HbA1C, fasting glucose, insulin, and HOMA-IR ( Pmeta  ≤ 0.001). Conclusions Higher ferritin and lower TSAT are associated with higher risk of preDM in a general population without confounding diseases. Further research is needed to examine the underlying mechanism of these two indices, especially TSAT, in the pathophysiology of preDM.
ISSN:0261-5614
1532-1983
DOI:10.1016/j.clnu.2012.11.024