Elevated serum ferritin concentration is associated with incident type 2 diabetes mellitus in a Chinese population: A prospective cohort study

Grape Seed Proanthocyanidins Protect Pancreatic β Cells Against Ferroptosis via the Nrf2 Pathway in Type 2 Diabetes

Pancreatic β cell damage is the primary contributor to type 2 diabetes mellitus (T2DM); however, the underlying mechanism remains nebulous. This study explored the role of ferroptosis in pancreatic β cell damage and the protective effects of grape seed proanthocyanidin extract (GSPE). In T2DM model rats, the blood glucose, water intake, urine volume, HbA1c, and homeostasis model assessment-insulin resistance were significantly increased, while the body weight and the insulin level were significantly decreased, indicating the successful establishment of the T2DM model. MIN6 mouse insulinoma β cells were cultured in high glucose and sodium palmitate conditions to obtain a glycolipid damage model, which was administered with GSPE, ferrostatin-1 (Fer-1), or nuclear factor erythroid 2-related factor 2 (Nrf2) small interfering (si) RNA. GSPE and Fer-1 treatment significantly improved pancreatic β-cell dysfunction and protected against cell death. Both treatments increased the superoxide dismutase and glutathione activity, reduced the malondialdehyde and reactive oxygen species levels, and improved iron metabolism. Furthermore, the treatments reversed the expression of ferroptosis markers cysteine/glutamate transporter (XCT) and glutathione peroxidase 4 (GPX4) caused by glycolipid toxicity. GSPE treatments activated the expression of Nrf2 and related proteins. These effects were reversed when co-transfected with si-Nrf2. GSPE inhibits ferroptosis by activating the Nrf2 signaling pathway, thus reducing β-cell damage and dysfunction in T2DM. Therefore, GSPE is a potential treatment strategy against T2DM.

Prevalence and Characteristics of Metabolic Hyperferritinemia in a Population-Based Central-European Cohort

BACKGROUND

Hyperferritinemia (HF) is a common finding and can be considered as metabolic HF (MHF) in combination with metabolic diseases. The definition of MHF was heterogenous until a consensus statement was published recently. Our aim was to apply the definition of MHF to provide data on the prevalence and characteristics of MHF in a Central-European cohort.

METHODS

This study was a retrospective analysis of the Paracelsus 10,000 study, a population-based cohort study from the region of Salzburg, Austria. We included 8408 participants, aged 40-77. Participants with HF were divided into three categories according to their level of HF and evaluated for metabolic co-morbidities defined by the proposed criteria for MHF.

RESULTS

HF was present in 13% (n = 1111) with a clear male preponderance (n = 771, 69% of HF). Within the HF group, 81% (n = 901) of subjects fulfilled the metabolic criteria and were defined as MHF, of which 75% (n = 674) were characterized by a major criterion. In the remaining HF cohort, 52% (n = 227 of 437) of subjects were classified as MHF after application of the minor criteria.

CONCLUSION

HF is a common finding in the general middle-aged population and the majority of cases are classified as MHF. The new classification provides useful criteria for defining MHF.

Differential effect of interventions in patients with prediabetes stratified by a machine learning-based diabetes progression prediction model

AIM

To investigate whether stratifying participants with prediabetes according to their diabetes progression risks (PR) could affect their responses to interventions.

METHODS

We developed a machine learning-based model to predict the 1-year diabetes PR (ML-PR) with the least predictors. The model was developed and internally validated in participants with prediabetes in the Pinggu Study (a prospective population-based survey in suburban Beijing; n = 622). Patients from the Beijing Prediabetes Reversion Program cohort (a multicentre randomized control trial to evaluate the efficacy of lifestyle and/or pioglitazone on prediabetes reversion; n = 1936) were stratified to low-, medium- and high-risk groups using ML-PR. Different effect of four interventions within subgroups on prediabetes reversal and diabetes progression was assessed.

RESULTS

Using least predictors including fasting plasma glucose, 2-h postprandial glucose after 75 g glucose administration, glycated haemoglobin, high-density lipoprotein cholesterol and triglycerides, and the ML algorithm XGBoost, ML-PR successfully predicted the 1-year progression of participants with prediabetes in the Pinggu study [internal area under the curve of the receiver operating characteristic curve 0.80 (0.72-0.89)] and Beijing Prediabetes Reversion Program [external area under the curve of the receiver operating characteristic curve 0.80 (0.74-0.86)]. In the high-risk group pioglitazone plus intensive lifestyle therapy significantly reduced diabetes progression by about 50% at year l and the end of the trial in the high-risk group compared with conventional lifestyle therapy with placebo. In the medium- or low-risk group, intensified lifestyle therapy, pioglitazone or their combination did not show any benefit on diabetes progression and prediabetes reversion.

CONCLUSIONS

This study suggests personalized treatment for prediabetes according to their PR is necessary. ML-PR model with simple clinical variables may facilitate personal treatment strategies in participants with prediabetes.

Comprehensive analysis of macrosomia: exploring the association between first-trimester alanine aminotransferase and uric acid measurements in pregnant women

OBJECTIVES

Investigating the relationship between liver enzymes, uric acid (UA), and macrosomia will benefit physicians in the early detection of complications that may emerge during/after pregnancy. The study analyzed liver enzyme activity and UA levels in first-trimester pregnant for the risk of macrosomia.

METHODS

This retrospective cross-sectional research analyzed the data of pregnant women who gave birth between Jan 2021-2023. All data were extracted from medical records, and UA and AST-ALT were examined in all the participants.

RESULTS

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in the macrosomia (p<0.05). Similarly, UA levels were higher in the macrosomia (p<0.001). There was a moderate positive correlation between ALT and birth weight (r=0.168, p<0.01), while we found a strong positive correlation between UA and birth weight (r=0.355, p<0.01). In the ROC (receiver operating characteristic), Area Under the Curve (AUC) for ALT and UA was significant (p<0.0001) but not for AST (p=0.157). UA showed a predictive value for macrosomia with 68.1 % sensitivity and 63.8 % specificity at a 3.15 cut-off (AUC:0.689; p:0.0001; CI:0.644-0.725).

CONCLUSIONS

These results indicate that ALT and UA may be potentially important in determining the risk of macrosomia. The UA had a more potent marker for macrosomia than ALT. The occurrence of macrosomia might be more closely related to the mother's metabolic syndrome rather than NAFLD.

Exposure to multiple metals and diabetes mellitus risk in dong ethnicity in China: from the China multi-ethnic cohort study

Metals play an important role in the development of diabetes mellitus (DM). The association of metals with diabetes among the Dong ethnicity in China remains poorly understood. The current study aimed to evaluate the association of single metal exposure and multi-metal co-exposure with DM risk. Urinary concentrations of arsenic, cadmium, chromium, copper, iron, lead, manganese, mercury, molybdenum, nickel, strontium, vanadium, and zinc were measured using inductively coupled plasma-mass spectrometry (ICP-MS) among 4479 Dong ethnic participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC) study. Based on tertiles, the metal exposure can be divided into three groups: low, middle, and high exposure. Multivariate logistic regression models and principal component analysis were performed to determine exposure to single-metal and multi-metal co-exposure in relation to DM. A decrease in risk of DM was associated with iron (OR = 0.78, 95% CI: 0.61-1.00 and 0.68, 0.53-0.88 for the middle and high vs. low) and strontium (OR = 0.87, 95% CI: 0.69-1.12 and 0.67, 0.51-0.86 for the middle and high vs. low), respectively. A principal component 3 (PC3) characterized by iron and strontium showed an inverse association with DM. A principal component 4 (PC4) characterized by manganese and lead positively associated with DM. Exposure to high concentrations of urinary iron and strontium may reduce the risk of diabetes mellitus. This study revealed an increase in the risk of diabetes mellitus by co-exposure to high concentrations of urinary manganese and lead.

Whole-exome sequencing analysis of amniotic fluid cells in 5 pregnant women with thalassemia: Case report

RATIONALE

While thalassemia is a monogenic disease that is relatively common worldwide, there is no recognized radical cure for thalassemia in current medical practice. Prenatal diagnosis is the most important contribution to thalassemia prevention, but due to its technical limitations, rare thalassemia mutations cannot be detected; and the birth of thalassemic babies cannot be completely circumvented. Whole-exome sequencing can, however, compensate for this shortcoming.

PATIENT CONCERNS

We report the results of whole exon sequencing of amniotic cells in 5 pregnant women with thalassemia.

DIAGNOSIS

Prenatal diagnosis revealed that 4 of them were α thalassemia carriers and 1 of them was β thalassemia carrier.

INTERVENTIONS AND OUTCOMES

We collected amniotic fluid of 5 pregnant women (age range: 25-27 years, Mean ± SD: 28 ± 1.8) with thalassemia. The gestational ages ranged between 16 and 19 weeks. The cells were separated from the amniotic fluid and passaged until a sufficient number of cells were obtained for exome sequencing. We therefore employed whole-exome sequencing of amniotic fluid cells from thalassemic carriers to validate prenatal diagnostic results and to identify novel mutation sites. We found that 4 of 5 samples are SEA which is consistent with the clinical prenatal diagnosis. However, 2 of 5 samples were point mutations in the HBB gene, and were thus different from the clinical prenatal diagnosis.

CONCLUSION

The identifications from this study showed that prenatal diagnosis has limitations. Whole-exome sequencing can compensate for this shortcoming. And this study would add new insights into understanding of molecular mechanisms in thalassemia.

Hyperferritinemia Is a Predictor of Onset of Diabetes in Japanese Males Independently of Decreased Renal Function and Fatty Liver: A Fifteen-Year Follow-Up Study

Background

Type 2 diabetes is an important health concern worldwide. The disease etiology may depend on multiple environmental and genetic factors that cause insulin resistance, including dysregulation of iron storage. The goal of this study was to examine the relationship of the serum ferritin concentration with onset of diabetes over a long period.

Methods

Correlations of serum ferritin and metabolic markers with onset of diabetes mellitus were examined over 15 years in 150 males participating in a health screening program.

Results

HOMA-β showed a gradual significant decrease in the first 4 years in subjects with ferritin > 190 ng/mL (group H) compared to those with ferritin ≤ 190 ng/mL, but there was no difference in HOMA-R between these groups. A significant number of cases with onset of diabetes was observed over 15 years (hazard ratio (HR): 3.97), and obesity, fasting blood glucose level, hemoglobin A1c (HbA1c), HOMA-R, fasting immunoreactive insulin (IRI) and C-peptide immunoreactivity (CPR) were all significant in univariate comparison between non-diabetes and diabetes-onset groups. In multivariate analysis, ferritin in group H (HR: 3.25), fatty liver (HR: 3.38), estimated glomerular filtration rate (eGFR) < 70 mL/min/1.73 m² (HR: 3.48) and high-density lipoprotein (HDL) < 40 mg/dL (HR: 2.61) were significant predictive factors for onset of type 2 diabetes mellitus.

Conclusions

These results suggest that the serum ferritin level is an important index for priority intervention in preventive medicine for reduction of onset of diabetes.

Interactive effects of serum ferritin and high sensitivity C-reactive protein on diabetes in hypertensive patients

BACKGROUND

Hypertensive patients, often characterized by chronic inflammation, are susceptible to diabetes. Evidence suggests that the positive association between serum ferritin (SF) and diabetes was affected by high-sensitivity C-reactive protein (hs-CRP), an inflammation marker. We investigate whether there was an interaction between SF and hs-CRP on diabetes in hypertensive patients.

METHODS

We analysed data of 1,735 hypertensive people in this cross-sectional study. Diabetes was diagnosed when fasting blood glucose ≥ 7.0 mmol/L and/or a previous clinical diagnosis of diabetes. Logistic regression models were used to estimate the association of the SF and hs-CRP with diabetes. Multiplicative interaction was evaluated by incorporating a cross-product term for SF and hs-CRP to the logistic regression model. Additive interaction was assessed by calculating the relative excess risk of interaction (RERI) and attributed proportion due to interaction (AP).

RESULTS

In the adjusted analysis, SF (highest vs lowest tertile: odds ratio [OR], 1.61; 95 % confidence interval [CI], 1.20-2.16) was positively associated with diabetes. There was no multiplicative interaction between SF and hs-CRP, but evidence of additive interaction in regard to diabetes (RERI: 0.86; 95 % CI: 0.06-1.67). Compared to the patients with low SF (lower two thirds) and low hs-CRP (≤ 2 mg/L), those with high SF (upper one third) and high hs-CRP (> 2 mg/L) had increased OR for diabetes (adjusted OR: 2.33 [1.65-3.30]), with 37.0 % of the effects attributed to the additive interaction (AP: 0.37; 95 % CI: 0.09-0.65).

CONCLUSIONS

Within a cross-sectional study consisting of hypertensive patients, co-exposure to high SF and high hs-CRP was synergistically associated with diabetes. Dietary intervention or pharmacological treatment to lowering SF concentration may help to reduce diabetes morbidity in hypertensive patient with chronic inflammation.

Trace elements concentration in adipose tissue and the risk of incident type 2 diabetes in a prospective adult cohort

The aim of this work was to study the associations of adipose tissue trace element concentrations with type 2 diabetes (T2DM) incidence over a 16-year follow-up period in an adult cohort from Southern Spain. 16-year T2DM incidence was gathered from hospital records. Chemical analyses of Cr, V, Zn, Fe, Cu and Se in adipose tissue were performed using inductively coupled plasma mass spectrometry. Multivariable Cox-regression models were used. Complementary cross-sectional analyses with markers of glucose homeostasis at recruitment were performed by multivariable linear regression. Out of 214 participants, 39 developed T2DM during the follow-up. Adipose tissue concentrations of Fe (HR = 1.97, 95% CI: 0.99 to 2.58, p = 0.057), Cr (HR = 1.58, 95% CI: 1.07-2.33, p = 0.022) and Cu (HR = 1.61, 95% CI: 1.01-2.58, p = 0.046) were individually associated with T2DM incidence. When Fe, Cr and Cu were simultaneously entered in a model, only Cr was significantly associated with T2DM incidence (HR = 1.68, 95% CI: 1.02-2.76, p = 0.041). Furthermore, adipose tissue V (β = 0.283, p = 0.004) and Zn (β = 0.217, p = 0.028) concentrations were positively associated with β-pancreatic cell function (HOMA-β), while Se showed an inverse association (β = -0.049, p = 0.027). Although further research is warranted on the potential mechanisms of action, our results suggest that adipose tissue concentrations of certain trace elements (particularly Fe, Cr and Cu) are associated with the risk of incident T2DM, while V and Zn might have a protective effect. These biomarkers might complement prediction algorithms and contribute to identify patients with an increased risk of T2DM.

Increased serum ferritin is associated with oxidized low-density lipoprotein in prediabetes patients: A pilot study

Aims

This pilot study aimed to determine if increased serum ferritin (SF) is associated with cardiovascular risk factors in patients with prediabetes.

Methods

Eighteen patients with prediabetes and 36 subjects without prediabetes (control), non-white Hispanic, non-indigenous origin, Mexican mestizo descent were included. Participants had no inflammation, or vascular complications. SF and metabolic markers were evaluated in both groups.

Results

SF and oxidized low-density lipoprotein (oxLDL) were increased in prediabetes subjects. Moreover, in prediabetes and control groups as a whole, natural logarithm (ln)-SF correlated with oxLDL and ln-oxLDL/LDL after adjustment for sex, ln-age, ln-fasting plasma glucose (FPG), ln-body mass index, ln-triglyceride (TG), total cholesterol (TC), and high-density lipoproteins. Finally, ln-SF was an independent contributor to ln-oxLDL/LDL ratio in control and prediabetes subjects (β = 0.2915) after the introduction of potential confounders such as FPG, TC, TG, and hypertension.

Conclusions

The results of this study indicate that hyperferritinemia is associated with oxLDL, considered one of the main cardiovascular risk factors, which allows us to suggest that an increase in SF could contribute to the progression of prediabetes, prior to the appearance of diabetes. Further research is required to establish a causal relationship of iron disruption metabolism in oxLDL generation under prediabetes conditions.

Profiling plasma-extracellular vesicle proteins and microRNAs in diabetes onset in middle-aged male participants in the ELSA-Brasil study

We measured plasma-derived extracellular vesicle (EV) proteins and their microRNA (miRNA) cargos in normoglycemic (NG), glucose intolerant (GI), and newly diagnosed diabetes mellitus (DM) in middle-aged male participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). Mass spectrometry revealed decreased IGHG-1 and increased ITIH2 protein levels in the GI group compared with that in the NG group and higher serotransferrin in EVs in the DM group than in those in the NG and GI groups. The GI group also showed increased serum ferritin levels, as evaluated by biochemical analysis, compared with those in both groups. Seventeen miRNAs were differentially expressed (DEMiRs) in the plasma EVs of the three groups. DM patients showed upregulation of miR-141-3p and downregulation of miR-324-5p and -376c-3p compared with the NG and GI groups. The DM and GI groups showed increased miR-26b-5p expression compared with that in the NG group. The DM group showed decreased miR-374b-5p levels compared with those in the GI group and higher concentrations than those in the NG group. Thus, three EV proteins and five DEMiR cargos have potential prognostic importance for diabetic complications mainly associated with the immune function and iron status of GI and DM patients.

Association between Iron Status and Incident Type 2 Diabetes: A Population-Based Cohort Study

Type 2 diabetes poses a major public health challenge. Here, we conducted a cohort study with a large sample size to determine the association of baseline serum ferritin (SF), a marker of iron status, with incident type 2 diabetes in primary healthcare patients in Catalonia, a western Mediterranean region. A total of 206,115 patients aged 35–75 years without diabetes and with available baseline SF measurements were eligible. The variables analyzed included sociodemographic characteristics, anthropometry, lifestyle, morbidity and iron status (SF, serum iron and hemoglobin). Incident type 2 diabetes during follow-up (2006–2016) was ascertained using the International Classification of Diseases, 10th edition. Cox proportional-hazards models adjusted for multiple baseline confounders/mediators were used to estimate hazard ratios (HRs). Over a median follow-up of 8.4 years, 12,371 new cases of type 2 diabetes were diagnosed, representing an incidence rate of 7.5 cases/1000 persons/year. Since at baseline, the median SF concentration was higher in subjects who developed type 2 diabetes (107.0 µg/L vs. 60.3 µg/L; p < 0.001), SF was considered an independent risk predictor for type 2 diabetes; the multivariable-adjusted HRs for incident type 2 diabetes across SF quartiles 1–4 were 1.00 (reference), 0.95 (95% CI = 0.85–1.06), 1.18 (95% CI = 1.65–1.31) and 1.51 (95% CI = 1.36–1.65), respectively. Our study suggested that higher baseline SF was significantly associated with an increased risk of new-onset type 2 diabetes in Catalan primary healthcare users, supporting the relevance of monitoring iron stores in order to improve the diagnosis and management of diabetes in clinical practice.

Ferritin modifies the relationship between inflammation and arterial stiffness in hypertensive patients with different glucose tolerance

Background

Ferritin, a crucial element for iron homeostasis, is associated with chronic diseases characterized by subclinical inflammation such as essential arterial hypertension and type 2 diabetes mellitus (T2DM), showing a prognostic value in different clinical settings. We investigated whether ferritin is associated with arterial stiffness (AS), an early indicator of atherosclerosis, and if it could act as effect modifier on the relationship between inflammation and AS in hypertensive patients with different glucose tolerance.

Methods

We enrolled 462 newly diagnosed untreated hypertensive (HT) patients. All subjects underwent an oral glucose tolerance test. Insulin sensitivity was assessed by MATSUDA index and ferritin levels were estimated by immunoradiometric assay. AS was defined by carotid-femoral pulse wave velocity (PWV).

Results

Out of 462 patients, 271 showed normal glucose tolerance (HT/NGT), 146 impaired glucose tolerance (HT/IGT) and 45 were diabetic (HT/T2DM). Iron levels significantly decreased and transferrin and ferritin significantly increased from the first to the third group. PWV values were significantly higher in HT/IGT and HT/T2DM patients. PWV was related directly with ferritin, high sensitivity C reactive protein (hs-CRP), transferrin, and inversely with MATSUDA index. Ferritin resulted the strongest determinant of PWV explaining a 14.9% of its variation; moreover it was a strong modifier of the relationship between hs-CRP and PWV. The estimated augmentation in PWV portended by a fixed increase in hs-CRP, was higher across increasing values of ferritin.

Conclusion

Ferritin represents an independent risk factor of arterial stiffness in our study population and a strong effect modifier on the relationship between inflammation and PWV. However, further studies are needed to fully elucidate the potential role of this biomarker in human atherosclerosis.

Dietary patterns and cardiovascular disease risk among Chinese adults: a prospective cohort study

BACKGROUND AND OBJECTIVE

We aimed to examine the prospective association between dietary patterns and cardiovascular disease (CVD) risk in Chinese adults.

METHODS

Adults aged ≥20 years in the China Health and Nutrition Survey (open cohort) were followed between 1991 and 2011. Participants may enter the cohort at any wave. Dietary intakes were obtained from a 3-day, 24-h recall combined with household weighing for oil and condiments. CVD was defined as having either myocardial infarction or stroke. Two sets of dietary patterns were derived using reduced rank regression and factor analysis. Iron-related dietary pattern (IDP) was generated using iron intake as a response variable. Multivariable Cox regression was used to analyse the relation between dietary patterns and CVD risk.

RESULTS

In total, 13,055 adults were followed for a median of 9 years. During 115,368 person years of follow-up, 502 participants developed CVD. Two dietary patterns were derived and labeled as traditional dietary pattern (high intake of rice, pork, fish, poultry, and fresh vegetable but low intake of wheat) and modern dietary pattern (high intake of fruit, soymilk, and fast food). Across the quartiles of intake, the hazard ratio (95% CI) for CVD were 1.0, 0.84 (0.64-1.10), 0.57 (0.42-0.77), and 0.58 (0.42-0.79) for traditional pattern (p for trend <0.001) and 1.0, 1.56 (1.16-2.09), 1.56 (1.13-2.14), and 1.68 (1.16-2.44) (p for trend = 0.118) for modern pattern. IDP was characterised by high intake of fresh vegetable, wheat, legume, beverage, offal, rice, and whole grain. IDP intake was not associated CVD. Comparing extreme quartiles, high rice intake was associated with halved while wheat intake was associated with a doubled risk of CVD.

CONCLUSIONS

Traditional dietary pattern and rice intake are inversely but modern dietary pattern and wheat is directly associated with CVD risk. IDP is not related to CVD in Chinese adults.

Associations of iron markers with type 2 diabetes mellitus and metabolic syndrome: Results from the prospective SHIP study

AIMS

To assess the role of serum ferritin and transferrin with prevalent and incident type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) and whether these associations are independent of inflammatory markers and hepatic enzymes.

METHODS

We analyzed data from 3,232 participants aged 20-81 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 10.6 years. Logistic and Cox regression analyses were performed.

RESULTS

Serum ferritin concentrations were associated with a higher prevalence of T2DM (total population OR: 1.16 [95% CI: 1.07, 1.26]; men OR: 1.18 [95% CI: 1.08, 1.30) and MetS (total population OR: 1.27 [95% CI: 1.16, 1.38]; men OR: 1.26 [95% CI: 1.15, 1.38]) in the total population and men independently of inflammatory markers and hepatic enzymes. In longitudinal analyses, baseline ferritin concentrations were associated with a higher risk of incident T2DM in women (HR: 1.38 [95% CI: 1.10, 1.71]), but not in men or in the total population and also with a higher risk of incident MetS (HR: 1.09 [95% CI: 1.01, 1.17]) in the total population. These longitudinal associations attenuated considerably after adjustment for hepatic enzymes but not inflammatory markers. Transferrin was not associated with any of the outcomes.

CONCLUSIONS

Our results suggest a link between ferritin and T2DM and MetS, which might be partially explained by hepatic dysfunction.

Association of serum ferritin with metabolic syndrome in eight cities in China

Objective

This study aims to evaluate the cross‐sectional association of serum ferritin (SF) and the risk of metabolic syndrome (MetS) and its components among adults in eight cities in China.

Methods

Subjects were recruited using a combination of systematic cluster random sampling and purposive sampling in eight cities in China. The sociodemographic characteristics, data of lifestyle factors, self‐reported disease history, and 24‐hr dietary intake were obtained using a validated questionnaire. Anthropometry was performed, and fasting blood was collected to test the SF, fasting blood glucose (FBG), insulin, high‐sensitivity C‐reactive protein (hs‐CRP), triglycerides (TG), and cholesterols. Logistic and linear regression analyses were conducted to investigate the associations, adjusting for age, city level, smoking, drinking, weekly moderate‐to‐vigorous activity, dietary factors, hs‐CRP, and BMI.

Results

Serum ferritin level is positively correlated with total cholesterol, TG, FBG, HOMA‐IR, and hs‐CRP after adjusting for age and BMI. The odds ratio (OR) for MetS in the highest quartile of SF was 2.23 (1.32, 3.77) after adjusting for men, compared with the lowest quartile. An elevated ferritin concentration was significantly related to hypertriglyceridemia (p < .001) and elevated glucose (p = .013) among men, but not among women. Furthermore, compared with Q1, the OR for insulin resistance in the ferritin Q4 group was 3.08 (1.50, 6.32) among men and 1.96 (1.19, 3.24) among women.

Conclusion

A positive association between elevated SF and MetS and its components including hypertriglyceridemia and elevated glucose was found in multivariate analyses among men, and SF levels are independently associated with IR.

Association of Metabolic Syndrome and Hyperferritinemia in Patients at Cardiovascular Risk

AIM

To evaluate the association between parameters of hyperferritinemia (HF) and metabolic syndrome (MS) in patients at cardiovascular risk.

PATIENTS AND METHODS

This is a cross-sectional analytical observational study that included 269 patients who attended a cardiology unit. Biochemical and anthropometric parameters were evaluated to identify the presence of HF and MS. The presence of MS was evaluated according to NCEP ATP III. Biochemical parameters (glycemia, triglycerides, HDL-c) were assessed according to the manufacturer's protocols. Anthropometric measurements and blood pressure measurements were made by a trained professional. The chi-square (X ²) test, odds ratio, normality distribution (verified by the Kolmogorov-Smirnov test), and Levene's test were used to analyze the variables. To evaluate the effect of MS, HF, and the interaction between MS and HF, two-way analysis of variance (ANOVA) was performed based on the homogeneity of the variances, followed by Bonferroni's post hoc comparisons. Spearman correlation analysis was performed to evaluate the relationship between quantitative variables. A multiple linear regression model was used to analyze the effect of covariables. A logistic regression model was built to analyze the variables that contribute significantly to predict the outcome (HF) using the backward method.

RESULTS

Our results showed that 57% of men and 49.5% of women presented with MS; 44% of men and 11% of women presented with HF. The presence of MS and hypertriglyceridemia increase the probability of having HF by up to 2.1 and 1.88 times, respectively, while for male sex it is increased by 6.2 times. Patients with HF have higher values of C-reactive protein, ferritin, and transferrin saturation, regardless of the presence of MS. The linear regression analysis model indicated that the variables considered in this study explain less than 30% of the variation in ferritin and that the presence of MS in men is responsible for 22% of the variation in the probability of the occurrence of HF.

CONCLUSION

Our results show that hyperferritinemia is closely associated with the components of MS (positive correlation with glycemia, triglycerides levels, blood pressure, and waist circumference, and negative correlation with HDL-c values) in the studied population.

Influence of ferritin levels and inflammatory markers on HbA1c in the Type 2 Diabetes mellitus patients

Objective:

Diabetes Mellitus (DM) is a significant public health issue worldwide due to the associated comorbidities. Recent studies have demonstrated a strong relationship between blood glucose levels and serum ferritin levels in patients with type 2 DM. The aim of the study was to investigate the association between Ferritin Levels and Inflammatory Markers on HbA1c in the Type 2 Diabetes Mellitus Patients.

Methods:

This single-center, cross-sectional, controlled study included patients who were admitted to the Endocrine and Metabolic Disorders outpatient clinics of the Private Kütahya Hospital in the province of Kutahya in the Western Turkey. The study included a total of 172 patients, 84 of whom had type 2 DM and 88 without diabetes and constituted the control group. A total of 190 patients with DM were admitted to the Adult Endocrine and Metabolic Diseases Outpatient Clinics of the hospital between July 1, 2018 and September 1, 2018, and among these, the study was conducted on 172 volunteer patients who met the study inclusion criteria and who did not have any missing data. The HbA1c levels, serum ferritin, hemoglobin (Hb), insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), C-Reactive Protein (CRP), lipid profiles, and uric acid levels were compared between the groups.

Results:

The serum ferritin levels of the patients with type 2 DM significantly increased with increasing HbA1c levels (p<0.01). A strong positive correlation was found between serum ferritin levels and HbA1c and fasting blood glucose (FBG) levels (p<0.01).

Conclusions:

Our study results show a significant relationship between HbA1c levels and serum ferritin and CRP levels, suggesting that serum ferritin and CRP levels can be used as a routine screening tool for the early diagnosis of DM. However, further large-scale, prospective studies are needed to confirm these findings.

Different Effects of Iron Indices on Mortality in Patients With Autosomal Dominant Polycystic Kidney Disease After Long-Term Hemodialysis: A Nationwide Population-Based Study

OBJECTIVE

Iron supplementation and erythropoietin stimulating agents (ESAs) are essential for maintaining hemoglobin levels in hemodialysis patients. However, patients with autosomal-dominant polycystic kidney disease (PKD) have higher endogenous erythropoietin levels, so their recommended iron indices for hemodialysis patients may differ. This study evaluated iron profiles, including ferritin levels and transferrin saturation (TSAT) to identify factors affecting mortality in patients on dialysis, and those associated with mortality in patients with and without PKD.

DESIGN

This cohort study from the Taiwan Renal Registry Data System stratified mortality risk by the presence of PKD recorded as the underlying disease.

SUBJECTS

We enrolled 1346 hemodialysis patients with PKD and 82,873 hemodialysis patients without PKD.

MAIN OUTCOME MEASURE

The primary outcome was 3-year all-cause mortality. Predictors included time-averaged and baseline serum ferritin levels and TSAT. Multivariate Cox regression analysis adjusting for age, comorbidities, and relevant laboratory parameters was used to estimate the all-cause hazard ratios (HRs) for mortality.

RESULTS

The mean ages of patients with and without PKD were 56.2±13.2 and 61.7±13.5 years and the median follow-up time was 37 (15-76) months. The adjusted mortality risks for time-averaged ferritin levels >800 ng/mL (HR=1.52; 95% confidence interval: 1.40-1.65) or TSAT levels >50% (HR=1.46; 95% confidence interval: 1.30-1.65) were significantly higher among patients without PKD than those for patients with normal iron indices. However, a U-shaped curve of mortality against ferritin/TSAT levels was not observed in patients with PKD. In the sensitivity test, there was no difference among PKD patients who underwent regular ESA therapy and those who did not.

CONCLUSION

Iron indices have different effects on mortality among patients with and without PKD. Iron supplementation, recommended serum ferritin levels, or TSAT should be monitored in hemodialysis patients, especially those without PKD. Clinicians should consider treating anemia in hemodialysis patients individually, especially in PKD.

Serum ferritin levels are associated with insulin resistance in Chinese men and post-menopausal women: the Shanghai Changfeng study

Associations between ferritin and insulin sensitivity have been described in recent studies. The possible association showed conflicting results by sex and menopausal status. We aimed to investigate the cross-sectional association of ferritin levels with insulin resistance and β-cell function. A total of 2518 participants (1033 men, 235 pre-menopausal women and 1250 post-menopausal women) were enrolled from the Changfeng Study. A standard interview was conducted, as well as anthropometric measurements and laboratory analyses, for each participant. The serum ferritin level was measured using electrochemiluminescence immunoassay. Insulin resistance and β-cell function indices were derived from a homeostasis model assessment. The results showed that the serum ferritin levels were 250·4 (sd 165·2), 94·6 (sd 82·0) and 179·8 (sd 126·6) ng/ml in the men, pre-menopausal and post-menopausal women, respectively. In fully adjusted models (adjusting for age, current smoking, BMI, waist:hip ratio, systolic blood pressure, diastolic blood pressure, TAG, HDL-cholesterol, LDL-cholesterol, log urine albumin:creatinine ratio, leucocytes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase), serum ferritin concentrations are significantly associated with insulin resistance in men and post-menopausal females, and the null association was observed in pre-menopausal females. Interestingly, an increased β-cell function associated with higher ferritin was observed in post-menopausal participants, but not in male participants. In conclusion, these results suggested that elevated serum ferritin levels were associated with surrogate measures of insulin resistance among the middle-aged and elderly male and post-menopausal women, but not in pre-menopausal women.