Serum ferritin in healthy subjects and type 2 diabetic patients

Factors Impacting Outcome and Prognosis of Invasive Fungal Sinusitis: How Vital is Iron Metabolism?

Iron is an important micronutrient involved in cell biology through vital reactions. We examined the correlations between iron metabolism parameters and the course of invasive fungal sinusitis. Patients with invasive fungal sinusitis were enrolled. Serum iron and ferritin levels, total iron-binding capacity, and transferrin saturation were measured at the initiation of treatment. Patients were followed for 6 months, and the clinical course was categorised as improvement or worsening/death. A total of 35 patients were enrolled. The average ferritin levels in mucormycosis patients was 944.9 ng/ml, versus 110.7 ng/ml for aspergillosis patients. Iron levels were significantly lower in mucormycosis than in aspergillosis (29.14 µg/dl vs. 68.55 µg/dl). Total iron-binding capacity was significantly different between the two groups (16.76 µg/dl vs. 330.36 µg/dl). After 6 months, improvement, worsening, and death were noted for 18, 8, and 9 patients, respectively. Higher iron levels and lower ferritin levels were linked with improvement. Total iron-binding capacity was significantly higher in improved patients (2314 vs. 151). Iron metabolism parameters play significant roles in the preemptive judgment of the course of fungal sinusitis. Based on these findings, studies on drugs affecting iron metabolism should be conducted.

Serum ferritin level in type 2 diabetic patients with renal dysfunction

Background and objective: Nephropathy is the major cause of end-stage renal disease (ESRD) in type 2 diabetes mellitus (T2DM). Delay in identification and management of nephropathy in T2DM may cause development of ESRD. An increased level of serum ferritin plays a role in the pathogenesis of chronic kidney disease (CKD) in T2DM. Hence, the present study intended to assess the level of serum ferritin in renal dysfunction in patients with T2DM. Material and methods: This was a retrospective study with 81 T2DM patients with and without nephropathy. They were categorized into two groups. Group-1 consisted of 46 T2DM cases without nephropathy and remaining 35 with nephropathy.The clinical and biochemical parameters such as blood glucose, urea, creatinine, iron, ferritin, transferrin, total iron binding capacity (TIBC), and haemoglobin were measured by standard methods, and estimated glomerular filtration rate (eGFR) by MDRD formula. Results: Significantly (p<0.05) elevated level of serum ferritin along with urea and creatinine was found in patients with T2DM with nephropathy.A significant positive correlation (r = 0.37) of serum ferritin and negative correlation (r = - 0.852) of eGFR with creatinine were found. It indicated that ferritin could be a good marker to monitor kidney function in T2DM. Conclusion: Apart from eGFR and serum creatinine, raised serum ferritin level was a good indicator of renal dysfunction in T2DM patients and might play an important role in renal dysfunction in early stage diabetic nephropathy. IMC J Med Sci 2022; 16(2): 008. DOI: https://doi.org/10.55010/imcjms.16.018 *Correspondence: Dr. Siva Prasad Palem., M.Sc., Ph.D., Department of Biochemistry, Faculty of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India. Affiliated with Kaloji Narayana Rao University of Health Sciences (KNRUHS), Warangal, Telangana, India. E-mail: sp.biocom@yahoo.co.in.

Trace element status in type 2 diabetes: A meta-analysis

Introduction

Type 2 diabetes is a chronic metabolic disorder that has been associated with alterations in the status of trace elements, including zinc, copper, iron and manganese. However, clinical studies reporting statuses of these trace elements in type 2 diabetes patients compared to controls have shown conflicting results.

Objective

This meta-analysis aimed to summarize the existing literature on the statuses of zinc, copper, iron, and manganese in Type 2 diabetes mellitus patients.

Methods

A literature search of Embase, PubMed, EBSCOHost, ScienceDirect, Scopus, Cochrane library and Web of Science electronic databases was conducted to find studies published from 1970 to November 2016 that compared the trace elements of interest between type 2 diabetic patients and healthy controls. Keywords used were type 2 diabetes, diabetes, hyperglycemia, insulin, glucose, HbA1c, trace elements, micronutrients, zinc, manganese, copper, ceruloplasmin, iron and ferritin. The bias corrected Hedges' g, was utilized as the effect sizes. Due to the biological interaction between trace elements, it is important to collectively evaluate the statuses of these minerals in type 2 diabetes. Thus, the robust variance estimation method was chosen to handle dependency between multiple outcomes.

Results

A total of 52 studies met the inclusion criteria, amounting to 98 effect sizes. Diabetic patients (n=20183) had significantly lower zinc status when compared to controls (effect size = -1.73, p<0.01); whereas copper (effect size = 1.10, p<0.05) and ferritin levels (effect size = 1.05, p<0.01) were significantly higher. Although not significant, ceruloplasmin (effect size = 1.85, p=0.06) and iron (effect size = 1.42, p=0.06) levels were higher, and manganese (effect size = 0.27, p=0.34) was lower in patients.

Conclusion

Results from this meta-analysis indicate lower zinc status accompanied by increased copper and ferritin levels in patients with type 2 diabetes when compared to controls.

Associations of dietary, lifestyle, and sociodemographic factors with iron status in Chinese adults: a cross-sectional study in the China Health and Nutrition Survey

BACKGROUND

Although a high prevalence of anemia and related disease burden have been documented in China, limited evidence is available on the current population-level iron status and risk factors for iron imbalance.

OBJECTIVE

We explored the associations of dietary, lifestyle, and sociodemographic factors with iron status in Chinese adults.

DESIGN

Our study population consisted of 7672 adults aged 18-65 y from the 2009 China Health and Nutrition Survey. Diet was assessed with the use of 3 consecutive 24-h dietary recalls. Serum ferritin, serum transferrin receptor, and hemoglobin concentrations were measured.

RESULTS

The geometric means ± SDs for ferritin concentrations were 135.9 ± 2.7 ng/mL in men and 42.7 ± 3.1 ng/mL in women. After adjustment for potential risk factors, including high-sensitivity C-reactive protein concentration, the association between age and ferritin concentration was inverse in men (P-trend < 0.001) and positive in women (P-trend < 0.001). We observed a positive association between body mass index (in kg/m²) and ferritin concentration in both men and women (both P-trends < 0.001). Dietary phytate intake was inversely associated with ferritin concentration in men (P-trend = 0.002) but not in women. Red meat consumption was positively associated with ferritin concentration both in men (P-trend = 0.002) and in older women (P-trend = 0.009). Lower intakes of grains and higher intakes of pork and poultry were associated with higher ferritin concentrations (all P-trends ≤ 0.05) in men but not in women. We observed variations in ferritin concentrations across different geographic regions (both P ≤ 0.01).

CONCLUSIONS

Serum ferritin concentrations varied across different sociodemographic, lifestyle, and dietary factors in this Chinese population. A higher intake of red meat was associated with higher ferritin concentrations in men and older women.

Iron Profile and Glycaemic Control in Patients with Type 2 Diabetes Mellitus

Iron overload is increasingly being connected to insulin resistance in Type 2 Diabetes Mellitus (T2DM) patients. Free iron causes the assembly of reactive oxygen species that invariably steer the body’s homeostasis towards oxidative stress-mediated diabetic complications. This study aims to assess the serum iron, total iron binding capacity (TIBC), and percentage transferrin saturation (Tsat) of 150 subjects divided into three groups (I,II,III) of 50. Healthy individuals (controls) constituted Group I. Group II consisted of T2DM patients with optimal glycaemic control. T2DM patients with suboptimal glycaemic control formed group III. Mean serum free iron concentration was 105.34 ± 3.5, 107.33 ± 3.45, and 125.58 ± 3.45 μg/dL in Group I, Group II, and Group III, respectively. Mean serum TIBC concentration in Group I, Group II, and Group III was 311.39 ± 5.47, 309.63 ± 6.1, and 284.2 ± 3.18μg/dL, respectively. Mean serum transferrin saturation (%) in Group I, Group II, and Group III was 34.17 ± 1.21, 35.02 ± 1.2, and 44.39 ± 1.07, respectively. The difference between TIBC, mean serum free iron concentration, and transferrin saturation between Group I and Group III (for all, p values <0.001), as well as between Group II and Group III (p values 0.0012, 0.0015, and <0.0001, respectively) was statistically significant. The fasting plasma glucose values of Groups II and III were significantly higher than those of Group I, (p < 0.0001). Glycated haemoglobin (HbA1c) values were also shown to increase from Group I to II and then III, and the increase was highly significant (all p values <0.0001). Thus, decreased glycaemic control and an increase in the glycation of haemoglobin was the key to elevation in serum iron values and alterations in other parameters. However, a significant correlation was absent between serum iron and HbA1c (r = 0.05) and transferrin saturation (r = 0.0496) in Group III.

Serum ferritin and glucose homeostasis: change in the association by glycaemic state

BACKGROUND

Data on the association between body iron and glucose homeostasis by the three glycaemic states are scarce. Thus, we investigated the association between body iron as assessed by a serum ferritin concentration and glucose homeostasis using homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) and beta cell function (HOMA-BcF) in different glycaemic states.

METHODS

A cross-sectional analysis was conducted in 2541 men aged 42-60 years in 1984-1989 in the Kuopio Ischemic Heart Disease Risk Factor Study. Subjects were classified into the three glycaemic states, normoglycaemia, prediabetes and type 2 diabetes (T2D), by fasting plasma glucose measurements and the information collected at study visit. The association between serum ferritin quartiles and HOMA-IR and HOMA-BcF for each glycaemic state was examined by analysis of covariance and linear regression analysis.

RESULTS

The mean age and serum ferritin concentrations were 53.1 years (standard deviation = 5.7, range = 42.0-61.3 years) and 166.2 µg/L (standard deviation = 141.7, range = 11-960 µg/L), respectively. After multivariable adjustments, a weak and direct association was observed between serum ferritin quartiles and HOMA-IR in normoglycaemia (P-trend = 0.001) but a direct association in prediabetes (P-trend = 0.007) and in T2D (P-trend = 0.078). In HOMA-BcF, the association was weak and direct in normoglycaemia (P-trend = 0.003), direct in prediabetes (P-trend = 0.005) and inverse in T2D (P-trend = 0.105). Strongest associations were observed in prediabetes (β = 0.25, 95% confidence interval = 0.14-0.36 and P = 0.004 in HOMA-IR; β = 0.23, 95% confidence interval = 0.15-0.31 and P = 0.008 in HOMA-BcF) after a 100-µg/L increase in serum ferritin (log-transformed).

CONCLUSIONS

These data suggest that both the strength and the direction of the association between body iron stores and glucose homeostasis are dependent on the glycaemic state of the population.

Body iron stores and heme-iron intake in relation to risk of type 2 diabetes: a systematic review and meta-analysis

Background and Objective

Emerging evidence from biological and epidemiological studies has suggested that body iron stores and heme-iron intake may be related to the risk of type 2 diabetes (T2D). We aimed to examine the association of body iron stores and heme-iron intake with T2D risk by conducting a systematic review and meta-analysis of previously published studies.

Research Design and Methods

Systematic review and subsequent meta-analysis were conducted by searching MEDLINE database up to June 22, 2012 to identify studies that analyzed the association of body iron stores or dietary heme-iron intake with T2D risk. The meta-analysis was performed using the effect estimates and 95% confidence intervals (CIs) to calculate the pooled risk estimates, while the heterogeneity among studies was examined using the I² and Q statistic.

Results

The meta-analysis included 16 high-quality studies: 12 studies analyzed ferritin levels (4,366 T2D patients and 41,091 controls) and 4 measured heme-iron intake (9,246 T2D patients and 179,689 controls). The combined relative risk (RR) comparing the highest and lowest category of ferritin levels was 1.66 (95% CI: 1.15–2.39) for prospective studies, 2.29 (95% CI: 1.48–3.54) for cross-sectional studies with heterogeneity (Q = 14.84, p = 0.01, I² = 66.3%; Q = 44.16, p<0.001, I² = 88.7%). The combined RR comparing the highest and lowest category of heme-iron intake was 1.31 (95% CI: 1.21–1.43) with heterogeneity (Q = 1.39, p = 0.71, I² = 0%). No publication bias was found. Additional 15 studies that were of good quality, had significant results, and analyzed the association between body iron stores and T2D risk were qualitatively included in the systematic review.

Conclusions

The meta-analysis and systematic review suggest that increased ferritin levels and heme-iron intake are both associated with higher risk of T2D.

Red meat consumption and risk of stroke in Swedish men

BACKGROUND

Red and processed meat consumption has been implicated in several diseases. However, data on meat consumption in relation to stroke incidence are sparse.

OBJECTIVE

Our objective was to examine the associations of red meat and processed meat consumption with stroke incidence in men.

DESIGN

We prospectively followed 40,291 men aged 45-79 y who had no history of cardiovascular disease or cancer at baseline. Meat consumption was assessed with a self-administered questionnaire in 1997.

RESULTS

During a mean follow-up of 10.1 y, 2409 incident casesof stroke (1849 cerebral infarctions, 350 hemorrhagic strokes, and 210 unspecified strokes) were identified from the Swedish Hospital Discharge Registry. Consumption of processed meat, but not of fresh red meat, was positively associated with risk of stroke. The multivariable relative risks (RRs) of total stroke for the highest compared with the lowest quintiles of consumption were 1.23 (95% CI: 1.07, 1.40; P for trend = 0.004) for processed meat and 1.07 (95% CI: 0.93, 1.24; P for trend = 0.77) for fresh red meat. Processed meat consumption was also positively associated with risk of cerebral infarction in a comparison of the highest with the lowest quintile (RR: 1.18; 95% CI: 1.01, 1.38; P for trend = 0.03).

CONCLUSION

The findings from this prospective cohort of men indicate that processed meat consumption is positively associated with risk of stroke. The Cohort of Swedish Men is registered at clinicaltrials.gov as NCT01127711.

Red meat consumption and risk of stroke in Swedish women

BACKGROUND AND PURPOSE

High red meat consumption has been associated with increased risk of some cancers and may also be a risk factor for cardiovascular diseases. However, epidemiological studies of red meat consumption in relation to risk of stroke are very limited. Our objective was to examine the association between red meat consumption and stroke incidence in the Swedish Mammography Cohort.

METHODS

We prospectively followed 34 670 women without cardiovascular disease and cancer at baseline. Participants completed a self-administered questionnaire on diet and other risk factors for cardiovascular diseases in 1997. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RR) and 95% CI.

RESULTS

During a mean follow-up of 10.4 years, we ascertained 1680 incident cases of stroke, comprising 1310 cerebral infarction, 154 intracerebral hemorrhage, 79 subarachnoid hemorrhage, and 137 unspecified stroke. Total red meat and processed meat consumption was associated with a statistically significant increased risk of cerebral infarction, but not of total stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. The multivariable RR of cerebral infarction for the highest versus the lowest quintile of consumption were 1.22 (95% CI, 1.01-1.46) for red meat and 1.24 (95% CI, 1.04-1.49) for processed meat. Fresh (unprocessed) meat consumption was not associated with total stroke or with any stroke subtype.

CONCLUSIONS

Findings from this study suggest that red and processed meat consumption may increase the risk of cerebral infarction in women.

The long-term impact of ferritin level on treatment and complications of type 2 diabetes

AIM

To investigate if high-serum ferritin has long-term impact on response to treatment and the development of diabetic complications in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We analysed the record of 90 consecutive type 2 diabetic subjects who had serum ferritin level determined soon after diagnosis of diabetes and who also had long-term follow-up data.

RESULTS

Patients with higher serum ferritin level had slightly worse triglyceride, blood pressure and liver enzyme levels at the end of follow up. However, ferritin level had no impact on the initial or final requirements for diabetic medication and the development of diabetic complications.

CONCLUSIONS

Although elevated serum ferritin is a marker of insulin resistance and chronic inflammation, it is not necessarily a bad prognostic indicator that should affect the clinician's approach to management.

Relationships of serum ferritin, transferrin saturation, and HFE mutations and self-reported diabetes in the Hemochromatosis and Iron Overload Screening (HEIRS) study

OBJECTIVE

We evaluated the associations of self-reported diabetes with serum ferritin concentration, transferrin saturation (TfSat), and HFE C282Y and H63D mutations in six racial/ethnic groups recruited at five field centers in the Hemochromatosis and Iron Overload Screening (HEIRS) study.

RESEARCH DESIGN AND METHODS

Analyses were conducted on 97,470 participants. Participants who reported a previous diagnosis of diabetes and/or hemochromatosis or iron overload were compared with participants who did not report a previous diagnosis.

RESULTS

The overall prevalence of diabetes was 13.8%; the highest prevalence was in Pacific Islanders (20.1%). Of all participants with diabetes, 2.0% reported that they also had hemochromatosis or iron overload. The mean serum ferritin concentration was significantly greater in women with diabetes in all racial/ethnic groups and in Native-American men with diabetes than in those without diabetes. The mean serum ferritin concentration was significantly lower in Asian men with diabetes than in those without diabetes. Mean TfSat was lower in participants with diabetes from all racial/ethnic groups except Native-American women than in those without diabetes. There was no significant association of diabetes with HFE genotype. The mean serum ferritin concentration was greater (P < 0.0001) in women with diabetes than in those without diabetes for HFE genotypes except C282Y/C282Y and C282Y/H63D. Log serum ferritin concentration was significantly associated with diabetes in a logistic regression analysis after adjusting for age, sex, racial/ethnic group, HFE genotype, and field center.

CONCLUSIONS

Serum ferritin concentration is associated with diabetes, even at levels below those typically associated with hemochromatosis or iron overload.

Dietary iron intake and blood donations in relation to risk of type 2 diabetes in men: a prospective cohort study

BACKGROUND

Excessive iron stores may promote insulin resistance and lead to the development of type 2 diabetes. However, prospective data relating iron intake and blood donations (determinants of body iron stores) to diabetes incidence are limited.

OBJECTIVE

We examined iron intake and blood donations in relation to the incidence of type 2 diabetes.

DESIGN

We followed men aged 40-75 y who participated in the Health Professionals' Follow-up Study; were free of diabetes, cardiovascular disease, and cancer in 1986; and provided dietary data (n = 38 394). Of those participants, 33 541 also provided a history of blood donation during the past 30 y in 1992.

RESULTS

During 12 y of follow-up, we ascertained 1168 new cases of type 2 diabetes. After adjustment for age, body mass index, and other diabetes risk factors, total iron intake was not associated with the risk of type 2 diabetes. Intakes of total heme iron [multivariate relative risk (RR) for extreme quintiles: 1.28; 95% CI: 1.02, 1.61; P for trend = 0.045] and of heme iron from red meat (RR: 1.63; 1.26, 2.10; P for trend < 0.001) were associated with an increased risk. However, heme-iron intake from sources other than red meat was not associated with diabetes risk (RR: 0.99; 0.81, 1.22). No significant associations were found between blood donation and the risk of type 2 diabetes.

CONCLUSIONS

Heme-iron intake from red meat sources is positively associated with the risk of type 2 diabetes. Total iron intake, heme-iron intake from non-red meat sources, and blood donations are not related to the risk of type 2 diabetes.

Body iron stores and their determinants in healthy postmenopausal US women

BACKGROUND

Data on the determinants of body iron stores in middle-aged women are sparse.

OBJECTIVE

We prospectively evaluated nondietary and dietary determinants of iron stores.

DESIGN

Using blood samples collected in 1989-1990, we measured plasma ferritin concentrations in 620 healthy postmenopausal women aged 44-69 y who participated in the Nurses' Health Study. Food-frequency questionnaires completed in 1980, 1984, and 1986 were used to calculate average dietary intakes. Generalized linear regression and multiple logistic regression models were used to assess the association between plasma ferritin and its determinants.

RESULTS

Among these postmenopausal women, the median plasma ferritin concentration was 73.8 ng/mL (interquartile range: 41.6-125.8 ng/mL), 2.7% were iron depleted (ferritin concentration < 12 ng/mL), and 9.8% had an elevated ferritin concentration (> 200 ng/mL). Age, time since menopause, time since the last postmenopausal hormone (PMH) use, body mass index, iron supplement use, and alcohol and heme-iron intakes were positively associated with ferritin concentrations, whereas PMH use, physical activity, aspirin use, and gastrointestinal ulcer were inversely related. The association between heme-iron intake and ferritin was most apparent among the women who consumed > 30 g alcohol/d.

CONCLUSIONS

Our prospective data confirm that in postmenopausal women, intakes of heme iron, supplemental iron, and alcohol are dietary determinants of plasma ferritin, and age, PMH use, body mass index, physical activity, aspirin use, and gastrointestinal ulcer are nondietary determinants.

Hyperinsulinemia may boost both hematocrit and iron absorption by up-regulating activity of hypoxia-inducible factor-1α

There is growing evidence that increases in both hematocrit and body iron stores are components of the insulin resistance syndrome. The ability of insulin and of IGF-I - whose effective activity is increased in the context of insulin resistance - to boost activity of the transcription factor hypoxia-inducible factor-1alpha (HIF-1alpha), may be at least partially responsible for this association. HIF-1alpha, which functions physiologically as a detector of both hypoxia and iron-deficiency, promotes synthesis of erythropoietin, and may also mediate the up-regulatory impact of hypoxia on intestinal iron absorption. Insulin/IGF-I may also influence erythropoiesis more directly, as they are growth factors for developing reticulocytes. Conversely, the activation of HIF-1alpha associated with iron deficiency may be responsible for the increased glucose tolerance noted in iron-deficient animals; HIF-1alpha promotes efficient glucose uptake and glycolysis - a sensible adaptation to hypoxia - by inducing increased synthesis of glucose transporters and glycolytic enzymes. Recent reports that phlebotomy can increase the efficiency of muscle glucose uptake in lean healthy omnivores are intriguing and require further confirmation. Whether increased iron stores contribute to the elevated vascular risk associated with insulin resistance is doubtful, inasmuch as most prospective studies fail to correlate serum ferritin or transferrin saturation with subsequent vascular events. However, current data are reasonably consistent with the possibility that moderately elevated iron stores are associated with increased overall risk for cancer - and for colorectal cancer in particular; free iron may play a catalytic role in 'spontaneous' mutagenesis. Thus, iron excess may mediate at least some of the increased cancer risk associated with insulin resistance and heme-rich diets. People who are insulin resistant can minimize any health risk associated with iron overload by avoiding heme-rich flesh foods and donating blood regularly.