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

• Published in: Nutrients 2020-10, Vol.12 (11), p.3249
• Main Authors: Díaz-López, Andrés, Iglesias-Vázquez, Lucía, Pallejà-Millán, Meritxell, Rey Reñones, Cristina, Flores Mateo, Gemma, Arija, Victoria
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcohol use; Alcoholism; Anthropometry; Biomarkers; Biomarkers - blood; Body mass index; Cohort analysis; Databases, Factual; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - epidemiology; Female; Ferritin; Ferritins - blood; Gender differences; Health care; Health hazards; Hemoglobin; Humans; Hypertension; Incidence; Iron; Iron - blood; iron status; Lifestyles; Longitudinal Studies; Male; Middle Aged; Morbidity; Mutation; Nutritional Status; Population; Population studies; Population-based studies; Primary care; Primary Health Care - statistics & numerical data; primary healthcare; Proportional Hazards Models; Public health; Risk Factors; serum ferritin; Sociodemographics; Spain - epidemiology; type 2 diabetes; type 2 diabetes incidence; Womens health
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu12113249

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; < 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.