Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, PO Box 1627, FI70211 Kuopio, Finland.
Eur J Endocrinol. 2013 Jul 13;169(2):247-53. doi: 10.1530/EJE-13-0145. Print 2013 Aug.
We investigated the risk of type 2 diabetes mellitus (T2DM) over a wide range of body iron stores.
Prospective cohort of 1613 men in the Kuopio Ischemic Heart Disease Risk Factor study, aged 42-60 years, free of T2DM and hereditary hemochromatosis at baseline in 1984-1989. Baseline serum ferritin (sF) and serum-soluble transferrin receptor (sTfR) concentrations were used to predict incident T2DM. T2DM was assessed by questionnaires, blood glucose measurements, and medication reimbursement register.
There were 331 cases of incident T2DM during the mean follow-up of 16.8 years (27,098 person-years). At baseline, subjects who later developed T2DM had average sF concentrations of 191 μg/l (S.D. 155) vs 151 μg/l (S.D. 119) among those who remained healthy, P<0.001. In a multivariate-adjusted logistic regression, each 100 μg/l increase in sF corresponded to an average of 14% increased (odds ratio=1.14, 95% CI 1.03-1.26, P=0.009) risk of developing T2DM. In a Cox regression, a markedly increased risk of developing T2DM was observed from the fourth sF quintile (185 μg/l, the median) upward (hazard ratio (HR) first vs fifth quintile=1.5, 95% CI 1.0-2.2, P-trend=0.05). In a corresponding Cox model in sTfR, the subjects in the third quintile (1840 μg/l, the median) had the least risk (HR=0.63, 95% CI 0.42-0.97, P=0.04).
Body iron within the sF reference range is not an important determinant of T2DM risk, whereas high normal and above is associated with markedly increased risk. Iron depletion toward iron deficiency as assessed by sTfR is not protective against T2DM. A rule of thumb safe range could be 30-200 μg/l of sF.
我们研究了广泛的体铁储存范围内 2 型糖尿病（T2DM）的发病风险。
1984-1989 年，在库奥皮奥缺血性心脏病风险因素研究中对 1613 名年龄在 42-60 岁的男性进行了前瞻性队列研究，这些男性在基线时无 T2DM 和遗传性血色素沉着症。使用基线血清铁蛋白（sF）和血清可溶性转铁蛋白受体（sTfR）浓度预测 T2DM 事件。T2DM 通过问卷调查、血糖测量和药物报销登记进行评估。
在平均 16.8 年（27098 人年）的随访中，共发生了 331 例 T2DM 事件。在基线时，与健康状况良好的人相比，后来发生 T2DM 的患者的平均 sF 浓度为 191μg/l（S.D. 155）vs 151μg/l（S.D. 119），P<0.001。在多变量调整的逻辑回归中，sF 每增加 100μg/l，T2DM 的发病风险平均增加 14%（比值比=1.14，95%可信区间 1.03-1.26，P=0.009）。在 Cox 回归中，从 sF 的第四五分位数（185μg/l，中位数）开始，T2DM 的发病风险显著增加（第 1 五分位与第 5 五分位相比，危险比（HR）=1.5，95%可信区间 1.0-2.2，P 趋势=0.05）。在 sTfR 中对应的 Cox 模型中，第三五分位数（1840μg/l，中位数）的受试者风险最低（HR=0.63，95%可信区间 0.42-0.97，P=0.04）。
sF 参考范围内的体铁不是 T2DM 风险的重要决定因素，而高正常及以上与明显增加的风险相关。sTfR 评估的缺铁性铁缺乏对 T2DM 没有保护作用。一个安全范围的经验法则可以是 30-200μg/l 的 sF。
