The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.
J Clin Endocrinol Metab. 2019 Oct 1;104(10):4539-4551. doi: 10.1210/jc.2019-00495.
Although the role of iron in the development of type 2 diabetes (T2D) has long been a concern, prospective studies directly linking body iron stores to T2D risk in a sex-dependent context have been inconsistent.
A systematic meta-analysis was conducted to explore the sex-specific association of circulating ferritin with T2D risk.
We searched PubMed, Web of Science, and EMBASE databases to identify available prospective studies through 1 August 2018.
Fifteen prospective studies comprising 77,352 participants and 18,404 patients with T2D, aged 20 to 80 years, and with ∼3 to 17 years of follow-up were identified. For each 100-μg/L increment in ferritin levels of overall participants, T2D risk increased by 22% (RR, 1.22; 95% CI, 1.14 to 1.31). Of note, major heterogeneities by sex were identified, with increased ferritin level having an apparently greater effect on T2D risk in women (RR, 1.53; 95% CI, 1.29 to 1.82) than in men (RR, 1.21; 95% CI, 1.15 to 1.27) after exclusion of a study with high heterogeneity (41,512 men and 6974 women for sex-specific analyses; P = 0.020 for sex difference). Further nonlinear analysis between circulating ferritin and T2D risk also showed sex-dimorphic association in that the T2D risk of women was twice as strong in magnitude as that of men at the same ferritin level.
Greater circulating ferritin levels were independently associated with increased T2D risk, which appeared stronger among women than men. Our findings provide prospective evidence for further testing of the utility of ferritin levels in predicting T2D risk in a sex-specific manner.
尽管铁在 2 型糖尿病（T2D）发展中的作用一直备受关注，但直接将体内铁储存与 T2D 风险联系起来的前瞻性研究在性别相关背景下一直不一致。
进行了系统的荟萃分析，以探索循环铁蛋白与 T2D 风险的性别特异性关联。
我们检索了 PubMed、Web of Science 和 EMBASE 数据库，以确定截至 2018 年 8 月 1 日的可用前瞻性研究。
确定了 15 项前瞻性研究，共纳入 77352 名参与者和 18404 名 T2D 患者，年龄 20 至 80 岁，随访时间约为 3 至 17 年。对于总体参与者铁蛋白水平每增加 100μg/L，T2D 风险增加 22%（RR，1.22；95%CI，1.14 至 1.31）。值得注意的是，通过性别识别出了主要的异质性，高铁蛋白水平对女性（RR，1.53；95%CI，1.29 至 1.82）的 T2D 风险的影响明显大于男性（RR，1.21；95%CI，1.15 至 1.27），排除了一项具有高度异质性的研究（性别特异性分析中纳入 41512 名男性和 6974 名女性；P=0.020 用于性别差异）。进一步的循环铁蛋白与 T2D 风险之间的非线性分析也显示出性别差异的关联，即女性的 T2D 风险在相同的铁蛋白水平下是男性的两倍。
更高的循环铁蛋白水平与 T2D 风险增加独立相关，女性的风险高于男性。我们的研究结果为进一步以性别特异性方式测试铁蛋白水平预测 T2D 风险的效用提供了前瞻性证据。
