Department of Nutrition and Food Hygiene, Zhejiang University School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Diabetes Metab J. 2022 Mar;46(2):307-318. doi: 10.4093/dmj.2020.0287. Epub 2022 Mar 7.
Recent studies have found that there are significant associations between body iron status and the development of diabetes. In the present study, we aimed to analyze the association among iron overload (IO), insulin resistance (IR), and diabetes in Chinese adults, and to explore the sex difference.
Men and women (age >19 years) who participated in the Chinese Health and Nutrition Survey and did not have diabetes at baseline were followed between 2009 and 2015 (n=5,779). Over a mean of 6 years, 75 participants were diagnosed with incident diabetes. Logistic regression was used to assess the risk factors associated with IO. Cox proportional hazard regression was used to estimate the risk of incident diabetes and to determine whether the risk differed among subgroups. Causal mediation analysis (CMA) was used to explore the mechanism linking IO and diabetes.
According to sex-stratified multivariable-adjusted Cox proportional hazards regression, IO increased the risk of incident diabetes. Women with IO had a higher risk of diabetes than men. Subgroup analysis with respect to age showed that the association between IO and diabetes was stronger in older women and younger men (P<0.001). CMA showed that liver injury (alanine transaminase) and lipid metabolism abnormalities (triglyceride, apolipoprotein B) contributed to the association between IO and diabetes.
IO is associated with diabetes and this association is sex-specific. IO may indirectly induce IR via liver injury and lipid metabolism abnormalities, resulting in diabetes.
最近的研究发现，体内铁状态与糖尿病的发展之间存在显著关联。本研究旨在分析中国成年人中铁过载（IO）、胰岛素抵抗（IR）和糖尿病之间的关系，并探讨性别差异。
年龄>19 岁的男性和女性参加了中国健康与营养调查，且在基线时没有糖尿病，随访时间为 2009 年至 2015 年（n=5779）。在平均 6 年的随访期间，有 75 名参与者被诊断为新发糖尿病。采用 logistic 回归分析评估与 IO 相关的危险因素。采用 Cox 比例风险回归估计新发糖尿病的风险，并确定风险是否在亚组之间存在差异。采用因果中介分析（CMA）探讨 IO 与糖尿病之间的关联机制。
根据性别分层的多变量调整 Cox 比例风险回归，IO 增加了新发糖尿病的风险。与男性相比，IO 女性患糖尿病的风险更高。亚组分析显示，IO 与糖尿病之间的关联在年龄较大的女性和年龄较小的男性中更强（P<0.001）。CMA 显示，肝损伤（丙氨酸转氨酶）和脂质代谢异常（甘油三酯、载脂蛋白 B）导致了 IO 与糖尿病之间的关联。
IO 与糖尿病相关，且这种关联具有性别特异性。IO 可能通过肝损伤和脂质代谢异常间接诱导 IR，从而导致糖尿病。
