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Ferritin Concentrations, Metabolic Syndrome, and Type 2 Diabetes in Middle-Aged and Elderly Chinese

Key Laboratory of Nutrition and Metabolism (L.S., Z.Y., H.L., X.Y., Q.Q., J.W., A.P., Y.L., X.L.), Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, 200031 Shanghai, China; Unilever Corporate Research (O.H.F.), Sharnbrook, Bedfordshire MK44 1LQ, United Kingdom; Departments of Nutrition and Epidemiology (F.B.H.), Harvard School of Public Health, Boston, Massachusetts 02115; and Departments of Medicine and Radiation Oncology (L.C.), University of Louisville, Louisville, Kentucky 40292

Address all correspondence and requests for reprints to: Xu Lin, Institute for Nutritional Sciences, 294 Tai-Yuan Rd., Shanghai 200031, China. E-mail: xlin{at}sibs.ac.cn.

Context: Elevated ferritin concentrations frequently cluster with well-established risk factors of diabetes including obesity, metabolic syndrome, chronic inflammation, and altered circulating adipokines. Few studies, however, have systematically evaluated the effect of these risk factors on ferritin-diabetes association, particularly in Chinese populations.

Objective: We aimed to investigate, in a middle-aged and elderly Chinese population, whether elevated ferritin concentrations are associated with higher risk of metabolic syndrome and type 2 diabetes and to what extent the associations were influenced by obesity, inflammation, and adipokines.

Design and Methods: We conducted a population-based, cross-sectional survey of 3289 participants aged 50–70 yr in Beijing and Shanghai in 2005. Fasting plasma ferritin, glucose, insulin, lipid profile, glycohemoglobin, inflammatory markers, adipokines, and dietary profile were measured.

Results: Median ferritin concentrations were 155.7 ng/ml for men and 111.9 ng/ml for women. After multiple adjustment, the odds ratios (ORs) were substantially higher for type 2 diabetes (OR 3.26, 95% confidence interval 2.36–4.51) and metabolic syndrome [OR 2.80 (95% confidence interval 2.24–3.49)] in the highest ferritin quartile compared with those in the lowest quartile. These associations remained significant after further adjustment for dietary factors, body mass index, inflammatory markers, and adipokines.

Conclusions: Elevated circulating ferritin concentrations were associated with higher risk of type 2 diabetes and metabolic syndrome in middle-aged and elderly Chinese independent of obesity, inflammation, adipokines, and other risk factors. Our data support the crucial role of iron overload for metabolic diseases, even in a country with relatively high prevalence of iron deficiency.

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