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Orban, E. ; Schwab, S. ; Thorand, B. ; Huth, C.

Association of iron indices and type 2 diabetes: A meta-analysis of observational studies.

Diabetes Metab. Res. Rev. 30, 372-394 (2013)

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Open Access Green möglich sobald Postprint bei der ZB eingereicht worden ist.

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BACKGROUND/PURPOSE: The literature on the role of body iron status in the development of type 2 diabetes in humans is inconsistent. We aimed to assess the association between iron indices and type 2 diabetes by a metaanalysis of previously published studies. METHODS: A systematic literature search was conducted in PubMed and EMBASE. Observational studies on the association of ferritin (if controlled for age and sex), transferrin saturation, soluble transferrin receptor, and transferrin with type 2 diabetes were included. Pooled association estimates were calculated using a random effects model. RESULTS: Forty-seven eligible studies were identified. The pooled multivariable adjusted relative risks of type 2 diabetes in the highest versus lowest quartile of ferritin levels were significantly elevated in both, cross-sectional as well as prospective studies and after restriction to inflammation-adjusted studies (overall: 1.67 (95%CI 1.41-1.99)). The mean difference indicated 43.54 ng/ml (95%CI 28.14-58.94) higher ferritin levels in type 2 diabetic individuals. The relative risk for a transferrin saturation ≥50% was 1.59 (95%CI 1.28-1.97), the mean difference was 1.92% (95%CI 2.99-(-0.85)). Study-specific results of soluble transferrin receptor and transferrin levels were extremely heterogeneous. CONCLUSIONS: Ferritin and clinically elevated transferrin saturation were strongly associated with an increased risk of type 2 diabetes, overall and in prospective studies. Ferritin was also significantly associated after multivariable adjustment including inflammation. Thus, the current evidence hints at a causal effect, however, publication bias and unmeasured confounding cannot be excluded. The study protocol was registered in PROSPERO, number CRD42012002362.

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