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Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence.

Abstract

BACKGROUND

Emerging evidence suggests that a strong link that exists between elevated baseline body iron stores and high risk of incident type 2 diabetes mellitus (T2DM) in general populations, but the precise magnitude of the associations remains uncertain.

METHODS

We conducted a systematic review and meta-analysis of published prospective studies evaluating the associations of baseline ferritin (a biomarker of body iron stores) levels with risk of T2DM in general populations. A subsidiary review of dietary heme iron status and T2DM risk associations was also conducted. Studies were identified in a literature search of PubMed, EMBASE, and Web of Science up to October 2012.

RESULTS

Of the 730 studies reviewed for eligibility, 12 published studies involving 185 462 participants and 11 079 incident T2DM events were included in the analyses. Nine studies assessed associations between ferritin levels and T2DM with heterogeneous findings (I(2)  = 58%, 12-80%, p = 0.014). The pooled fully adjusted relative risk (RR) with (95% confidence interval) for T2DM was 1.73 (1.35-2.22) in a comparison of extreme fifths of baseline ferritin levels. Three studies evaluated associations between dietary heme iron status and T2DM with a corresponding RR for T2DM of 1.28 (1.16-1.41). In dose-response analyses, the pooled RRs for an increment of 5 ng/mL in ferritin levels and 5 mg/day in dietary heme iron were, respectively, 1.01 (0.99-1.02) and 3.24 (2.05-5.10).

CONCLUSION

Elevated levels of ferritin may help identify individuals at high risk of T2DM. Further research is warranted to establish causality of these associations and to ascertain which patients are likely to benefit from lifestyle or therapeutic interventions.

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  • Authors+Show Affiliations

    ,

    Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. skk31@cantab.net

    , ,

    Source

    MeSH

    Biomarkers
    Diabetes Mellitus, Type 2
    Ferritins
    Humans
    Meta-Analysis as Topic
    Prospective Studies
    Risk Factors

    Pub Type(s)

    Journal Article
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23381919

    Citation

    Kunutsor, Setor K., et al. "Ferritin Levels and Risk of Type 2 Diabetes Mellitus: an Updated Systematic Review and Meta-analysis of Prospective Evidence." Diabetes/metabolism Research and Reviews, vol. 29, no. 4, 2013, pp. 308-18.
    Kunutsor SK, Apekey TA, Walley J, et al. Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence. Diabetes Metab Res Rev. 2013;29(4):308-18.
    Kunutsor, S. K., Apekey, T. A., Walley, J., & Kain, K. (2013). Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence. Diabetes/metabolism Research and Reviews, 29(4), pp. 308-18. doi:10.1002/dmrr.2394.
    Kunutsor SK, et al. Ferritin Levels and Risk of Type 2 Diabetes Mellitus: an Updated Systematic Review and Meta-analysis of Prospective Evidence. Diabetes Metab Res Rev. 2013;29(4):308-18. PubMed PMID: 23381919.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence. AU - Kunutsor,Setor K, AU - Apekey,Tanefa A, AU - Walley,John, AU - Kain,Kirti, PY - 2012/11/06/received PY - 2013/01/04/revised PY - 2013/01/05/accepted PY - 2013/2/6/entrez PY - 2013/2/6/pubmed PY - 2013/12/16/medline SP - 308 EP - 18 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab. Res. Rev. VL - 29 IS - 4 N2 - BACKGROUND: Emerging evidence suggests that a strong link that exists between elevated baseline body iron stores and high risk of incident type 2 diabetes mellitus (T2DM) in general populations, but the precise magnitude of the associations remains uncertain. METHODS: We conducted a systematic review and meta-analysis of published prospective studies evaluating the associations of baseline ferritin (a biomarker of body iron stores) levels with risk of T2DM in general populations. A subsidiary review of dietary heme iron status and T2DM risk associations was also conducted. Studies were identified in a literature search of PubMed, EMBASE, and Web of Science up to October 2012. RESULTS: Of the 730 studies reviewed for eligibility, 12 published studies involving 185 462 participants and 11 079 incident T2DM events were included in the analyses. Nine studies assessed associations between ferritin levels and T2DM with heterogeneous findings (I(2)  = 58%, 12-80%, p = 0.014). The pooled fully adjusted relative risk (RR) with (95% confidence interval) for T2DM was 1.73 (1.35-2.22) in a comparison of extreme fifths of baseline ferritin levels. Three studies evaluated associations between dietary heme iron status and T2DM with a corresponding RR for T2DM of 1.28 (1.16-1.41). In dose-response analyses, the pooled RRs for an increment of 5 ng/mL in ferritin levels and 5 mg/day in dietary heme iron were, respectively, 1.01 (0.99-1.02) and 3.24 (2.05-5.10). CONCLUSION: Elevated levels of ferritin may help identify individuals at high risk of T2DM. Further research is warranted to establish causality of these associations and to ascertain which patients are likely to benefit from lifestyle or therapeutic interventions. SN - 1520-7560 UR - https://www.unboundmedicine.com/medline/citation/23381919/Ferritin_levels_and_risk_of_type_2_diabetes_mellitus:_an_updated_systematic_review_and_meta_analysis_of_prospective_evidence_ L2 - https://doi.org/10.1002/dmrr.2394 DB - PRIME DP - Unbound Medicine ER -