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Body Iron Stores and Dietary Iron Intake in Relation to Diabetes in Adults in North China

Response to Luan et al.

¹ Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
² Research Center for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia

Address correspondence to Zumin Shi, MD, PhD, Department of Nutrition and Food Hygiene, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Rd., Nanjing 210009, P. R. China. E-mail: zumins{at}vip.sina.com

A study on the association between iron status and diabetes in adults in North China has recently been reported by Luan et al. (1). The results partly confirmed our previous finding from South China (2). In Luan et al.’s study, only heme iron was found to be associated with risk of diabetes. However, the intake of heme iron in their dataset is very low: mean intake ± SD in first quartile only 0.3 ± 0.3 mg/day. Thus, the reference group is mainly composed of vegetarians. It may not be appropriate to examine the association between heme iron and diabetes without adjusting for socioeconomic status because those eating less heme iron may be the poor, who have a lower risk of diabetes in China.

We reanalyzed our data and examined the association between heme and nonheme iron intake and diabetes. Although the subjects in our study had a similar heme iron intake (mean ± SD 2.27 ± 3.3 mg/day), we found opposite results. Among women but not men, only nonheme iron intake was associated with diabetes. In an age-, sex-, and energy- adjusted model, heme iron intake was positively associated with diabetes: the odds ratios (ORs) across heme iron intake quartiles were 1.00, 1.19, 1.27, and 2.13 (P for trend 0.023). In a fully-adjusted model, the ORs across nonheme iron intake quartiles were 1.00, 3.69 (95% CI 1.35–10.10), 4.52 (1.39–14.76), and 5.01 (1.25–19.98) (P for trend 0.017) in women and 1.00, 0.34 (0.12–1.00), 0.97 (0.36–2.62), and 1.15 (0.35–3.80) (P for trend 0.557) in men; ORs across heme iron intake quartiles were 1.00, 0.88 (0.32–0.45), 0.70 (0.20–2.40), and 1.52 (0.41–5.61) (P for trend 0.612) in women and 1.00, 0.68 (0.21–2.19), 0.77 (0.25–2.40), and 0.81 (0.23–2.86) (P for trend 0.816) in men. The above association as well as that between total iron intake and diabetes did not change after adjustment of blood lipids, which is also different from Luan et al.’s study.

Four studies among the Chinese population found a cross-sectional association between iron and diabetes or insulin resistance (1–4). Current evidence suggests that further longitudinal study is needed. When we finish the 5-year follow-up of the previous participants, by the end of this year, we can examine the association with a longitudinal approach. If a positive association between iron intake and diabetes is established, it will challenge the current practice of anemia prevention in China: using iron-fortified soy sauce.

References

1. Luan DC, Li H, Li SJ, Zhao Z, Li X, Liu ZM: Body iron stores and dietary iron intake in relation to diabetes in adults in North China. Diabetes Care 31:285–286, 2008[Abstract/Free Full Text]
   
2. Shi Z, Hu X, Yuan B, Pan X, Meyer HE, Holmboe-Ottesen G: Association between serum ferritin, hemoglobin, iron intake, and diabetes in adults in Jiangsu, China. Diabetes Care 29:1878–1883, 2006[Abstract/Free Full Text]
   
3. Lao TT, Ho LF: Impact of iron deficiency anemia on prevalence of gestational diabetes mellitus. Diabetes Care 27:650–656, 2004[Abstract/Free Full Text]
   
4. Sheu WH, Chen YT, Lee WJ, Wang CW, Lin LY: A relationship between serum ferritin and the insulin resistance syndrome is present in non-diabetic women but not in non-diabetic men. Clin Endocrinol (Oxf) 58:380–385, 2003[Medline]
   

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				D. C. Luan, H. Li, S. J. Li, Z. Zhao, X. Li, and Z. M. Liu Body Iron Stores and Dietary Iron Intake in Relation to Diabetes in Adults in North China: Response to Shi and Pan Diabetes Care, April 1, 2008; 31(4): e26 - e26. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shi, Z. Articles by Pan, X. Search for Related Content PubMed PubMed Citation Articles by Shi, Z. Articles by Pan, X. Social Bookmarking                What's this?