Korean Journal of Health Promotion

Serum Ferritin Levels Are Associated with the Higher Risk of Diabetes Mellitus in Men and Postmenopausal Women, Based on the 2010-2012 KNHANES

Original Article

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.47

Serum Ferritin Levels Are Associated with the Higher Risk of Diabetes Mellitus in Men and Postmenopausal Women, Based on the 2010-2012 KNHANES

Joo-Yeon Kim¹, Hee-Taik Kang^1,², Yong-Jae Lee³, Jin-Young Kim¹, Tae-Jong Kim¹, Hyoung-Ji Lim¹, Jae-Woo Lee¹

¹Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea

²Department of Family Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea

³Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding author : Hee-Taik Kang, MD Department of Family Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea
Tel: +82-43-269-6301, Fax: +82-43-269-6675 E-mail: kanght0818@gmail.com

Received April 03, 2017 Accepted June 13, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:: The aim of this study was to investigate the relationship between serum ferritin and diabetes mellitus (DM) in the Korean population.

Methods:: This cross-sectional study included 9,576 subjects (4,264 men, 2,394 premenopausal women, and 2,918 postmenopausal women) older than 19 years using data from the 2010-2012 Korean National Health and Nutrition Examination Survey. DM was defined as fasting plasma glucose ≥126 mg/dL, glycosylated hemoglobin ≥6.5%, or use of any glucose-lower medication including insulin therapy.

Results:: The overall prevalence of DM was 12.0, 3.6, and 17.3% in men, premenopausal women, and post-menopausal women, respectively. DM prevalence was greater with ferritin levels from Q1 to Q4: 10.3, 10.2, 12.7, and 14.8% in men; 2.0, 2.8, 2.8, and 6.4% in premenopausal women; and 13.9, 14.4, 18.1, and 22.9% in post-menopausal women, respectively. Compared with participants in Q1, the odds ratios (95% confidence intervals) for DM among participants in Q4 were 1.67 (1.20-2.32) in men, 2.06 (0.91-4.66) in premenopausal women, and 1.60 (1.09-2.35) in post-menopausal women after adjusting for age and other covariates.

Conclusion:: Serum ferritin concentration was positively associated with a higher risk of DM in adult men and post-menopausal women.

Key words: Diabetes mellitus; Ferritin; Insulin resistance

Table 1.

Participant characteristics by sex and menopausal status

	Men	Women
		Premenopausal	Postmenopausal
Unweighted N	4,264	2,394	2,918
Age, y	43.7±0.3	35.4±0.2	60.0±0.3
BMI, kg/m²	24.2±0.1	22.6±0.1	24.4±0.1
SBP, mmHg	119.9±0.3	108.4±0.3	124.4±0.5
DBP, mmHg	79.1±0.2	72.2±0.3	76.0±0.3
FPG, mg/dL	99.9±0.5	91.8±0.5	101.5±0.6
HbA1c, %	5.85±0.02	5.5±0.02	6.0±0.02
Hemoglobin, g/dL	15.5±0.02	13.3±0.02	13.4±0.02
Ferritin, ng/mL	128.1±1.9	34.9±0.8	68.6±1.2
Iron, μg/dL	134.1±1.0	110.9±1.2	105.2±0.7
TIBC, μg/dL	310.6±0.9	324.5±1.1	314.9±1.0
Cholesterol, mg/dL	188.5±0.8	180.9±0.8	202.5±0.8
Triglyceride, mg/dL	154.1±2.3	98.3±2.9	136.9±2.0
HDL-C, mg/dL	46.7±0.2	54.0±0.3	49.9±0.3
Creatinine, mg/dL ⁹	0.97±0.00	0.71±0.00	0.73±0.00
WBC, ×10⁹/L	6.3±0.03	5.7±0.04	5.7±0.04
Regular drinker, %	38.9±0.9	13.1±0.8	6.1±0.6
Current smoker, %	44.4±1.0	8.6±0.8	4.9±0.5
Regular exerciser, %	41.2±1.0	37.3±1.2	32.7±1.1
Higher education, %	36.8±1.1	42.6±1.3	10.5±0.9
DM, %	12.0±0.7	3.6±0.4	17.3±1.0

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FPG, fasting plasma glucose; TIBC, total iron binding capacity; HDL-C, high-density lipoprotein cholesterol; WBC, white blood cells; DM, diabetes mellitus. Values are presented as mean±standard error.

Table 2.

Participant characteristics according to ferritin quartiles

Men	Q1	Q2	Q3	Q4	P	P for trend
Ferritin levels	≤68.4	68.4-104.6	104.7-158.5	>158.5
Age, y	45.1±0.6	42.6±0.5	43.2±0.6	44.0±0. 6	0.008	0.290
BMI, kg/m²	23.6±0.1	24.0±0.1	24.3±0.1	25.0±0.2	<0.001	<0.001
SBP, mmHg	119.6±0.5	118.9±0.6	119.5±0.6	121.6±0.5	<0.001	0.05
DBP, mmHg	77.9±0.5	78.2±0.4	79.1±0.4	81.3±0.4	<0.001	<0.001
FPG, mg/dL	96.6±0.8	98.0±0.8	100.1±1.0	104.9±1.1	<0.001	<0.001
HbA1c, %	5.7±0.03	5.7±0.03	5.7±0.04	5.8±0.04	0.001	0.012
Hb, g/dL	15.2±0.1	15.5±0.04	15.5±0.04	15.7±0.04	<0.001	<0.001
Ferritin, ng/mL	45.2±0. 7	86.6±0.4	129.2±0.6	252.9±4.2	<0.001	<0.001
Iron, μg/dL	127.6±2.2	133.6±1.9	135.8±1.9	139.4±2.0	0.001	<0.001
TIBC, μg/dL	323.4±1.6	307.9±1.4	305.6±0.3	306.0±1.5	<0.001	<0.001
Cholesterol, mg/dL	182.9±1.3	186.1±1.3	191.1±1.4	193.8±1.3	<0.001	<0.001
Creatinine, mg/dL	0.96±0.00	0.97±0.01	0.97±0.00	0.96±0.00	0.069	0.765
WBC, ×10⁹/L	6.1±0.1	6.3±0.1	6.3±0.05	6.4±0.05	0.003	<0.001
Regular drinker, %	27.2±1.7	37.0±1.9	39.7±1.8	51.6±2.0	<0.001	<0.001
Current smoker, %	39.0±2.0	44.4±2.0	47.2±1.8	47.0±2.0	<0.001	<0.001
Regular exerciser, %	45.2±2.0	40.9±1.9	42.6±2.0	35.9±1.9	<0.001	<0.001
Higher education, %	30.7±1.9	37.9±1.9	39.8±2.1	38.4±2.0	<0.001	<0.001
DM, %	10.3±1.1	10.2±1.1	12.7±1.3	14.8±1.3	<0.001	<0.001
Premenopausal women
Ferritin levels	≤14.3	14.4-27.3	27.4-44.4	>44.4
Age, y	35.5±0.5	35.1±0.5	34.8±0.5	36.1±0.5	0.231	0.530
BMI, kg/m²	22.0±0.2	22.6±0.2	22.8±0.2	23.1±0.2	0.001	<0.001
SBP, mmHg	108.4±0.6	107.4±0.6	107.9±0.6	109.7±0.7	0.064	0.105
DBP, mmHg	71.9±0.5	71.8±0.5	71.7±0.5	73.3±0.4	0.033	0.029
FPG, mg/dL	90.1±0.7	90.7±0.7	90.9±0.7	95.0±1.4	0.015	0.001
HbA1c, %	5.5±0.02	5.4±0.02	5.4±0.03	5.5±0.04	0.003	0.081
Hb, g/dL	13.0±0.03	13.3±0.03	13.4±0.04	13.5±0.04	<0.001	<0.001
Ferritin, ng/mL	8.7±0.2	20.5±0.2	35.4±0.2	72.1±1.8	<0.001	<0.001
Iron, μg/dL	96.4±2.3	111.2±2.2	115.4±2.1	120.1±2.2	<0.001	<0.001
TIBC, μg/dL	360.0±2.5	324.5±1.8	312.4±2.0	302.6±1.6	<0.001	<0.001
Cholesterol, mg/dL	181.3±1.6	179.0±1.6	177.9±1.6	185.2±1.8	0.011	0.168
Creatinine, mg/dL	0.72±0.01	0.71±0.00	0.71±0.01	0.71±0.00	0.548	0.160
WBC, ×10⁹/L	5.5±0.1	5.7±0.1	5.8±0.1	5.8±0.1	0.008	0.001
Regular drinker, %	11.1±1.4	11.6±1.8	11.8±1.6	17.6±1.9	<0.001	<0.001
Current smoker, %	7.1±1.6	8.2±1.4	8.3±1.5	10.6±1.6	<0.001	<0.001
Regular exerciser, %	37.3±2.6	37.0±2.3	36.5±2.4	38.1±2.5	<0.001	<0.001
Higher education, %	42.4±2.4	44.5±2.7	44.4±2.4	39.3±2.5	<0.001	<0.001
DM, %	2.0±0.6	2.8±0.7	2.8±0.7	6.4±1.2	<0.001	<0.001
Post-menopausal women
Ferritin levels	≤36.5	36.6-57.7	57.8-87.3	>87.3
Age, y	57.4±0.8	60.2±0.5	60.4±0.5	61.8±0.6	<0.001	<0.001
BMI, kg/m²	24.0±0.1	24.2±0.2	24.7±0.2	24.8±0.2	<0.001	<0.001
SBP, mmHg	123.6±1.0	123.4±0.8	126.1±0.9	124.5±0.7	0.089	0.163
DBP, mmHg	76.1±0.5	75.4±0.5	76.8±0.5	75.7±0.5	0.140	0.969
FPG, mg/dL	97.9±1.0	99.2±1.0	101.8±1. 4	107.2±1.5	<0.001	<0.001
HbA1c, %	5.9±0.04	6.0±0.04	6.0±0.05	6.1±0.05	0.005	<0.001
Hb, g/dL	13.3±0.04	13.5±0.04	13.5±0.04	13.5±0.04	<0.001	<0.001
Ferritin, ng/mL	24.4±0.4	46.9±0.3	71.4±0.40	134.2±2.6	<0.001	<0.001
Iron, μg/dL	101.5±1.5	105.5±1.3	103.0±1.4	110.8±1.7	<0.001	0.001
TIBC, μg/dL	336.8±1.9	314.6±1.7	307.2±1.8	300.3±1.9	<0.001	<0.001
Cholesterol, mg/dL	199.6±1.6	203.3±1.7	203.4±1.7	203.7±1.7	0.250	0.087
Creatinine, mg/dL	0.72±0.01	0.72±0.01	0.73±0.01	0.74±0.01	0.239	0.069
WBC, ×10⁹/L	5.6±0.1	5.6±0.1	5.6±0.1	5.7±0.1	0.614	0.270
Regular drinker, %	4.2±1.0	4.7±0.9	6.2±1.2	9.4±1.4	<0.001	<0.001
Current smoker, %	4.8±0.9	4.0±0.9	5.0±1.2	5.9±1.2	<0.001	<0.001
Regular exerciser, %	29.5±2.1	34.5±2.2	34.2±2.1	32.6±2.0	<0.001	<0.001
Higher education, %	15.0±1.9	9.4±1.6	7.6±1.3	9.9±1.6	<0.001	<0.001
DM, %	13.9±1.6	14.4±1.5	18.1±1.9	22.9±2.1	<0.001	<0.001

Values are presented as mean±standard error. Their P value and P for trend are determined by general linear model for continuous variables and chi square test for categorical variables. Q indicates quartile.

Table 3.

ORs (95% CI) for diabetes according to sex and menopausal specific ferritin quartiles

	Q1	Q2	Q3	Q4
Men
Ferritin, ng/mL	≤68.3	68.4-104.6	104.7-158.5	>158.5
Model 1^a	1	0.99 (0.71-1.38)	1.27 (0.93-1.72)	1.52 (1.14-2.03)
Model 2^b	1	1.18 (0.82-1.69)	1.54 (1.10-2.16)	1.68 (1.22-2.31)
Model 3^c	1	1.17 (0.81-1.69)	1.51 (1.08-2.13)	1.67 (1.20-2.32)
Premenopausal women
Ferritin, ng/mL	≤14.3	14.4-27.3	27.4-44.4	>44.4
Model 1^a	1	1.41 (0.63-3.15)	1.41 (0.63-3.16)	3.29 (1.55-7.00)
Model 2^b	1	1.21 (0.51-2.86)	1.05 (0.43-2.57)	2.07 (0.94-4.56)
Model 3^c	1	1.20 (0.50-2.87)	1.12 (0.45-2.81)	2.06 (0.91-4.66)
Post- menopausal women Ferritin, ng/mL	≤36.5	36.6-57.7	57.8-87.3	>87.3
Model 1^a	1	1.04 (0.74-1.47)	1.36 (0.96-1.93)	1.83 (1.29-2.60)
Model 2^b	1	1.00 (0.68-1.46)	1.21 (0.84-1.74)	1.57 (1.07-2.30)
Model 3^c	1	0.98 (0.67-1.45)	1.19 (0.83-1.72)	1.60 (1.09-2.35)

Abbreviations: OR, odds ratios; CI, confidence interval. The ORs were calculated using logistic regression analyses.

^aModel 1 was not adjusted.

^bModel 2 was adjusted for age, BMI, SBP, total cholesterol, WBC count.

^cModel 3 was adjusted for age, BMI, SBP, total cholesterol, WBC count, alcohol habit, smoking status, physical activity and education level.

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