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Feng J, Shan X, Wang L, Lu J, Cao Y, Yang L. Association of Body Iron Metabolism with Type 2 Diabetes Mellitus in Chinese Women of Childbearing Age: Results from the China Adult Chronic Disease and Nutrition Surveillance (2015). Nutrients 2023; 15:nu15081935. [PMID: 37111154 PMCID: PMC10141641 DOI: 10.3390/nu15081935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
High iron stores have been reported to be associated with type 2 diabetes mellitus (T2DM). However, evidence for the associations of iron metabolism with T2DM is inconsistent, and whether there is a threshold effect remains controversial. In the present study, we aimed to examine the associations between various iron biomarkers and the risk of T2DM as well as impaired glucose metabolism (IGM) and hyperglycemia in Chinese women of childbearing age. A total of 1145 women were divided into three groups (normal blood glucose metabolism group; IGM group; T2DM group). Biomarkers of iron metabolism (serum ferritin (SF), transferrin, soluble transferrin receptor (sTfR), transferrin saturation, serum iron, total body iron, and sTfR-to-lgferritin index) were measured. After adjusting for various confounding risk factors, SF and sTfR were positively associated with the risk of IGM (fourth vs. first quartile: SF odds ratio (OR) = 1.93 (95% CI 1.17-3.20) and sTfR OR = 3.08 (95% CI 1.84-5.14)) and T2DM (SF OR = 2.39 (95% CI 1.40-4.06) and sTfR OR = 3.84 (95% CI 2.53-5.83)). There was a nonlinear relationship between SF and risk of T2DM and hyperglycemia (p for nonlinearity < 0.01). Our findings suggested that SF and sTfR could be independent predictors of T2DM risk.
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Affiliation(s)
- Jie Feng
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoyun Shan
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Hunan Key Laboratory of Typical Environmental Pollution and Health Hazards, School of Public Health, Hengyang Medical School, University of South China, Hengyang 241001, China
| | - Lijuan Wang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiaxi Lu
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yang Cao
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lichen Yang
- Key Laboratory of Trace Element Nutrition of National Health Committee, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Wai KM, Akuzawa R, Umeda Y, Munakata W, Takahashi Y, Nakaji S, Ihara K. Effects of body compositions on the associations between ferritin and diabetes parameters among Japanese community dwellers. J Trace Elem Med Biol 2023; 78:127174. [PMID: 37080017 DOI: 10.1016/j.jtemb.2023.127174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Ferritin is associated with an increased prevalence of diabetes mellitus. Moreover, the ferritin levels differ across the body compositions. Although there were studies reporting the association of ferritin and diabetes, the alteration in ferritin-diabetes association by body composition differences is rarely explained. Thus, the aim of this study is to identify the effects of body compositions on the association between ferritin and diabetes parameters among the Japanese population. METHODS This study analyzed the data of a cross-sectional study with 1065 subjects aged over 19 years in the Iwaki area, Japan. Independent variables were ferritin and body compositions, while dependent variables were blood sugar, HbA1c, and diabetes mellitus. Correlations between serum ferritin and blood sugar and HbA1c were analyzed using Spearman's Rank Correlation. Multivariate linear or logistic regressions were used to investigate the effects of body compositions (body fat percentage, muscle mass, or visceral fat level) on the ferritin-diabetes associations by adjusting the confounders. RESULTS There were significant positive correlations between ferritin and blood sugar in both sexes (p < 0.05), while a significant correlation between ferritin and HbA1c was found only in females (p < 0.001). Higher ferritin was significantly associated with an increase in blood sugar in individuals with normal body fat percentage (lowest vs. highest quartile group, coefficient=5.07, 95 % confidence intervals [CI]: 1.48-8.65), normal visceral fat level (lowest vs. highest quartile group, coefficient=4.84, 95 % CI: 1.74-7.94), and very high muscle mass (lowest vs. highest quartile group, coefficient=14.14, 95 % CI: 5.00-23.29). CONCLUSIONS By our study findings, individuals' body composition notably influenced the associations of serum ferritin and diabetes parameters, and the association was attenuated in obese individuals.
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Affiliation(s)
- Kyi Mar Wai
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Japan.
| | - Rei Akuzawa
- School of Medicine, Hirosaki University, Japan
| | - Yoko Umeda
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Japan
| | - Yoshiko Takahashi
- Center of Innovation, Research Initiatives Organization, Hirosaki University, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Japan; Center of Innovation, Research Initiatives Organization, Hirosaki University, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Japan
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Ding X, Bian N, Wang J, Chang X, An Y, Wang G, Liu J. Serum Ferritin Levels Are Associated with Adipose Tissue Dysfunction-Related Indices in Obese Adults. Biol Trace Elem Res 2023; 201:636-643. [PMID: 35297006 DOI: 10.1007/s12011-022-03198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023]
Abstract
Iron overload is associated with type 2 diabetes and metabolic syndrome. However, little is known about the role of iron status on adipose tissue. We aimed to investigate the association of iron metabolism markers with adipose tissue dysfunction-related indices in obese individuals. A total of 226 obese adults with body mass index (BMI) ≥ 30 kg/m2 were recruited into the study. Hemoglobin, serum ferritin, iron, soluble transferrin receptor (sTfR), total iron-binding capacity (TIBC), transferrin saturation (TSAT), and other clinical parameters were measured. Adipose tissue dysfunction was assessed by adipose tissue insulin resistance (adipose-IR), visceral adiposity index (VAI), and lipid accumulation product (LAP) index. Serum ferritin levels, adipose-IR, and VAI progressively increased from class I to class III obesity and significantly higher in class III obesity. Correlation analysis suggested that only serum ferritin levels were positively correlated with adipose-IR (r = 0.284, P < 0.001), VAI (r = 0.209, P = 0.002), and LAP (r = 0.324, P < 0.001). Moreover, further logistic regression analysis revealed serum ferritin was significantly associated with elevated adipose-IR, VAI, and LAP. After adjustment for potential confounders, serum ferritin levels remained independently associated with elevated adipose-IR (OR = 1.004, 95% CI 1.000-1.009, P < 0.05) and VAI (OR = 1.005, 95% CI 1.001-1.009, P < 0.05). Serum ferritin was associated with elevated adipose-IR, VAI, and LAP, suggesting that ferritin could be an important early indicator for the risk of developing adipose tissue dysfunction in obese individuals.
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Affiliation(s)
- Xiaoyu Ding
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China
| | - Nannan Bian
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China
| | - Jiaxuan Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China
| | - Xiaona Chang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China.
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang district, Beijing, 100020, China.
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Naeem M, Schipf S, Bülow R, Werner N, Dörr M, Lerch MM, Kühn JP, Rathmann W, Nauck M, Paulista Markus MR, Targher G, Ittermann T, Völzke H. Association between hepatic iron overload assessed by magnetic resonance imaging and glucose intolerance states in the general population. Nutr Metab Cardiovasc Dis 2022; 32:1470-1476. [PMID: 35282980 DOI: 10.1016/j.numecd.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM While there is evidence that iron overload disorders are associated with type 2 diabetes, the relationship between hepatic iron overload and prediabetes remains unclear. We aimed to investigate the association between hepatic iron overload, as assessed by magnetic resonance imaging (MRI), and different glucose intolerance states in the population-based Study. METHODS AND RESULTS We included data from 1622 individuals with MRI data, who did not have known type 2 diabetes (T2DM). Using an oral glucose tolerance testing, participants were classified as having isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT) or previously unknown T2DM. Hepatic iron and fat contents were assessed through quantitative MRI. We undertook linear and multinomial logistic regression models adjusted for potential confounders and MRI-assessed hepatic fat content to examine the association of hepatic iron overload with different glucose intolerance states or continuous markers of glucose metabolism. MRI-assessed hepatic iron overload was positively associated only with both 2-h plasma glucose (β = 0.32; 95%CI 0.04-0.60) and the combined IFG + IGT category (relative risk ratio = 1.87; 95%CI 1.15-3.06). No significant associations were found between hepatic iron overload and other glucose intolerance states or biomarkers of glucose metabolism, independently of potential confounders. CONCLUSIONS MRI-assessed hepatic iron overload was associated with higher 2-h glucose concentrations and the combined IFG + IGT category, but not with other glucose intolerance states. Our findings suggest a weak adverse impact of hepatic iron overload on glucose metabolism, but further studies are needed to confirm these findings.
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Affiliation(s)
- Muhammad Naeem
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Zoology, University of Malakand, 18800, Pakistan.
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany
| | - Nicole Werner
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany
| | - Markus M Lerch
- Department of Gastroenterology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Dresden, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Matthias Nauck
- Institute for Laboratory Medicine and Clinical Chemistry, University Medicine Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
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Suárez-Ortegón MF, McLachlan S, Fernandez-Real JM, Tuomainen TP, Aregbesola A, Wild SH. Serum ferritin and incident cardiometabolic diseases in Scottish adults. Cardiovasc Diabetol 2022; 21:26. [PMID: 35172838 PMCID: PMC8851777 DOI: 10.1186/s12933-022-01450-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Background Iron stores, estimated as ferritin levels, and type 2 diabetes (T2D) have been associated previously, while findings regarding coronary heart disease (CHD) and cerebrovascular disease (CEVD) are still inconclusive. No study has focused on simultaneous evaluation of associations between iron stores and the above cardiometabolic diseases (CMD) in the same population. We aim to evaluate the association between serum ferritin and risk of T2D, CHD and CEVD in Scottish population over a wide range of ferritin levels. Methods Longitudinal study in 6,497 participants of the 1995 and 1998 Scottish health surveys, who were followed-up until 2011. Cox regression models were conducted adjusting for age, sex/menopausal status, fibrinogen, GGT levels, smoking, alcohol consumption, total cholesterol, HDL-cholesterol, blood pressure, and BMI. Ferritin was used as continuous (sex/menopausal status-specific Z score) and categorical variable (sex/menopausal status-specific quartiles, quintiles and sextiles). Results During follow-up, 4.9% of the participants developed T2D, 5.3% CHD, and 2.3% CEVD. By using ferritin quartiles, serum ferritin was positively associated with T2D, CHD and CEVD but only the association with T2D remained after adjustment for covariates [Quartile 4 v. 1: adjusted HR 95% CI 1.59 (1.10–2.34); P = 0.006]. When ferritin sextiles were used (6 v. 1), the ferritin-CEVD association became slightly stronger and significant [adjusted HR 95% CI 2.08 (1.09–3.94); P = 0.024]. Conclusions Iron stores relate differently to each CMD. Serum ferritin levels were positively and independently associated with incident T2D, and with incident CEVD if higher cut-off points for high ferritin levels were considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01450-7.
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Affiliation(s)
- Milton-Fabian Suárez-Ortegón
- Departamento de Alimentación Y Nutrición, Facultad de Ciencias de La Salud, Pontificia Universidad Javeriana Seccional Cali, Calle 18 No. 118-250, Cali, Colombia. .,Grupo de Investigación en Ciencias Básicas Y Clínicas de La Salud, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Cali, Colombia.
| | | | - José-Manuel Fernandez-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBERobn Fisiopatología de La Obesidad Y Nutrición (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), and Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alex Aregbesola
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Paediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Sakuma Y, Ogino J, Iwai R, Inoue T, Takahashi H, Suzuki Y, Kinoshita D, Takemura K, Takahashi H, Shimura H, Sato Y, Yoshida S, Hashimoto N. Hyperferritinemia Is a Predictor of Onset of Diabetes in Japanese Males Independently of Decreased Renal Function and Fatty Liver: A Fifteen-Year Follow-Up Study. J Clin Med Res 2022; 13:541-548. [PMID: 35059072 PMCID: PMC8734509 DOI: 10.14740/jocmr4635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Type 2 diabetes is an important health concern worldwide. The disease etiology may depend on multiple environmental and genetic factors that cause insulin resistance, including dysregulation of iron storage. The goal of this study was to examine the relationship of the serum ferritin concentration with onset of diabetes over a long period. Methods Correlations of serum ferritin and metabolic markers with onset of diabetes mellitus were examined over 15 years in 150 males participating in a health screening program. Results HOMA-β showed a gradual significant decrease in the first 4 years in subjects with ferritin > 190 ng/mL (group H) compared to those with ferritin ≤ 190 ng/mL, but there was no difference in HOMA-R between these groups. A significant number of cases with onset of diabetes was observed over 15 years (hazard ratio (HR): 3.97), and obesity, fasting blood glucose level, hemoglobin A1c (HbA1c), HOMA-R, fasting immunoreactive insulin (IRI) and C-peptide immunoreactivity (CPR) were all significant in univariate comparison between non-diabetes and diabetes-onset groups. In multivariate analysis, ferritin in group H (HR: 3.25), fatty liver (HR: 3.38), estimated glomerular filtration rate (eGFR) < 70 mL/min/1.73 m2 (HR: 3.48) and high-density lipoprotein (HDL) < 40 mg/dL (HR: 2.61) were significant predictive factors for onset of type 2 diabetes mellitus. Conclusions These results suggest that the serum ferritin level is an important index for priority intervention in preventive medicine for reduction of onset of diabetes.
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Affiliation(s)
- Yukie Sakuma
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Jun Ogino
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Chiba, Japan
| | - Rie Iwai
- Department of Clinical Laboratory, Asahi General Hospital, Chiba, Japan
| | - Takashi Inoue
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Haruo Takahashi
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Yoshifumi Suzuki
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Chiba, Japan
| | - Daisuke Kinoshita
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Chiba, Japan
| | - Koji Takemura
- Department of Diabetes and Metabolic Diseases, Asahi General Hospital, Chiba, Japan
| | - Hidenori Takahashi
- Preventive Medicine Research Center, Asahi General Hospital, Chiba, Japan
| | - Haruhisa Shimura
- Preventive Medicine Research Center, Asahi General Hospital, Chiba, Japan.,Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Shouji Yoshida
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Naotake Hashimoto
- Preventive Medicine Research Center, Asahi General Hospital, Chiba, Japan
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Kim J, Woo HW, Shin MH, Kim YM, Lim JE, Oh B, Song DS, Koh I, Kim MK. Genome-wide gene and serum ferritin interaction in the development of type 2 diabetes in adults aged 40 years or older. Nutr Metab Cardiovasc Dis 2022; 32:231-240. [PMID: 34916119 DOI: 10.1016/j.numecd.2021.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Elevated serum ferritin is associated with incident Type 2 diabetes (T2D), but the interactions between serum ferritin and genetic factors which may improve understanding underlying mechanism in the development of T2D are still unclear. We determined the gene-ferritin interactions on the development of T2D by genome-wide gene-ferritin interaction analyses. METHODS AND RESULTS A total of 3405 participants from two prospective cohorts of community living residents were included, and the median follow-time was 3.99 years. Genome-wide gene-ferritin interactions were analyzed using the joint test with two degrees of freedom and the interaction test with one degree of freedom. There were 18 SNPs selected in the joint test. Finally, four independent variants [rs355140 (LINC00312), rs4075576 (nearby PDGFA), rs1332202 (PTPRD), and rs713157 (nearby LINC00900)] with low pairwise linkage disequilibrium (r2<0.2) and located at least 1000 kb from the index SNP showed interactions with serum ferritin level. In the association analyses between serum ferritin levels (tertiles of ferritin and ferritin status) and the incidence of T2D according to genotype, the Incidence Rate Ratios (IRRs) in the highest tertile of ferritin level (vs. the lowest tertile) were greater for participants with heterozygotes of risk alleles of each of the four SNP than IRRs for those with wild type. Compared with the normal group, the elevated ferritin group also had a higher risk of T2D for all genetic variants of risk alleles, particularly its homozygotes. CONCLUSION Serum ferritin level interacts with genetic variants (rs355140, rs4075576, rs1332202, and rs713157) in the development of T2D.
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Affiliation(s)
- Jihye Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Hye Won Woo
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - Ji Eun Lim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Bermseok Oh
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Dae Sub Song
- Division of Epidemiology and Health Index, Center for Genome Science, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, South Korea
| | - Insong Koh
- Department of Physiology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea.
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Association of dyslipidemia, diabetes and metabolic syndrome with serum ferritin levels: a middle eastern population-based cross-sectional study. Sci Rep 2021; 11:24080. [PMID: 34916585 PMCID: PMC8677797 DOI: 10.1038/s41598-021-03534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022] Open
Abstract
Elevated serum ferritin (SFer) levels are implicated in many energy metabolism abnormalities. The association between SFer levels and metabolic disorders has not been studied in Middle Eastern populations. We aimed at exploring the association between SFer levels and serum lipids, diabetes determinants, and metabolic syndrome in a sample of Qatari adults. This study used biochemical parameters obtained from 1928 participants from the Qatar Biobank cohort. We utilized adjusted multivariable logistic regression analysis to estimate the odds ratios (ORs) for dyslipidemia, type 2 diabetes, the homeostasis model assessment of insulin resistance (HOMA-IR), and metabolic syndrome (MetS) according to sex-specific SFer quartiles (Q1 to Q4). Results revealed that the ORs for dyslipidemia increased progressively and significantly across the SFer quartiles, up to two folds in Q4 for women (OR 2.47 (1.68–3.62)) and men (OR 2.24 (1.41–3.55)) versus Q1 (OR:1). Exclusively in women, the ORs for IR (HOMA-IR > 3.58) increased significantly in Q4 (OR 1.79 (1.19–2.70)) versus OR 1 in Q1 as did the ORs for diabetes (OR: 2.03 (1.15–3.57) in Q4 versus OR 1 in Q1). We observed the same result when we pooled the participants with prediabetes and diabetes in one group. The OR for MetS also increased significantly across the Sfer Quartiles from OR: 1 in Q1 to 1.92 (1.06–3.02) in Q4 for women and to 2.07 (1.08–3.98) in Q4 in men. Our results suggest the elevated Sfer levels as a potential risk biomarker for dyslipidemia and MetS in adult Qatari men and women, and diabetes and IR in women only.
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Pitchika A, Kühn JP, Schipf S, Nauck M, Dörr M, Lerch MM, Kromrey ML, Felix SB, Markus MRP, Rathmann W, Völzke H, Ittermann T. Hepatic steatosis and hepatic iron overload modify the association of iron markers with glucose metabolism disorders and metabolic syndrome. Liver Int 2021; 41:1841-1852. [PMID: 33683798 DOI: 10.1111/liv.14868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iron status has been linked with impaired glucose metabolism (IGM), type 2 diabetes mellitus (T2DM) and the metabolic syndrome (MetS), but the role of hepatic steatosis or iron overload on these associations remains uncertain. METHODS We analysed data from 2310 participants without known T2DM of the population-based Study of Health in Pomerania (SHIP-TREND, Germany) through logistic regression models. We tested additive and multiplicative interactions between ferritin and hepatic steatosis or iron overload. RESULTS Serum ferritin was positively associated with IGM (OR per 100 µg/L: 1.11 [1.01, 1.23]), T2DM (OR per 100 µg/L: 1.20 [1.06, 1.36]) and MetS (OR per 100 µg/L: 1.11 [1.02, 1.20]) in the total population as well as in participants without hepatic iron overload. However, the synergistic effect of higher ferritin concentrations and hepatic iron overload showed stronger associations with IGM and T2DM. Similarly, while ferritin was positively associated with T2DM and MetS even in the absence of hepatic steatosis, the synergistic effect of higher ferritin concentrations and hepatic steatosis showed stronger associations with IGM, T2DM and MetS. Transferrin was associated with isolated impaired glucose tolerance but not with T2DM and MetS. CONCLUSIONS Our study suggests that ferritin may be associated with glucose metabolism disorders and MetS even in people without hepatic steatosis or iron overload. However, in individuals with higher ferritin concentrations, the presence of hepatic steatosis may indicate stronger risk for glucose metabolism disorders and MetS, while the presence of hepatic iron overload may indicate stronger risk only for glucose metabolism disorders.
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Affiliation(s)
- Anitha Pitchika
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Marcello R P Markus
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany
| | - Wolfgang Rathmann
- DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany.,Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Düsseldorf, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany.,DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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10
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Wen S, Sha Y, Li Y, Rui Z, Si C, Zhou Y, Yan F, Wang B, Hu J, Han X, Shi D. Serum Iron and Ferritin Levels Are Correlated with Complement C3. Biol Trace Elem Res 2021; 199:2482-2488. [PMID: 32935207 DOI: 10.1007/s12011-020-02379-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
Iron is one of the most important trace elements in the body, and its homeostasis is essential to the normal function of the immune system. Complement component C3, which is the converging of three main pathways of complement system activation, plays a key role in the innate immunity. However, the relationship between iron homeostasis and complement C3 remains unknown. The aim of our study was to analyze the relationship between serum iron and ferritin level and complement C3 and C4. A total of 590 healthy individuals were recruited in our study. Higher serum complement C3 level (p < 0.001) was found in individuals with higher serum ferritin level (> 104.0 μg/L). Moreover, serum iron level and serum ferritin level were positively correlated with complement C3 (r = 0.133, p = 0.001; r = 0.221, p < 0.001) and complement C4 (r = 0.117, p = 0.004; r = 0.123, p = 0.003). The linear regression analysis displayed that both serum iron level and serum ferritin level were linearly correlated with serum complement C3 level (adjusted beta: 2.382, 95% CI: 0.841-3.923; adjusted beta: 42.911, 95% CI: 29.070-56.751). To explore the relationship between iron homeostasis and complement C3 further, the serum samples from C3-/- mice and the wild-type (WT) control mice were obtained. Significantly lower serum iron level and higher ferritin level were found in C3-/- mice than those in WT mice (p < 0.001; p < 0.001), indicating that complement C3 might influence iron distribution and utilization. Overall, these data suggested that serum iron and ferritin levels were correlated with complement C3. The deficiency of complement C3 may disrupt the regular iron metabolism in the body.
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Affiliation(s)
- Shuang Wen
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Yeqin Sha
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Yinling Li
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Zhilian Rui
- Department of Laboratory Medicine, Liyang People's Hospital, Liyang, 213300, Jiangsu, China
| | - Chenhong Si
- Department of Pediatrics, Liyang Women and Children Health Hospital, Liyang, 213000, Jiangsu, China
| | - Yuning Zhou
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Fengfeng Yan
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Bicheng Wang
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Jingming Hu
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Xu Han
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Dongyan Shi
- Department of Immunology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.
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11
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Zhang J, Cao J, Xu H, Dong G, Huang K, Wu W, Ye J, Fu J. Ferritin as a key risk factor for nonalcoholic fatty liver disease in children with obesity. J Clin Lab Anal 2020; 35:e23602. [PMID: 33249617 PMCID: PMC7891541 DOI: 10.1002/jcla.23602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background The association between serum ferritin and nonalcoholic fatty liver disease (NAFLD) in children with obesity is not clear. This study was designed to investigate whether serum ferritin can be an independent predictor for NAFLD. Methods According to the hepatic ultrasound results, a total of 347 children with obesity were enrolled in this study. Among them, 95 patients with NAFLD and 95 without NAFLD were matched for gender, age, blood pressure and body mass index, the odds ratios (OR) and 95% confidence intervals (CI) for the association of ferritin and the risk of NAFLD were analyzed. Results After propensity score matching, ferritin values of the patients with NAFLD were significantly higher than those without NAFLD group. Alanine aminotransferase and ferritin were strongly associated with NAFLD in multivariate stepwise logistic regression analysis. The medium and high levels of ferritin increased risk of NAFLD, and the adjusted ORs were 3.298 (95% CI:1.326‐8.204), 7.322 (95% CI:2.725‐19.574) across the ferritin concentration tertiles after adjustment for confounders. Ferritin was shown to be the best predictor for NAFLD with sensitivity and specificity of 60.0% and 77.9%, respectively, area under the curve was 0.733. Conclusion The results show that serum ferritin can usefully be considered as a predictor of NAFLD in children with obesity.
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Affiliation(s)
- Junfeng Zhang
- Department of Clinical Laboratory, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiajia Cao
- Department of Clinical Laboratory, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Hui Xu
- Department of Clinical Laboratory, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endocrinology, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China
| | - Ke Huang
- National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endocrinology, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China
| | - Wei Wu
- National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endocrinology, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China
| | - Jingjing Ye
- National Clinical Research Center for Child Health, Hangzhou, China.,Department of Ultrasound, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China
| | - Junfen Fu
- National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endocrinology, School of Medicine, The Children's Hospital, Zhejiang University, Zhejiang, China
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12
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Pitchika A, Schipf S, Nauck M, Dörr M, Lerch MM, Felix SB, Markus MRP, Völzke H, Ittermann T. Associations of iron markers with type 2 diabetes mellitus and metabolic syndrome: Results from the prospective SHIP study. Diabetes Res Clin Pract 2020; 163:108149. [PMID: 32304796 DOI: 10.1016/j.diabres.2020.108149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 01/29/2023]
Abstract
AIMS To assess the role of serum ferritin and transferrin with prevalent and incident type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) and whether these associations are independent of inflammatory markers and hepatic enzymes. METHODS We analyzed data from 3,232 participants aged 20-81 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 10.6 years. Logistic and Cox regression analyses were performed. RESULTS Serum ferritin concentrations were associated with a higher prevalence of T2DM (total population OR: 1.16 [95% CI: 1.07, 1.26]; men OR: 1.18 [95% CI: 1.08, 1.30) and MetS (total population OR: 1.27 [95% CI: 1.16, 1.38]; men OR: 1.26 [95% CI: 1.15, 1.38]) in the total population and men independently of inflammatory markers and hepatic enzymes. In longitudinal analyses, baseline ferritin concentrations were associated with a higher risk of incident T2DM in women (HR: 1.38 [95% CI: 1.10, 1.71]), but not in men or in the total population and also with a higher risk of incident MetS (HR: 1.09 [95% CI: 1.01, 1.17]) in the total population. These longitudinal associations attenuated considerably after adjustment for hepatic enzymes but not inflammatory markers. Transferrin was not associated with any of the outcomes. CONCLUSIONS Our results suggest a link between ferritin and T2DM and MetS, which might be partially explained by hepatic dysfunction.
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Affiliation(s)
- Anitha Pitchika
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research (DZHK e.V.), Partner site Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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13
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Akter S, Kuwahara K, Matsushita Y, Nakagawa T, Konishi M, Honda T, Yamamoto S, Hayashi T, Noda M, Mizoue T. Serum 25-hydroxyvitamin D3 and risk of type 2 diabetes among Japanese adults: the Hitachi Health Study. Clin Nutr 2020; 39:1218-1224. [DOI: 10.1016/j.clnu.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 12/31/2022]
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14
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Jiang L, Wang K, Lo K, Zhong Y, Yang A, Fang X, Akezhuoli H, Song Z, Chen L, An P, Xu M, Min J, Wang F. Sex-Specific Association of Circulating Ferritin Level and Risk of Type 2 Diabetes: A Dose-Response Meta-Analysis of Prospective Studies. J Clin Endocrinol Metab 2019; 104:4539-4551. [PMID: 31074789 DOI: 10.1210/jc.2019-00495] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
CONTEXT Although the role of iron in the development of type 2 diabetes (T2D) has long been a concern, prospective studies directly linking body iron stores to T2D risk in a sex-dependent context have been inconsistent. OBJECTIVE A systematic meta-analysis was conducted to explore the sex-specific association of circulating ferritin with T2D risk. DATA SOURCES We searched PubMed, Web of Science, and EMBASE databases to identify available prospective studies through 1 August 2018. RESULTS Fifteen prospective studies comprising 77,352 participants and 18,404 patients with T2D, aged 20 to 80 years, and with ∼3 to 17 years of follow-up were identified. For each 100-μg/L increment in ferritin levels of overall participants, T2D risk increased by 22% (RR, 1.22; 95% CI, 1.14 to 1.31). Of note, major heterogeneities by sex were identified, with increased ferritin level having an apparently greater effect on T2D risk in women (RR, 1.53; 95% CI, 1.29 to 1.82) than in men (RR, 1.21; 95% CI, 1.15 to 1.27) after exclusion of a study with high heterogeneity (41,512 men and 6974 women for sex-specific analyses; P = 0.020 for sex difference). Further nonlinear analysis between circulating ferritin and T2D risk also showed sex-dimorphic association in that the T2D risk of women was twice as strong in magnitude as that of men at the same ferritin level. CONCLUSIONS Greater circulating ferritin levels were independently associated with increased T2D risk, which appeared stronger among women than men. Our findings provide prospective evidence for further testing of the utility of ferritin levels in predicting T2D risk in a sex-specific manner.
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Affiliation(s)
- Li Jiang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
- The First Affiliated Hospital, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kai Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Kenneth Lo
- Departments of Cardiology and Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Yueyang Zhong
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Aimin Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Kong Kong SAR, China
| | - Xuexian Fang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hailati Akezhuoli
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Zijun Song
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyun Chen
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng An
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
| | - Mingqing Xu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China
| | - Junxia Min
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Fudi Wang
- The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
- The First Affiliated Hospital, School of Public Health, Zhengzhou University, Zhengzhou, China
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15
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Chen S, Akter S, Kuwahara K, Matsushita Y, Nakagawa T, Konishi M, Honda T, Yamamoto S, Hayashi T, Noda M, Mizoue T. Serum amino acid profiles and risk of type 2 diabetes among Japanese adults in the Hitachi Health Study. Sci Rep 2019; 9:7010. [PMID: 31065046 PMCID: PMC6504928 DOI: 10.1038/s41598-019-43431-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/24/2019] [Indexed: 12/25/2022] Open
Abstract
Amino acids have emerged as novel biomarkers for predicting type 2 diabetes (T2D), but the epidemiologic data linking circulating amino acid profiles with T2D are sparse in Asian populations. We conducted a nested case-control study within a cohort of 4,754 nondiabetic Japanese employees who attended a comprehensive health checkup in 2008-2009 and agreed to provide blood samples. During a 5-year follow-up, incident T2D cases were ascertained based on plasma glucose, glycated hemoglobin, and self-report. Two controls matched to each case on sex, age, and the date of serum sampling were randomly selected by using density sampling, resulting in 284 cases and 560 controls with amino acid measures. High concentrations of valine, leucine, isoleucine, phenylalanine, tyrosine, alanine, glutamate, ornithine, and lysine were associated with an increased risk of incident T2D, in a linear manner. High glutamine concentrations were associated with a decreased risk of incident T2D. Further adjustment for the homeostasis model assessment of insulin resistance attenuated these associations. Overall, these amino acids may be novel useful biomarkers in the identification of people at risk of T2D before overt symptoms. Insulin resistance may account for or mediate the relationship between these amino acids and risk of incident T2D.
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Affiliation(s)
- Sanmei Chen
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Shamima Akter
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.,Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Yumi Matsushita
- Department of Clinical Research, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi, Ltd., Ibaraki, Japan
| | - Maki Konishi
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd., Ibaraki, Japan
| | | | | | - Mitsuhiko Noda
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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16
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Khorasani V, Jeddi S, Yaghmaei P, Tohidi M, Ghasemi A. Effect of long-term sodium nitrate administration on diabetes-induced anemia and glucose homeostasis in obese type 2 diabetic male rats. Nitric Oxide 2019; 86:21-30. [DOI: 10.1016/j.niox.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 01/20/2023]
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17
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Liu JR, Liu Y, Yin FZ, Liu BW. Serum ferritin, an early marker of cardiovascular risk: a study in Chinese men of first-degree relatives with family history of type 2 diabetes. BMC Cardiovasc Disord 2019; 19:82. [PMID: 30943893 PMCID: PMC6448272 DOI: 10.1186/s12872-019-1068-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ferritin is one of the key proteins that regulate iron homeostasis and is widely available clinical biomarker of iron status. This study aimed to discuss the influence of serum ferritin (SF) on cardiovascular risk factors in the first-degree relatives with family history of type 2 diabetes (FHD). METHODS This cross-sectional study included 232 men. Anthropometric measurements and blood samples were analyzed. The people were divided into four groups according to median SF (102.8 ng/ml) and people with or without FHD. Group A (FHD-and low SF), group B (FHD-and high SF), group C (FHD+ and low SF), and group D (FHD+ and high SF). RESULTS The subjects in different categories of SF concentrations showed significant differences in BMI (SF main effect: P = 0.010), WC (P = 0.030), SBP (P < 0.001), FPG (P < 0.001), PPG-2 h (P < 0.001), FINS (P < 0.001), and HOMA-IR (P = 0.015; all: 2-way ANOVA). There was a significant difference in SBP (FHD main effect: P = 0.003), DBP (P = 0.006), and FINS (P = 0.013, all: 2-way ANOVA) between the groups with or without FHD. The interaction term between SF and FHD was significant for SBP (P = 0.011), DBP (P = 0.012), and PPG-2 h (P = 0.022). Logistic analysis showed that accumulation of CVD risk factors, which were ≥ 2 items and ≥ 3 items in group D were 7.546 and 3.343 times higher compared with group A (P < 0.05). CONCLUSIONS The increased SF levels increased the risk of cardiovascular risk factors and the occurrence of insulin resistance in first-degree relatives with FHD.
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Affiliation(s)
- Jun-Ru Liu
- Department of Endocrinology, Qinhuangdao First Hospital, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Yang Liu
- Department of General Surgery, Qinhuangdao First Hospital, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Fu-Zai Yin
- Department of Endocrinology, Qinhuangdao First Hospital, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Bo-Wei Liu
- Department of Endocrinology, Qinhuangdao First Hospital, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China.
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18
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Munasinghe LL, Ekwaru JP, Mastroeni MF, Mastroeni SSBS, Veugelers PJ. The association of serum 25-hydroxyvitamin D concentrations with elevated serum ferritin levels in normal weight, overweight and obese Canadians. PLoS One 2019; 14:e0213260. [PMID: 30845159 PMCID: PMC6405102 DOI: 10.1371/journal.pone.0213260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/19/2019] [Indexed: 12/31/2022] Open
Abstract
In light of the growing body of literature suggesting a beneficial effect of vitamin D on inflammatory response, we hypothesized that vitamin D affects serum ferritin (SF), a biomarker of inflammation. The objective of the present study is to examine the association of serum 25-hydroxyvitamin D [25(OH)D] with elevated SF concentrations indicative of inflammation as no earlier study has done so. Data from 5550 Canadian adults who participated in the 2012/2013 and the 2014/2015 Canadian Health Measures Surveys were analysed. We observed that 9.4% of Canadian adults have elevated SF concentrations and that 35.6% were vitamin D insufficient. Among Canadians with under/normal body weights, those with serum 25(OH)D ≥ 75 nmol/L relative to those with serum 25(OH)D < 50 nmol/L, were substantially less at risk for elevated SF concentrations (OR = 0.24; 95% CI = 0.06, 0.89; p = 0.034). We did not observe this association for overweight and obese Canadians. Canadians of older age, non-white ethnicity, males, those with income above $100,000, those who consumed alcohol, and those with high total cholesterol concentrations and elevated blood pressures were more likely to have elevated SF concentrations. Serum 25(OH)D ≥ 75 nmol/L is likely to provoke anti-inflammatory benefits, but intervention studies that achieve high 25(OH)D concentrations and with long follow up are needed to establish the role of vitamin D on SF.
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Affiliation(s)
| | - John P. Ekwaru
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Marco F. Mastroeni
- Post-graduation Program in Health and Environment, University of Joinville Region, Joinville, Brazil
| | | | - Paul J. Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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19
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Li J, Xiao C, Yang H, Zhou Y, Wang R, Cao Y. Anemia and Iron Status Among Different Body Size Phenotypes in Chinese Adult Population: a Nation-Wide, Health and Nutrition Survey. Biol Trace Elem Res 2018; 185:1-10. [PMID: 29224080 DOI: 10.1007/s12011-017-1213-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
Previous studies have shown that there is a controversial relationship between iron homeostasis and obesity. This study aims to explore the relationship of anemia and iron status with different body size phenotypes in adult Chinese population. Using information on iron status-related parameters and lifestyle data from 8462 participants of the 2009 wave of China Health and Nutrition Survey (2009 CHNS), we performed multivariable logistic regression analyses to estimate the odds ratios (ORs) for the risk of anemia and iron parameters according to different body size phenotypes. Participants with higher body mass index (BMI) had a lower anemia prevalence with significant trends in both metabolic status groups (P < 0.001). Serum ferritin, transferrin, and soluble transferrin receptor (sTfR)/log ferritin index were significant in different metabolic status groups and in different body size phenotypes, respectively. The ORs for higher ferritin and transferrin increased across different body size phenotypes in both genders, and for sTfR/log ferritin index decreased (P < 0.01 for trend). This association was still statistically significant after adjustment for multiple confounders. We found an inverse association of BMI levels with the prevalence of anemia and strong association of serum ferritin and transferrin with higher risk of obesity or overweight in both metabolic status groups.
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Affiliation(s)
- Jiang Li
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China.
| | - Cheng Xiao
- China-Japan Friendship Hospital, Institute of Clinical Medicine, Beijing, 100029, China
| | - Hui Yang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China
| | - Yun Zhou
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China
| | - Rui Wang
- Blood Screening Laboratory, Beijing Red Cross Blood Center, Beijing, 100088, China
| | - Yongtong Cao
- Department of Laboratory Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Rd, Beijing, 100029, China.
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20
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Oh HL, Lee JA, Kim DH, Lim JS. Reference values for serum ferritin and percentage of transferrin saturation in Korean children and adolescents. Blood Res 2018; 53:18-24. [PMID: 29662858 PMCID: PMC5898989 DOI: 10.5045/br.2018.53.1.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/13/2017] [Accepted: 09/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Ferritin reference values vary by age, gender, and ethnicity. We aimed to determine reference values of serum ferritin (SF) and the percentage of transferrin saturation (TSAT) for Korean children and adolescents. Methods We analyzed data from 2,487 participants (1,311 males and 1,176 females) aged 10-20 years from the Korea National Health and Nutrition Examination Survey (2010-2012). We calculated age- and gender-stratified means and percentile values for SF and TSAT. Results We first plotted mean SF and TSAT by gender and according to age. In males, mean SF tended to be relatively constant among participants aged 10 to 14 years, with an upward trend thereafter. Mean SF trended downward among female participants until the age of 15 years and remained constant thereafter. Thus, significant gender differences in ferritin exist from the age of 14 years. High levels of SF were associated with obesity, and lower SF levels were associated with anemia and menarche status. Conclusion We established reference values of SF and TSAT according to age and gender. The reference values for SF calculated in this study can be used to test the association between SF values and other defined diseases in Korean children and adolescents.
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Affiliation(s)
- Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Dong Ho Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
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21
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Li J, Bao W, Zhang T, Zhou Y, Yang H, Jia H, Wang R, Cao Y, Xiao C. Independent relationship between serum ferritin levels and dyslipidemia in Chinese adults: A population study. PLoS One 2017; 12:e0190310. [PMID: 29272309 PMCID: PMC5741262 DOI: 10.1371/journal.pone.0190310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Several studies have indicated that elevated levels of circulating ferritin are associated with disturbances in energy metabolism. But none of this gave a clearly pathologic mechanism. We aimed to explore the independent relationship between serum ferritin levels and dyslipidemia. Methods We performed multivariable logistic regression analyses to estimate the odds ratios (ORs) for dyslipidemia, lipid parameters, the homeostasis model assessment of insulin resistance (HOMA-IR) and the risk of diabetes, according to sex-specific quartiles of serum ferritin by using the data of China Health and Nutrition Survey (2009 CHNS). We used three models to estimate the strength of the correlation. The basic model (Model 1) is without adjustment and the Model 2 and Model 3 are adjusted for demographic, anthropometric, and lifestyle confounding factors. Results In both genders, the ORs for high TG level, TC level and LDL-C level increased progressively and for HDL-C decreased across the ferritin quartiles (P<0.001 for trend). After adjustment for confounding factors in different logistic regression models, the results remained unchanged. The ORs for the risk of diabetes and high HOMA-IR level in the highest quartile group of serum ferritin levels were significantly increased in Model 1, but after adjustment for lipid parameters, the ORs for the risk of diabetes was decreased from 1.91 (95% CI: 1.37–2.67; P<0.001 for trend) to 1.48 (95% CI: 1.03–2.12; P = 0.036 for trend) in men, and from 5.40 (95% CI: 3.38–8.63; P<0.001 for trend) to 1.43 (95% CI: 0.83–2.43; P = 0.498 for trend) in women, and the ORs for IR was decreased from 1.86 (95% CI: 1.57–2.20; P<0.001 for trend) to 1.25 (95% CI: 1.05–1.50; P = 0.114 for trend) in men, and from 1.93 (95% CI: 1.63–2.28; P<0.001 for trend) to 1.24 (95% CI: 1.01–1.51; P = 0.012 for trend) in women. Conclusion Our results provide evidence that serum ferritin levels are significantly associated with lipid parameters, independent of glucose metabolism disorders and components of metabolic syndrome (MetS). Thus, serum ferritin plays a key role in energy metabolism disorders and may affect glucose metabolism through lipid metabolism.
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Affiliation(s)
- Jiang Li
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weimin Bao
- Community Health Service Center of Hepingli of Dongcheng District, Beijing, China
| | - Tie Zhang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yun Zhou
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Hui Yang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Hongbing Jia
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Rui Wang
- Blood Screening Laboratory, Beijing Red Cross Blood Center, Beijing, China
| | - Yongtong Cao
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (YC); (CX)
| | - Cheng Xiao
- Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (YC); (CX)
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22
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Wang YL, Koh WP, Yuan JM, Pan A. Plasma ferritin, C-reactive protein, and risk of incident type 2 diabetes in Singapore Chinese men and women. Diabetes Res Clin Pract 2017; 128:109-118. [PMID: 28448891 DOI: 10.1016/j.diabres.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/31/2017] [Accepted: 04/07/2017] [Indexed: 01/05/2023]
Abstract
AIMS Ferritin is postulated to be involved in diabetogenesis as a marker of iron stores. We prospectively examined the association between ferritin levels and type 2 diabetes (T2D) risk in a Chinese population. METHODS Plasma ferritin concentrations were assayed among 485 diabetes cases and 485 controls nested within the Singapore Chinese Health Study. Cases and controls were matched on age, gender, date of blood collection, and dialect group. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at blood collection (1999-2004). Incident self-reported T2D cases were identified at follow-up II interview (2006-2010). Multivariable conditional logistic regression models were used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs). RESULTS After adjusting for T2D risk factors, including high-sensitivity C-reactive protein (hs-CRP), adiponectin, triglycerides, HDL cholesterol and alanine aminotransferase, the OR comparing the highest versus lowest quartile of ferritin levels was 1.87 (95% CI 1.10-3.19) (P-trend=0.004). When the analysis was limited to participants with hs-CRP<1.5mg/L (below median; n=482), the OR comparing extreme quartiles of ferritin levels was 1.16 (95% CI 0.62-2.16; P-trend=0.63); while the corresponding OR was 2.51 (95% CI 1.31-4.79; P-trend<0.001) when confined to those with hs-CRP≥1.5mg/L (n=488; P-interaction=0.022). Compared to participants with both ferritin and hs-CRP levels below median, those with both levels above median had markedly increased T2D risk (P-interaction for multiplicative scale=0.037). CONCLUSIONS The elevation of blood ferritin levels, in the presence of raised hs-CRP, was significantly associated with increased risk of T2D.
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Affiliation(s)
- Ye-Li Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549, Singapore.
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549, Singapore; Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
| | - An Pan
- Department of Epidemiology and Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430030, China.
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Akter S, Nanri A, Kuwahara K, Matsushita Y, Nakagawa T, Konishi M, Honda T, Yamamoto S, Hayashi T, Noda M, Mizoue T. Circulating ferritin concentrations and risk of type 2 diabetes in Japanese individuals. J Diabetes Investig 2017; 8:462-470. [PMID: 28060459 PMCID: PMC5497053 DOI: 10.1111/jdi.12617] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/16/2016] [Accepted: 01/01/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS/INTRODUCTION Higher iron storage has been linked to an increased risk of type 2 diabetes, but little is known about the mediator of this association. Here, we prospectively investigated the association between circulating ferritin, a marker of iron storage, and the incidence of type 2 diabetes among Japanese individuals. MATERIALS AND METHODS The participants were 4,754 employees who attended a comprehensive health check-up in 2008-2009 and donated blood for the study. During 5 years of follow up, diabetes was identified based on plasma glucose, glycated hemoglobin and self-report. Two controls matched to each case on sex, age and date of check-up were randomly chosen using density sampling, giving 327 cases and 641 controls with ferritin measurement. Cox proportional hazards regression was used to estimate the hazard ratio while adjusting for a series of potential confounders or mediators. RESULTS Elevated serum ferritin levels were associated with a significantly increased risk of type 2 diabetes, with the hazard ratio adjusted for known risk factors in the highest vs lowest quartile of 1.42 (95% confidence interval: 1.03-1.96). This association was unchanged after adjustment for C-reactive protein and adiponectin, but attenuated after adjustment for liver enzyme and insulin resistance (hazard ratio 1.04). The ferritin-diabetes association was confined to non-obese participants. CONCLUSIONS These results suggest that elevated iron storage is associated with increased risk of type 2 diabetes in normal weight individuals, and that this association is partly mediated through liver dysfunction and resulting insulin resistance.
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Affiliation(s)
- Shamima Akter
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiko Nanri
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.,Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Yumi Matsushita
- Department of Clinical Research Coordination, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi, Ltd., Ibaraki, Japan
| | - Maki Konishi
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd., Ibaraki, Japan
| | | | | | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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