Document Type : Original Article
Authors
1 Department of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan
2 Department of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: Some studies have shown that increased rate of iron stores even in a normal
range may increase cardiovascular diseases (CVDs) in some individuals. Lipid disorders are
also the risk factors for CVDs. Therefore, the question is whether or not iron store is correlated
with lipid profile, this study evaluates the association between dietary iron, iron stores and serum
lipid profiles. Materials and Methods: This cross-sectional study was done on 82 healthy
university students and university staff females in Isfahan University of Medical Sciences who
were in reproductive age and announced their readiness to participate in the study. Serum
ferritin concentration, components of lipid profile, blood glucose, and insulin were measured in
all the subjects. Dietary intake was assessed by semi-quantitative food frequency questionnaire.
Data analysis was done through SPSS software, version 18. Results: Pearson correlation
test showed a positive and significant correlation between serum ferritin concentration levels
with triglyceride (r = 0.278; P = 0.006), total cholesterol (r = 0.267; P = 0.008), and blood
glucose (r = 0.275; P = 0.006); however, the correlation between serum ferritin, high-density
lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and insulin was not significant.
After adjustment of confounding factors, only the significant correlation occurred for blood
glucose (P = 0.016). Before and after adjustment of confounding factors, there was no
significant correlation between hemoglobin and hematocrit with concentration of lipid profile
components, glucose and insulin. Before and after adjustment of confounding factors, there
was no significant correlation between total amount of iron, heme iron, and non-heme dietary
iron with concentration of lipid profile components, glucose and insulin. Conclusion: According
to the current study, serum ferritin is directly and significantly correlated with concentration of
fasting blood glucose, which emphasized on the amount of iron store with blood glucose even
in healthy people. The results of the present study indicate no significant correlation between
iron store and dietary iron intake with lipid
parameters and insulin. Conducting more
extensive epidemiologic studies in men and
other age groups is recommended.
Keywords
Libby P, Bonow RO, Braunwald E, editors. Braunwald’s Heart
Disease. 7th ed. Philadelphia: Elsevier Saunders; 2005. p. 423-55.
2. Maghsodnia SH. Primary of Medical Care of Eldery with colleague
of Universal Health Organization. Tehran: University of Scientific
Wrlfare and Rehabilitation; 2007. p. 71.
3. World Health Organization. Global Info Base Online. Available
from: http://www.who.int/ncd_surveillance/infobase/web/
InfoBasePolicyMaker/reports/ReporterFullView.aspxi d=5 [Last
accessed on 2007 Jul 17].
4. Falk E, Shah PK, Fuster V. Atherothrombosis and thrombosisprone
plaques. In: Fuster V, Alexander RW, O’Rourke RA, editors. Hurst’s
The Heart. 11th ed. New York: McGraw-Hill; 2004. p. 1123-34.
5. Dwivedi MK, Tripathi AK, Shukla S, Chauhan UK. Homocysteine
and cardiovascular disease. Biotechnol Mol Biol Rev 2011;5:101-7.
6. Kaptoge S, White IR, Thompson SG, Wood AM, Lewington S,
Lowe GD, et al. Associations of plasma fibrinogen levels with
established cardiovascular disease risk factors, inflammatory
markers, and other characteristics: Individual participant
meta-analysis of 154,211 adults in 31 prospective studies: The
fibrinogen studies collaboration. Am J Epidemiol 2007;166:867-79.
7. Neven E, De Schutter TM, Behets GJ, Gupta A, D’Haese PC. Iron
and vascular calcification. Is there a link? Nephrol Dial Transplant
2011;26:1137-45.
8. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and
other markers of inflammation in the prediction of cardiovascular
disease in women. N Engl J Med 2000;342:836-43.
9. Gallagher ML. The nutrients and their metabolism. In: Mahan K,
editor. Krause’s Food and Nutrition Therapy. 12th ed. Philadelphia:
Elsevier Saunders; 2008. p. 39-143.
10. Iribarren C, Sempos CJ, Eckfeldt JH, Folsom AR. Lack of association
between ferritin level and measures of LDL oxidation: The ARIC
Study. Atherosclerosis 1998;139:189-95.
11. Berge LN, Bønaa KH, Nordøy A. Serum ferritin, sex hormones, and
cardiovascular risk factors in healthy women. Arterioscler Thromb
1994;14:857-61.
12. Sullivan JL. Iron and the sex difference in heart disease risk. Lancet
1981;13:1293-4.
13. Sullivan JL. The iron paradigm of ischemic heart disease. Am Heart
J 1989;117:1177-88.
14. Ahluwalia N, Genoux A, Ferrieres J, Perret B, Carayol M, Drouet L,
et al. Iron status is associated with carotid atherosclerotic plaques
in middle-aged adults. J Nutr 2010;140:812-6.
15. Wolff B, Volzke H, Ludemann J, Robinson D, Vogelgesang D,
Staudt A, et al. Association between high serum ferritin levels and
carotid atherosclerosis in the study of health in Pomerania (SHIP).
Stroke 2004;35:453-7.
16. Jiang R, Manson JE, Meigs JB, Ma J, Rifai N, Hu FB. Body iron stores
in relation to risk of type 2 diabetes in apparently healthy women.
JAMA 2004;291:711-7.
17. Sempos CT. Do body iron stores increase the risk of developing
coronary heart disease? Am J Clin Nutr 2002;76:501-3.
18. Sempos CT, Looker AC, Gillum RE, McGee DL, Vuong CV, Johnson CL.
Serum ferritin and death from all causes and cardiovascular disease:
The NHANES II Mortality Study. National Health and Nutrition
Examination Study. Ann Epidemiol 2000;10:441-8.
19. Sun Q, Ma J, Rifai N, Franco OH, Rexrode KM, Hu FB. Excessive
body iron stores are not associated with risk of coronary heart
disease in women. J Nutr 2008;138:2436-41.
20. Bothwell TH. Overview and mechanisms of iron regulation. Nutr
Rev 1995;5:237-45.
21. van der AD, Peeters PH, Grobbee DE, Marx JJ, van der Schouw YT.
Dietary haem iron and coronary heart disease in women. Eur Heart
J 2005;26:257-62.
22. Malaviarachchi D, Veugelers PJ, Yip AM, MacLean DR. Dietary iron
as a risk factor for myocardial infarction. Public health considerations
for Nova Scotia. Can J Public Health 2002;93:267-7023. Reunanen A, Takkunen H, Knekt P, Seppanen R, Aromaa A. Body
iron stores, dietary iron intake and coronary heart disease mortality.
J Intern Med 1995;238:223-30.
24. Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D,
Salem DN, et al. Anemia as a risk factor for cardiovascular disease
and all-cause mortality in diabetes: The impact of chronic kidney
disease. J Am Soc Nephrol 2005;16:3403-10.
25. Anand IS, Chandrashekar Y, Ferrari R, Poole –Wilson PA, Harris PC.
Pathogenesis of oedema in chronic severe anemia: Studies of body
water and sodium, renal function, haemodynamic variables, and
plasma hormones. Br heart J 1993;70;357-62.
26. Elhendy A, Modesto KM, Mahoney DW, Khandheria BK, Seward JB,
Pellikka PA. Prediction of mortality in patients with left ventricular
hypertrophy by clinical, exercise stress, and echocardiographic
data. J Am Coll Cardiol 2003;41:129-35.
27. Srinivasan SR, Myers L, Brenson GS. Distribution and correlates
of non-high-density lipoprotein cholesterol in children: Bogalusa
Heart Study. Pediatrics 2002;110:29.
28. Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction
of atherosclerotic disease: New perspectives based on the
Framingham Study. Ann Intern Med 1979;90:85-91.
29. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor
for cardiovascular disease independent of high-density lipoprotein
cholesterol level: A meta-analysis of populationbased prospective
studies. J Cardiovasc Risk 1996;3:213-19.
30. Kamei A, Watanabe Y, Ishijima T, Uehara M, Arai S, Kato H, et al.
Dietary iron-deficient anemia induces a variety of metabolic changes
and even apoptosis in rat liver: A DNA microarray study. Physiol
Genomics 2010;42:149-56.
31. Choi JW, Kim SK, Pai SH. Changes in serum lipid concentrations
during iron depletion and after iron supplementation. Ann Clin Lab
Sci 2001;31:151-6.
32. Ozdemir A, Sevinc C, Selamet U, Turkmen F. The relationship
between iron deficiency anemia and lipid metabolism in
premenopausal women. Am J Med Sci 2007;334:331-3.
33. Vari IS, Balkau B, Kettaneh A, Andre P, Tichet J, Fumeron F, et al.
Ferritin and transferrin are associated with metabolic syndrome
abnormalities and their change over time in a general population:
Data from an Epidemiological Study on the Insulin Resistance
Syndrome (DESIR). Diabetes Care 2007;30:1795-801.
34. Williams MJ, Poulton R, Williams S. Relationship of serum ferritin
with cardiovascular risk factors and inflammation in young men
and women. Atherosclerosis 2002;165:179-84.
35. Commission of the European Communities. Report of the Scientific
Committee for Food: nutrient and energy intakes for the European
community. Luxembourg: Office for official publications of the
European communities; 1992. ISBN 92-826-4754-4
36. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR,
Coward WA, et al. Critical evaluation of energy intake data using
fundamental principles of energy physiology: 1. Derivation of cut-off
limits to identify under-recording. Eur J Clin Nutr 1991;45:569-81.
37. Black AE, Coward WA, Cole TJ, Prentice AM. Human energy
expenditure in affluent societies: An analysis of 574 doubly-labelled
water measurements. Eur J Clin Nutr 1996;50:72-92.
38. Ghaffarpour M, Houshiar-Rad A, Kianfar H. The manual for
household measures, cooking yields factors and edible portion of
foods. Tehran: Keshaverzi Press; 1999. p. 1-46.
39. Monsen ER. Iron nutrition and absorption: Dietary factors which
impact iron bioavailability. J Am Diet Assoc 1988;88:786-90.
40. Klipstein-Grobusch K, Grobbee DE, den Breeijen JH, Boeing H,
Hofman A, Witteman JC. Dietary iron and risk of myocardial
infarction in the Rotterdam Study. Am J Epidemiol 1999;149:421-8.
41. Lee DH, Folsom AR, Jacobs DR Jr. Dietary iron intake and Type 2
diabetes incidence in postmenopausal women: The Iowa Women’s
Health Study. Diabetologia 2004;47:185-94.
42. Sun L, Franco OH, Hu FB, Cai L, Yu Z, Li H, et al. Ferritin
concentrations, metabolic syndrome, and type 2 diabetes in
middle-aged and elderly chinese. J Clin Endocrinol Metab
2008;93:4690-6.
43. Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility
and relative validity of food group intake in a food frequency
questionnaire developed for the Tehran Lipid and Glucose Study.
J Epidemiol 2010;20:150-8.
44. Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability
and relative validity of an FFQ for nutrients in the Tehran lipid and
glucose study. Public Health Nutr 2010;13:654-62.
45. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ,
et al.Compendium of physical activities: An update of activity codes
and MET intensities. Med Sci Sports Exerc 2000;32:s498-504.
46. Alissa EM, Ahmed WH, Al-Ama N, Ferns GA. Relationship between
indices of iron status and coronary risk factors including diabetes
and the metabolic syndrome in Saudi subjects without overt
coronary disease. J Trace Elem Med Biol 2007;21:242-54.
47. Ramakrishnan U, Kuklina E, Stein AD. Iron stores and cardiovascular
disease risk factors in women of reproductive age in the United
States. Am J Clin Nutr 2002;76:1256-60.
48. 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) 2003;58:380-5.
49. Bozzini C, Girelli D, Olivieri O, Martinelli N, Bassi A, De Matteis G,
et al. Prevalence of body iron excess in the metabolic syndrome.
Diabetes Care 2005;28:2061-3.
50. Halle M, Konig D, Berg A, Keul J, Baumstark MW. Relationship
of serum ferritin concentrations with metabolic cardiovascular
risk factors in men without evidence for coronary artery disease.
Atherosclerosis 1997;128:235-40.
51. Wolff SP. Diabetes mellitus and free radicals. Free radicals, transition
metals and oxidative stress in the aetiology of diabetes mellitus and
complications. Br Med Bull 1993;49:642-52.
52. Green A, Basile R, Rumberger JM. Transferrin and iron induce
insulin resistance of glucose transport in adipocytes. Metabolism
2006;55:1042-5.
53. Tuomainen TP, Nyyssonen K, Salonen R, Tervahauta A, Korpela H,
Lakka T, et al. Body iron stores are associated with serum insulin
and blood glucose concentrations. Population study in 1,013 eastern
Finnish men. Diabetes Care 1997;20:426-8.
54. Rajpathak S, Ma J, Manson J, Willett WC, Hu FB. Iron intake and
the risk of type 2 diabetes in women: A prospective cohort study
Diabetes Care 2006;29:1370-6.
55. Jiang R, Ma J, Ascherio A, Stampfer MJ, Willett WC, Hu FB. Dietary
iron intake and blood donations in relation to risk of type 2 diabetes
in men: A prospective cohort study. Am J Clin Nutr 2004;79:70-5.