title: Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study.
abstract: OBJECTIVE
  The aim of this study was to examine the association between baseline body iron stores and new-onset diabetes.
  
  
  METHODS
  We studied the association between baseline serum ferritin concentration and type 2 diabetes in 360 clinically incident diabetes cases and 758 controls nested within the EPIC (European Prospective Investigation of Cancer)-Norfolk Cohort Study. Serum ferritin levels were categorised into five groups: sex-specific quartiles of the normal range of ferritin and a group with clinically raised ferritin below levels indicative of haemochromatosis.
  
  
  RESULTS
  Baseline serum ferritin was higher among cases than control participants (geometric mean: men 96.6 vs 67.8 ng/ml, respectively, p < 0.001; women 45.9 vs 34.8 ng/ml, respectively, p = 0.005). In analyses adjusted for known risk factors (age, BMI, sex, family history, physical activity, smoking habit) and dietary factors measured by 7-day food diary, the risk of diabetes was markedly elevated in participants with clinically raised ferritin compared with the lowest quartile (odds ratio [OR] 7.4, 95% CI 3.5-15.4). Further adjustment for potential confounding by inflammation (C-reactive protein, IL-6 and fibrinogen) had no material impact on the observed association, while adjustment for hepatic enzymes (alanine aminotransferase and gamma glutamyl transferase) and adiponectin attenuated the magnitude of association, but it remained statistically significant (OR 3.2 [1.3-7.6]).
  
  
  CONCLUSIONS
  Serum ferritin is an important and independent predictor of the development of diabetes. This finding may have important implications for understanding the aetiology of diabetes.
authors.affiliation: MRC Epidemiology Unit, Elsie Widdowson Laboratories, Fulbourn Road, Cambridge, CB1 9NL, UK. nita.forouhi@mrc-epid.cam.ac.uk
authors.forename: N G
authors.initials: NG
authors.lastname: Forouhi
authors.forename: A H
authors.initials: AH
authors.lastname: Harding
authors.forename: M
authors.initials: M
authors.lastname: Allison
authors.forename: M S
authors.initials: MS
authors.lastname: Sandhu
authors.forename: A
authors.initials: A
authors.lastname: Welch
authors.forename: R
authors.initials: R
authors.lastname: Luben
authors.forename: S
authors.initials: S
authors.lastname: Bingham
authors.forename: K T
authors.initials: KT
authors.lastname: Khaw
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D002149:Energy Intake; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002097:C-Reactive Protein; D005293:Ferritins