Interactive effects of serum ferritin and high sensitivity C-reactive protein on diabetes in hypertensive patients

Juan Zhou; Ning Wang; Dongxia Wang; Rui Zhao; Dan Zhao; Binfa Ouyang; Xiaolin Peng; Liping Hao

doi:10.1016/j.jtemb.2021.126824

Interactive effects of serum ferritin and high sensitivity C-reactive protein on diabetes in hypertensive patients

J Trace Elem Med Biol. 2021 Dec:68:126824. doi: 10.1016/j.jtemb.2021.126824. Epub 2021 Jul 28.

Authors

Juan Zhou¹, Ning Wang¹, Dongxia Wang¹, Rui Zhao¹, Dan Zhao², Binfa Ouyang², Xiaolin Peng², Liping Hao³

Affiliations

¹ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China.
² Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong Province, 518051, PR China.
³ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China. Electronic address: haolp@mails.tjmu.edu.cn.

PMID: 34352498
DOI: 10.1016/j.jtemb.2021.126824

Abstract

Background: Hypertensive patients, often characterized by chronic inflammation, are susceptible to diabetes. Evidence suggests that the positive association between serum ferritin (SF) and diabetes was affected by high-sensitivity C-reactive protein (hs-CRP), an inflammation marker. We investigate whether there was an interaction between SF and hs-CRP on diabetes in hypertensive patients.

Methods: We analysed data of 1,735 hypertensive people in this cross-sectional study. Diabetes was diagnosed when fasting blood glucose ≥ 7.0 mmol/L and/or a previous clinical diagnosis of diabetes. Logistic regression models were used to estimate the association of the SF and hs-CRP with diabetes. Multiplicative interaction was evaluated by incorporating a cross-product term for SF and hs-CRP to the logistic regression model. Additive interaction was assessed by calculating the relative excess risk of interaction (RERI) and attributed proportion due to interaction (AP).

Results: In the adjusted analysis, SF (highest vs lowest tertile: odds ratio [OR], 1.61; 95 % confidence interval [CI], 1.20-2.16) was positively associated with diabetes. There was no multiplicative interaction between SF and hs-CRP, but evidence of additive interaction in regard to diabetes (RERI: 0.86; 95 % CI: 0.06-1.67). Compared to the patients with low SF (lower two thirds) and low hs-CRP (≤ 2 mg/L), those with high SF (upper one third) and high hs-CRP (> 2 mg/L) had increased OR for diabetes (adjusted OR: 2.33 [1.65-3.30]), with 37.0 % of the effects attributed to the additive interaction (AP: 0.37; 95 % CI: 0.09-0.65).

Conclusions: Within a cross-sectional study consisting of hypertensive patients, co-exposure to high SF and high hs-CRP was synergistically associated with diabetes. Dietary intervention or pharmacological treatment to lowering SF concentration may help to reduce diabetes morbidity in hypertensive patient with chronic inflammation.

Keywords: Additive interaction; Diabetes; Ferritin; Hypertension; hs-CRP.

MeSH terms

C-Reactive Protein / metabolism*
Cross-Sectional Studies
Diabetes Mellitus*
Ferritins / blood*
Humans
Hypertension*
Inflammation
Risk Factors

Substances

C-Reactive Protein
Ferritins