Abstract
Dietary intake of iron is known to be associated with impaired glucose metabolism. However, its involvement in derangements of glucose metabolism after acute pancreatitis (AP) is not completely understood. The aim was to investigate the association between dietary iron intake and markers of glucose metabolism in individuals after an attack of AP. Fasting blood samples were collected to analyse markers of glucose metabolism (fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c)). The EPIC-Norfolk food frequency questionnaire was used to determine the habitual intake of dietary iron (total, haem, and non-haem). Multivariable linear regression analyses were conducted and six statistical models were built to adjust for covariates. A total of 109 individuals after AP were studied in a cross-sectional fashion. Total iron (β (95% confidence interval) = −0.19 (−0.35, −0.05); p = 0.01 in the most adjusted model) and non-haem iron (β (95% confidence interval) = −0.19 (−0.33, −0.04); p = 0.03 in the most adjusted model) were significantly associated with FPG, consistently in all adjusted model. Total iron and non-haem iron did not have consistent significant associations with HbA1c. Dietary haem iron intake was not associated with either FPG or HbA1c. Habitual intake of dietary iron is inversely associated with FPG in individuals after an attack of AP and may be involved in the pathogenesis of new-onset diabetes after pancreatitis. Prospective longitudinal studies are now warranted to unveil the specific mechanism underlying the involvement of dietary iron.
Highlights
Iron is thought to play a role in the development of a broad spectrum of metabolic derangements, even in the absence of iron deficiency anaemia or iron overload [1,2,3,4,5,6]
While hyperglycaemia in acute pancreatitis (AP) was historically deemed to be a brief and transient consequence of metabolic stress associated with acute illness, a comprehensive meta-analysis of clinical cross-sectional and case-control studies has shown that new-onset prediabetes or diabetes mellitus develops in 40% of individuals after their first attack of AP [12]
The present study was the first to investigate the association between habitual dietary iron intake and markers of glucose metabolism (FPG and haemoglobin A1c (HbA1c)) in individuals with history of pancreatitis
Summary
Iron is thought to play a role in the development of a broad spectrum of metabolic derangements (e.g., dyslipidaemia, metabolic dysfunction associated fatty liver disease, metabolic syndrome), even in the absence of iron deficiency anaemia or iron overload [1,2,3,4,5,6]. Nutrients 2020, 12, 3579 metabolism—decreased ferritin and increased hepcidin—have been reported in individuals with chronic hyperglycaemia after an attack of AP [16]. While hyperglycaemia in AP was historically deemed to be a brief and transient consequence of metabolic stress associated with acute illness, a comprehensive meta-analysis of clinical cross-sectional and case-control studies has shown that new-onset prediabetes or diabetes mellitus develops in 40% of individuals after their first attack of AP [12]. Population-based studies have shown that the risk of new-onset diabetes increases more than two-fold after AP in comparison with the general population [17]. In the first prospective longitudinal cohort study involving individuals after an attack of AP (without pre-existing diabetes), derangements in glucose metabolism were shown to occur progressively after AP [18]
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