Abstract
Though elevated ferritin level and decreased lung function both predispose people to cardio-metabolic disease, few reports have investigated the association between them. Furthermore, it remains unclear whether the association reflects a change in iron stores or an epiphenomenon reflecting metabolic stress. Therefore, we looked for possible associations between ferritin, iron, and transferrin saturation (TSAT) and lung function to clarify the role of iron-related parameters in healthy men. We conducted a cohort study of 42,927 healthy Korean men (mean age: 38.6 years). Percent predicted forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) were categorized into quartiles. Adjusted odds ratios (aORs) and 95% confidence intervals (using the highest quartile as reference) were calculated for hyperferritinemia, high iron, and high TSAT after controlling for potential confounders. The median ferritin level was 199.8 (141.5-275.6) ng/mL. The prevalence of hyperferritinemia (defined as >300 ng/mL) was 19.3%. Subjects with hyperferritinemia had lower FEV1% and FVC% than those with normal ferritin level with a slight difference, but those were statistically significant (99.22% vs.99.61% for FEV1%, p = 0.015 and 98.43% vs. 98.87% for FVC, p = 0.001). However, FEV1/FVC ratio was not significantly different between groups (P = 0.797). Compared with the highest quartile, the aORs for hyperferritinemia across decreasing quartiles were 1.081 (1.005-1.163), 1.100 (1.007-1.200), and 1.140 (1.053-1.233) for FEV1% (p for trend = 0.007) and 1.094 (1.018-1.176), 1.101 (1.021-1.188), and 1.150 (1.056-1.252) for FVC% (p for trend = 0.001). However, neither FEV1% nor FVC% was associated with iron or TSAT. Hyperferritinemia was associated with decreased lung function in healthy Korean men, but iron and TSAT were not. Longitudinal follow-up studies are required to validate our findings.
Highlights
Iron is essential for multiple metabolic processes, but it is hazardous in excess amounts because its ability to catalyze the generation of reactive oxygen species can cause oxidative stress and damage cellular membranes [1]
Hyperferritinemia was associated with decreased lung function in healthy Korean men, but iron and transferrin saturation (TSAT) were not
Iron overabundance relative to metabolic needs inside lung epithelial cells can result in ferritin release from damaged cells, which could result in elevated serum ferritin concentration and loss of lung function under normal physiological conditions [6,7,8]
Summary
Iron is essential for multiple metabolic processes, but it is hazardous in excess amounts because its ability to catalyze the generation of reactive oxygen species can cause oxidative stress and damage cellular membranes [1]. Decreased lung function is associated with oxidative stress and systemic inflammation [4] and increased risk of insulin resistance, diabetes, and cardiovascular disease [5]. This suggests that decreased lung function could be associated with elevated serum ferritin level in pathological conditions. Iron overabundance relative to metabolic needs inside lung epithelial cells can result in ferritin release from damaged cells, which could result in elevated serum ferritin concentration and loss of lung function under normal physiological conditions [6,7,8]
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