TY - JOUR
T1 - Inverse Association between Iron Deficiency and Glycated Hemoglobin Levels in Ghanaian Adults-the RODAM Study
AU - Lyons, Julia
AU - van der Linden, Eva L
AU - Meeks, Karlijn
AU - Beune, Erik
AU - Smeeth, Liam
AU - Bahendeka, Silver
AU - Spranger, Joachim
AU - Klipstein-Grobusch, Kerstin
AU - Mockenhaupt, Frank P
AU - Danquah, Ina
AU - Agyemang, Charles
N1 - Funding Information:
Supported by European Commission Framework Program grant 278901. KM is supported by the NIH Intramural Research Program in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Center for Information Technology, and the Office of the Director at the NIH, grant 1ZIAHG200362. LM was supported by Wellcome Trust grant WT082178. JS was supported by the DZHK (German Centre for Cardiovascular Research) and the Berlin Institute of Health. Author disclosures: The authors report no conflicts of interest. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Address correspondence to JL (e-mail: [email protected]; [email protected]). Abbreviations used: aOR, adjusted OR; AT, α-thalassemia; CKD, chronic kidney disease; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; G6PD, glucose-6-phosphate dehydrogenase; HbA1c, glycated hemoglobin; HIC, high-income country; HMB, heavy menstrual bleeding; ID, iron deficiency; RODAM, Research on Obesity and Diabetes among African Migrants; SSA, sub-Saharan Africa/African; T2D, type 2 diabetes.
Publisher Copyright:
Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - BACKGROUND: Glycated hemoglobin (HbA1c) is often used to diagnose type 2 diabetes (T2D), but studies show that iron deficiency (ID) is associated with elevated HbA1c in the absence of hyperglycemia. It is unknown whether ID prevalence varies between sub-Saharan African populations living in different locations and whether ID influences HbA1c levels in these populations. OBJECTIVES: We assessed the prevalence of ID among Ghanaian migrants in Europe and nonmigrant Ghanaians, and the influence of ID on HbA1c categories among Ghanaians without T2D. METHODS: We used the database from the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. This contained data on 3377 Ghanaian men and women aged 25-70 y living in urban and rural Ghana and Ghanaian migrants living in Amsterdam, London, and Berlin. ID was defined as ferritin < 15 ng/mL or, if C-reactive protein was ≥5 mg/mL, as ferritin < 30 ng/mL according to the WHO. We used binary logistic regression to assess differences in ID between sites and its association with clinically defined HbA1c categories (<5.5%, ≥5.5% to <6.5%, ≥6.5%). Men and women were analyzed separately. RESULTS: The prevalence of ID was higher in migrant [28.4%; adjusted OR (aOR): 3.08; 95% CI: 2.04, 4.65)] and urban (23.2%; aOR: 2.37; 95% CI: 1.56, 3.59) women than in rural women (11.9%). Among women, ID was associated with higher odds of HbA1c ≥ 5.5% to <6.5% in the absence of hyperglycemia (aOR: 1.43; 95% CI: 1.08, 1.87). This association was not found in men. CONCLUSIONS: Further research is needed to identify factors underlying the high prevalence of ID among urban and migrant Ghanaian women, and the association of ID with HbA1c ≥ 5.5% to <6.5% in women. In addition, our study reinforces the need to consider iron concentrations if interpreting HbA1c among African populations.
AB - BACKGROUND: Glycated hemoglobin (HbA1c) is often used to diagnose type 2 diabetes (T2D), but studies show that iron deficiency (ID) is associated with elevated HbA1c in the absence of hyperglycemia. It is unknown whether ID prevalence varies between sub-Saharan African populations living in different locations and whether ID influences HbA1c levels in these populations. OBJECTIVES: We assessed the prevalence of ID among Ghanaian migrants in Europe and nonmigrant Ghanaians, and the influence of ID on HbA1c categories among Ghanaians without T2D. METHODS: We used the database from the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. This contained data on 3377 Ghanaian men and women aged 25-70 y living in urban and rural Ghana and Ghanaian migrants living in Amsterdam, London, and Berlin. ID was defined as ferritin < 15 ng/mL or, if C-reactive protein was ≥5 mg/mL, as ferritin < 30 ng/mL according to the WHO. We used binary logistic regression to assess differences in ID between sites and its association with clinically defined HbA1c categories (<5.5%, ≥5.5% to <6.5%, ≥6.5%). Men and women were analyzed separately. RESULTS: The prevalence of ID was higher in migrant [28.4%; adjusted OR (aOR): 3.08; 95% CI: 2.04, 4.65)] and urban (23.2%; aOR: 2.37; 95% CI: 1.56, 3.59) women than in rural women (11.9%). Among women, ID was associated with higher odds of HbA1c ≥ 5.5% to <6.5% in the absence of hyperglycemia (aOR: 1.43; 95% CI: 1.08, 1.87). This association was not found in men. CONCLUSIONS: Further research is needed to identify factors underlying the high prevalence of ID among urban and migrant Ghanaian women, and the association of ID with HbA1c ≥ 5.5% to <6.5% in women. In addition, our study reinforces the need to consider iron concentrations if interpreting HbA1c among African populations.
KW - ferritin
KW - Ghanaians
KW - HbA1c
KW - iron deficiency
KW - iron deficiency prevalence
KW - migrants in Europe
KW - rural area
KW - type 2 diabetes
KW - urban area
UR - http://www.scopus.com/inward/record.url?scp=85087532951&partnerID=8YFLogxK
U2 - 10.1093/jn/nxaa109
DO - 10.1093/jn/nxaa109
M3 - Article
C2 - 32433726
SN - 0022-3166
VL - 150
SP - 1899
EP - 1908
JO - The Journal of nutrition
JF - The Journal of nutrition
IS - 7
ER -