Iron metabolism and the exocrine pancreas

Kimita, Wandia; Petrov, Maxim S.

doi:10.1016/j.cca.2020.10.013

Cited by 36 publications

(25 citation statements)

References 70 publications

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“…In contrast, other studies have shown iron dysregulation with increased ferritin and reduced hepcidin caused by inflammation from pancreatitis with alterations in circulating markers of iron absorption and intrapancreatic iron deposition in acute or chronic pancreatitis [2,3,15]. It is also important to note the possible confounding effects of concurrent liver disease causing increased ferritin and reduced hepcidin in these patients.…”

Section: Discussionmentioning

confidence: 93%

“…Iron deposition in pancreatic beta cells is a well-established cause of diabetes mellitus in patients with hemochromatosis [1]. The association between iron dysregulation and PED has been reported as early as 1965, but this interrelation and its mechanisms were not well acknowledged [2][3][4]. We report a case of a CD with PED and iron deposition in the pancreas.…”

Section: Introductionmentioning

confidence: 98%

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Iron-Storage Disorder Presenting as Chronic Diarrhea

Vobugari¹,

Kim²,

Gandhi³

et al. 2021

Cureus

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The involvement of the endocrine pancreas leading to bronze diabetes is well studied. However, little is known about the pathophysiology of iron dysregulation involving the exocrine pancreas. We present a unique association between the exocrine pancreas and iron dysregulation. A 45-year-old female presented with chronic diarrhea and low fecal elastase indicative of pancreatic exocrine dysfunction. MRI of the abdomen/pelvis showed iron deposition in the pancreas, suggesting an associated iron-storage disorder without features suggesting chronic pancreatitis. Association of an iron-storage disorder with pancreatic exocrine dysfunction has been reported only in one other case report. Pancreatic exocrine dysfunction can be directly associated with an iron-storage disorder that involves the pancreas. This should be included in the differential and diagnostic work-up of chronic diarrhea of unclear etiology. Based on the literature, we have highlighted the potential pathophysiology relevant to the case.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 98%

Iron-Storage Disorder Presenting as Chronic Diarrhea

Vobugari¹,

Kim²,

Gandhi³

et al. 2021

Cureus

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“…It has also been suggested that elevated ferritin levels in type 2 diabetes are due to inflammatory mechanisms rather than iron overload as there were no differences in transferrin receptor levels [81,82]. A comprehensive review of iron metabolism and the exocrine pancreas provided evidence for crosstalk between iron metabolism and the exocrine pancreas [83]. Chand et al found that hepcidin levels were significantly increased and ferritin levels significantly decreased in participants with prediabetes/diabetes after AP, providing further evidence that iron may be involved in and the pathogenesis of NODAP [77].…”

Section: Iron Intake and Glucose Metabolismmentioning

confidence: 99%

Associations of Habitual Mineral Intake with New-Onset Prediabetes/Diabetes after Acute Pancreatitis

Norbitt

Kimita

et al. 2021

Nutrients

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Associations between habitual dietary intake of minerals and glucose metabolism have been extensively studied in relation to metabolic disorders. However, similar research has yet to be conducted in individuals after acute pancreatitis (AP). The main aim was to investigate the associations between habitual intake of 13 minerals and glycaemic status: new-onset prediabetes/diabetes after AP (NODAP), pre-existing prediabetes/type 2 diabetes (T2DM), and normoglycaemia after AP (NAP). Associations between the dietary intake of minerals and markers of glucose metabolism (glycated haemoglobin and fasting plasma glucose) were also studied. The EPIC-Norfolk food frequency questionnaire was used in a cross-sectional fashion to determine the habitual intake of 13 dietary minerals. ANCOVA as well as multiple linear regression analyses were conducted and five statistical models were built to adjust for covariates. The study included 106 individuals after AP. In the NODAP group, intake of 4 minerals was significantly less when compared with the NAP group: iron (B = −0.076, p = 0.013), nitrogen (B = −0.066, p = 0.003), phosphorous (B = −0.046, p = 0.006), and zinc (B = −0.078, p = 0.001). Glycated haemoglobin was significantly associated with iodine intake (B = 17.763, p = 0.032) and manganese intake (B = −17.147, p = 0.003) in the NODAP group. Fasting plasma glucose was significantly associated with manganese intake (B = −2.436, p = 0.027) in the NODAP group. Habitual intake of minerals differs between individuals with NODAP, T2DM, and NAP. Prospective longitudinal studies and randomised controlled trials are now warranted to further investigate the associations between mineral intake and NODAP.

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“…The comprehensive EPIC-Norfolk food frequency questionnaire was used to record the participants' usual food intake in the preceding 12 months [41,42]. Total dietary iron intake (mg/day) and total energy intake (kcal/day) were estimated using the standardised EPIC Nutrient Database [43].…”

Section: Assessment Of Dietary Iron Intakementioning

confidence: 99%

Relationship between Energy Balance and Circulating Levels of Hepcidin and Ferritin in the Fasted and Postprandial States

Kimita

Bharmal

et al. 2021

Nutrients

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Markers of iron metabolism are altered in new-onset diabetes, but their relationship with metabolic signals involved in the maintenance of energy balance is poorly understood. The primary aim was to explore the associations between markers of iron metabolism (hepcidin and ferritin) and markers of energy balance (leptin, ghrelin, and the leptin/ghrelin ratio) in both the fasted and postprandial states. These associations were also studied in the sub-groups stratified by diabetes status. This was a cross-sectional study of individuals without disorders of iron metabolism who were investigated after an overnight fast and, in addition, some of these individuals underwent a mixed meal test to determine postprandial responses of metabolic signals. The associations between hepcidin, ferritin, and leptin, ghrelin, leptin/ghrelin ratio were studied using several multiple linear regression models. A total of 76 individuals in the fasted state and 34 individuals in the postprandial state were included. In the overall cohort, hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −883.45 ± 400.94; p = 0.031) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −148.26 ± 61.20; p = 0.018) in the fasted state. The same associations were not statistically significant in the postprandial state. In individuals with new-onset prediabetes or diabetes (but not in those with normoglycaemia or longstanding prediabetes or diabetes), hepcidin was significantly inversely associated with leptin (in the most adjusted model, the β coefficient ± SE was −806.09 ± 395.44; p = 0.050) and the leptin/ghrelin ratio (in the most adjusted model, the β coefficient ± SE was −129.40 ± 59.14; p = 0.037). Leptin appears to be a mediator in the link between iron metabolism and new-onset diabetes mellitus. These findings add to the growing understanding of mechanisms underlying the derangements of glucose metabolism.

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Iron metabolism and the exocrine pancreas

Cited by 36 publications

References 70 publications

Iron-Storage Disorder Presenting as Chronic Diarrhea

Iron-Storage Disorder Presenting as Chronic Diarrhea

Associations of Habitual Mineral Intake with New-Onset Prediabetes/Diabetes after Acute Pancreatitis

Relationship between Energy Balance and Circulating Levels of Hepcidin and Ferritin in the Fasted and Postprandial States

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