High body iron stores have been associated with risk for non-communicable diseases (NCD) like diabetes (high fasting blood sugar, FBS), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but not in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children.
The association of NCD with serum ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, Body Mass Index, C-Reactive Protein, haemoglobin and sex, in adolescent (10-19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents.
The odds ratio (OR) of high FBS, HTN and TC were 1.05 (95% CI 1.01-1.08), 1.02 (95% CI: 1.001-1.03) and 1.04 (95% CI: 1.01-1.06) respectively for every 10µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBS by 2%-14% across states of India. Similar increments in HTN and TC can also be expected.
High SF is associated with a significant risk for NCD in adolescents, and this is dependent on the wealth class, and on co-existing prediabetes. This should be considered when evaluating the benefits and harms of enhancing iron intake in anaemia prevention programs.