Skip to main content
Download PDF

Threshold-effect of ferritin levels with pathoglycemia in Chinese adults: a cross-sectional study based on China health and nutrition survey data

BMC Endocrine Disorders volume 25, Article number: 4 (2025) Cite this article

Abstract

Background

The present study aimed to explore the threshold-effect association of serum ferritin levels with type 2 diabetes mellitus (T2DM) and prediabetes mellitus in Chinese adults.

Methods

A total of 8365 people from CHNS a cross-sectional survey in 2009 were finally included. The biomarker data, including major cardiovascular biomarkers and important nutrition biomarkers were collected. The association of serum ferritin levels with T2DM and prediabetes mellitus were assessed by using restricted cubic spline function combined with multivariate logistic regression model.

Results

The mean age of the study subjects was 50.3 years, and 46.5% were men. The risk of T2DM and prediabetes mellitus increased when the ferritin level was greater than 140 ng/ml. The OR(OR = 0.59, 95% CI, 0.35–0.98)was lowest between 40 to < 60 ng/ml in men with prediabetes mellitus. The OR(OR = 0.61, 95% CI, 0.41–0.90)was lowest between 20 to < 40 ng/ml in women with prediabetes mellitus. Serum ferritin levels and OR value of women younger than 50 years old are lower than those of other participants.

Conclusions

There is a correlation between ferritin levels and pathoglycemia, with women under 50 years old having a lower risk for the same ferritin level, and maintaining low levels of ferritin can reduce the risk of developing diabetes mellitus.

Peer Review reports

Introduction

China is now the country with the fastest growing diabetes mellitus in the world, and about 11% of the population has diabetes mellitus [1, 2]. According to the results of the Global Burden of Disease (GBD) study, compared with 2007, the incidence and death rates of diabetes mellitus worldwide in 2017 increased by 27.3% and 25.6% respectively [3]. In addition, there are still many undiagnosed diabetics and prediabetics in China. Those already sick and potential diabetic patients will bring a heavy economic and social burden to China. Therefore, early detection and management of high-risk individuals is crucial to prevent numerous complications of diabetes, thereby potentially improving the social and economic effects of diabetes.

Serum ferritin is usually used as an important indicator of iron storage in the body [4]. Moreover, a number of studies have shown that serum ferritin is a strong marker of T2DM in recent decades. Cross-sectional surveys have shown that serum ferritin level was positively correlated with T2DM, independent of traditional diabetes mellitus risk factors, such as age, obesity or family history of diabetes mellitus [5, 6]. It has been suggested that high iron reserves contribute to the development of T2DM by increasing the level of oxidative stress and causing pancreatic β cell damage and insulin resistance [7, 8]. Iron can attack cell membrane, protein and DNA by catalyzing hydrogen peroxide into free radical ions [9], thus damaging tissues and possibly leading to diabetes mellitus [10, 11]. In addition, excessive iron reserves are thought to be related to the high risk of other metabolic disorders, including hypertension [12, 13]metabolic syndrome [14], and cardiovascular disease [15].

A number of prospective studies in western regions also showed that ferritin has a close relationship with T2DM [16,17,18,19,20,21,22,23,24,25]. Two of the studies based on the European Prospective Investigation into Cancer and Nutrition confirmed serum ferritin is an important and independent predictor of T2DM [16, 17]. The Asian cohort studies also showed that excessive iron reserves in the body was a risk factor for T2DM [18,19,20,21,22,23,24,25].

Although many studies all over the world have confirmed that ferritin may be used as a robust predictor of T2DM, there is still a lack of large-scale research in China and exploration on the threshold effect relationship between serum ferritin level and T2DM risk. In the present study, we aimed to explore the threshold-effect association of serum ferritin levels with diabetes mellitus and prediabetes mellitus in Chinese adults by China Health and Nutrition Survey (CHNS) 2009.

Subjects and methods

Study population

The China Health and Nutrition Survey (CHNS) began in 1989. Its goal is to establish a multi-level method of collecting data from individuals, families and their communities, so as to understand how the extensive social and economic changes in China affect a series of nutrition and health-related results. CHNS used a multistage random-cluster sampling process to select samples from 15 provinces in China. From 1989 to 2009, CHNS held nine rounds in nine provinces (autonomous regions). The 9th round was held in 12 provinces (autonomous regions) in 2011, with Beijing, Shanghai and Chongqing added; The 10th round was held in 15 provinces (autonomous regions) in 2015, with Shanxi, Yunnan and Zhejiang added. This survey was established by the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, the institutional review committees of the University of North Carolina at Chapel Hill, and the China–Japan Friendship Hospital, Ministry of Health. The survey design and methods have been described in detail elsewhere [26, 27].

During the CHNS wave in the 2009, blood samples were collected and evaluated for the first time. We excluded those with missing information on serum ferritin, glucose, or other interested variables. A total of 8365 adults aged 18 years and over were included in the final analyses(Figure S1). This study is reported as per the STROBE guideline (Table S1 STROBE Statement—Checklist).

Diabetes mellitus and prediabetes mellitus

Fasting glucose was measured using by the GOD-PAP method (Randox Laboratories Ltd, UK), and glycated hemoglobin (HbA1C) was assessed with high-performance liquid chromatography method. The concentrations of fasting serum ferritin were determined by a commercial Radioimmunoassay Kit (Beijing North Institute of Biological Technology, China). Diabetes mellitus was defined as fasting glucose ≥ 126 mg/dl or current usage of anti-diabetes medications. Participants with fasting blood glucose > 100 mg/dl and HbA1C > 5.7% without type 2 diabetes mellitus were defined as prediabetes mellitus.

Covariates

Covariates including age, highest level of education, Body mass index (BMI) and hypertension were obtained by general information questionnaires. BMI was calculated as weight in kilograms divided by the square of height in meters. In the CHNS, education level is defined as the highest level of education that participants attained. Hypertension is defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or current antihypertensive medications use. Cigarette smoking is defined by individuals who have ever smoked cigarettes. Ferritin levels were categorized as < 20 ng/ml, 20 to < 40 ng/ml, 40 to < 60 ng/ml, 60 to < 80 ng/ml, 80 to < 100 ng/ml, 100 to < 120 ng/ml, 120 to < 140 ng/ml, 140 to < 160 ng/ml, 160 to < 180 ng/ml, 180 to < 200 ng/ml, and ≥ 200 ng/ml.

Statistical analysis

Continuous variables were expressed as mean ± standard deviation, and categorical variables were presented as n(%). The Kolmogorov-Smirnov test is employed to assess the adherence of variables to a normal distribution. Differences among serum ferritin levels were examined using the Wilcoxon rank-sum and Kruskal–Wallis H test for continuous variables and Chi-square test for categorical variables. The odds ratios (OR) and 95% confidence intervals (CI) were used to assess the risk of prediabetes mellitus with different serum ferritin levels, after adjusting for potential confounding factors. The threshold effect between serum ferritin levels and patients with prediabetes mellitus was explored using restricted cubic splines. All analyses were performed using STATA version 15.0. The significance level was P < 0.05.

Results

Baseline characteristics

The baseline characteristics of participants across levels of serum ferritin are summarized in Table 1. The mean age of the study subjects was 50.3 years, and 46.5% were men. Of all participants, the prevalence, basic demographics (age, gender, education level, BMI and smoking status) and metabolic parameters (insulin, LDL-C, HDL-C, TC and TG) of serum ferritin levels were significantly different (P < 0.01). There are more women than men with diabetes mellitus or prediabetes mellitus between 0-100ng/ml serum ferritin, and there are more men with diabetes mellitus or prediabetes mellitus above 100ng/ml serum ferritin. The median ferritin of the total population was 79.72ng/ml, the median ferritin of the men population was 122.72ng/ml, and the median ferritin of the women population was 51.08ng/ml, and the difference was statistically significant (Table S2).

Table 1 Basic characteristics of the study population
Full size table

Associations of ferritin levels with prediabetes mellitus and diabetes mellitus

The overload threshold of women and men ferritin level was used as the reference value. The Fig. 1 shows adjusted ORs (95%CI) for prediabetes mellitus and diabetes mellitus across the levels of ferritin. In all participants, the risk of developing diabetes increased as ferritin levels increased. This was statistically significant in women with prediabetes mellitus.

Fig. 1
figure 1

Adjusted ORs (95%CI) for prediabetes in adult women (a) and men (c) and diabetes in adult women (b) and men (d) across the levels of ferritin

Full size image

Table 2 shows the ORs of prediabetes mellitus according to levels of ferritin in Chinese adults. In all participants, when the serum ferritin level is higher than 140 ng/ml, the risk of diabetes mellitus and prediabetes mellitus will increase. After adjusting for potential confounders in each model, in the prediabetes mellitus participants, the OR (OR = 1.85, 95% CI, 1.31–2.62)was highest when ferritin levels were > 200ng/ml and the OR(OR = 0.59, 95% CI, 0.35–0.98)was lowest between 40 to < 60 ng/ml in men(P < 0.01). In women with prediabetes mellitus, the OR (OR = 2.66, 95% CI, 1.39–5.09) were highest when ferritin levels were 180 to < 200 ng/ml and the OR(OR = 0.61, 95% CI, 0.41–0.90)was lowest between 20 to < 40 ng/m(P < 0.01). In the diabetes mellitus participants, the OR(OR = 2.06, 95% CI, 0.87–4.84) was highest that ferritin levels were 160 to < 180 ng/ml in men. The OR(OR = 1.35, 95% CI, 0.56–3.24)was highest that ferritin levels were 120 to < 140 ng/ml in women diabetes mellitus (Table S3).

Table 2 Adjusted ORs (95%CI) for prediabetes across the levels of ferritin in adults
Full size table

Ferritin levels are associated with prediabetes mellitus in women

The median ferritin level over age 50 is 82.88 ng/ml and the median ferritin level under age 50 is 28.14 ng/ml in women (Table S2), median ferritin levels were lower in participants younger than 50 years of age. The Fig. 2 shows adjusted ORs (95%CI) for prediabetes mellitus across the levels of ferritin in adult women younger than 50. A comparison of Fig. 2 and Figure S2 shows that when stratified by age, participants younger than 50 years of age had a lower risk of developing the disease at the same ferritin level compared to the entire prediabetes mellitus women participants.

Fig. 2
figure 2

Adjusted ORs (95%CI) for prediabetes across the levels of ferritin in adult women younger than 50

Full size image

Discussion

In this study, we found that the serum ferritin level of men is generally higher than that of women, and maintaining low levels of ferritin can reduce the risk of developing diabetes mellitus. Median ferritin levels were lowest in women younger than 50 with prediabetes mellitus. The previous study had been showed that a significant association of ferritin concentration and the risk of diabetes according to gender [28]. Ford also found that elevated stored iron was associated with an increased risk of developing T2DM in women [29]. Kato found that the average serum ferritin concentration in postmenopausal women was more than twice that of premenopausal women [30].

Estrogen can affect iron storage by regulating iron responsive elements in the body. That is, a decrease in estrogen levels leads to a decrease in iron-responsive elements, which leads to an increase in iron stores in the body and an increase in serum ferritin levels [30]. Before menopause, women lose some iron each month from menstruation, while iron accumulates in the body after menopause due to lack of menstruation. This accumulation increases serum ferritin levels by 2–3 times in postmenopausal women [31, 32]. The average age of menopause for Chinese women is around 50 years old [33]and women younger than 50 had a lower risk than women as a whole, possibly because the majority of women before age 50 were premenopausal. Therefore, attention to ferritin levels in health check-up programs may be beneficial to better prevent the occurrence of diabetes in postmenopausal women.

However, the amount of blood lost during menstruation varies from person to person, and many women with small cell anemia have low levels of ferritin. Because the CHNS database lacks this part of the information on whether women have small cell anemia, it is not possible to exclude the effect of this population, which may affect the generality of the results. In addition, the number of diabetes mellitus and prediabetes mellitus in the sample population is much lower than other reports, which may be mainly due to the different definitions of diabetes mellitus and the different age structure of the study population. Unlike previous studies that used oral glucose tolerance tests to diagnose diabetes, CHNS defined diabetes by fasting blood glucose or current use of antidiabetic drugs, which would significantly underestimate the true number of people with diabetes. Due to the limited number of people with T2DM, the tables was mainly focused on participants with prediabetes mellitus. Especially for the women participants stratified by age, the restricted cubic spline graph was used for comparison and analysis.

Our research is a cross-sectional study, so we can’t infer causality. Nevertheless, the advantage of our study is that the sample size is large, and the threshold effect relationship is discussed, which has not been addressed in previous studies. It should be noted that elevated serum ferritin levels can be attributed to various causes, including excessive iron intake or pathological alterations within the body. Therefore, the treatment of high serum ferritin levels should be individualized based on the specific etiological factors. In summary, serum ferritin serves as a robust marker for predicting the risk of type T2DM, yet its underlying biological mechanism demands further investigation and exploration. Our study suggests an optimal range for maintaining serum ferritin levels in prediabetic patients, and individuals with iron overload should be vigilant in preventing the development of T2DM.

Conclusions

In conclusion, we found that for the whole population, the risk of pathoglycemia increased when ferritin levels were greater than 140 ng/ml. In thewoman population, maintaining the serum ferritin level between 20 and 40 ng/ml is beneficial for reducing the risk of developing diabetes. In the man population, maintaining the ferritin level between 40 and 60 ng/ml is conducive to reducing the risk of diabetes.

Data availability

The CHNS data that support the findings of this study are available upon application from https://www.cpc.unc.edu/projects/china.

References

  1. Ma RCW. Epidemiology of diabetes and diabetic complications in China [published correction appears in Diabetologia. 2018]. Diabetologia. 2018;61(6):1249–60.

    Article  PubMed  Google Scholar 

  2. Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59.

    Article  PubMed  CAS  Google Scholar 

  3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of Disease Study. Lancet. 2020;395(10219):200–11.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cook JD, Flowers CH, Skikne BS. The quantitative assessment of body iron. Blood. 2003;101(9):3359–64.

    Article  PubMed  CAS  Google Scholar 

  5. Yeap BB, Divitini ML, Gunton JE, et al. Higher ferritin levels, but not serum iron or transferrin saturation, are associated with type 2 diabetes mellitus in adult men and women free of genetic haemochromatosis. Clin Endocrinol (Oxf). 2015;82(4):525–32.

    Article  PubMed  CAS  Google Scholar 

  6. Luan de C, Li H, Li SJ, et al. Body iron stores and dietary iron intake in relation to diabetes in adults in North China. Diabetes Care. 2008;31(2):285–6.

    Article  PubMed  Google Scholar 

  7. Niederau C, Berger M, Stremmel W, et al. Hyperinsulinaemia in non-cirrhotic haemochromatosis: impaired hepatic insulin degradation? Diabetologia. 1984;26(6):441–4.

    Article  PubMed  CAS  Google Scholar 

  8. Fernández-Real JM, Ricart-Engel W, Arroyo E, et al. Serum ferritin as a component of the insulin resistance syndrome. Diabetes Care. 1998;21(1):62–8. https://doiorg.publicaciones.saludcastillayleon.es/10.2337/diacare.21.1.62.

    Article  PubMed  Google Scholar 

  9. Emerit J, Beaumont C, Trivin F. Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother. 2001;55(6):333–9.

    Article  PubMed  CAS  Google Scholar 

  10. Opara EC. Role of oxidative stress in the etiology of type 2 diabetes and the effect of antioxidant supplementation on glycemic control. J Investig Med. 2004;52(1):19–23.

    Article  PubMed  CAS  Google Scholar 

  11. Wolff SP. Diabetes mellitus and free radicals. Free radicals, transition metals and oxidative stress in the aetiology of diabetes mellitus and complications. Br Med Bull. 1993;49(3):642–52.

    Article  PubMed  CAS  Google Scholar 

  12. Piperno A, Trombini P, Gelosa M, et al. Increased serum ferritin is common in men with essential hypertension. J Hypertens. 2002;20(8):1513–8.

    Article  PubMed  CAS  Google Scholar 

  13. Kim MK, Baek KH, Song KH, et al. Increased serum ferritin predicts the development of hypertension among middle-aged men. Am J Hypertens. 2012;25(4):492–7.

    Article  PubMed  CAS  Google Scholar 

  14. Chand MR, Agarwal N, Nishanth D, et al. Association of Serum Ferritin Levels with metabolic syndrome in India: a cross-sectional study. Maedica (Bucur). 2021;16(1):48–53.

    PubMed  Google Scholar 

  15. Kadoglou NPE, Biddulph JP, Rafnsson SB, et al. The association of ferritin with cardiovascular and all-cause mortality in community-dwellers: the English longitudinal study of ageing. PLoS ONE. 2017;12(6):e0178994. Published 2017 Jun 7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Forouhi NG, Harding AH, Allison M, et al. Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study. Diabetologia. 2007;50(5):949–56.

    Article  PubMed  CAS  Google Scholar 

  17. Montonen J, Boeing H, Steffen A et al. Body iron stores and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. 2012;55(11):3144]. Diabetologia. 2012;55(10):2613–2621.

  18. Gao S, Zhao D, Qi Y, et al. The association between serum ferritin levels and the risk of new-onset type 2 diabetes mellitus: a 10-year follow-up of the Chinese Multi-provincial Cohort Study. Diabetes Res Clin Pract. 2017;130:154–62.

    Article  PubMed  CAS  Google Scholar 

  19. Kim S, Park SK, Ryoo JH, et al. Incidental risk for diabetes according to serum ferritin concentration in Korean men. Clin Chim Acta. 2015;451(Pt B):165–9.

    Article  PubMed  CAS  Google Scholar 

  20. Chen L, Li Y, Zhang F, et al. Elevated serum ferritin concentration is associated with incident type 2 diabetes mellitus in a Chinese population: a prospective cohort study. Diabetes Res Clin Pract. 2018;139:155–62.

    Article  PubMed  CAS  Google Scholar 

  21. Jung CH, Lee MJ, Hwang JY, et al. Elevated serum ferritin level is associated with the incident type 2 diabetes in healthy Korean men: a 4 year longitudinal study. PLoS ONE. 2013;8(9):e75250. Published 2013 Sep 30.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Han LL, Wang YX, Li J, et al. Gender differences in associations of serum ferritin and diabetes, metabolic syndrome, and obesity in the China Health and Nutrition Survey. Mol Nutr Food Res. 2014;58(11):2189–95.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Zhou F, Zhao Z, Tian L, et al. Association of Serum Ferritin Level with risk of incident abnormal glucose metabolism in Southwestern China: a prospective cohort study. Biol Trace Elem Res. 2016;169(1):27–33.

    Article  PubMed  CAS  Google Scholar 

  24. Jiang R, Manson JE, Meigs JB, et al. Body iron stores in relation to risk of type 2 diabetes in apparently healthy women. JAMA. 2004;291(6):711–7.

    Article  PubMed  CAS  Google Scholar 

  25. Rajpathak SN, Wylie-Rosett J, Gunter MJ, et al. Biomarkers of body iron stores and risk of developing type 2 diabetes. Diabetes Obes Metab. 2009;11(5):472–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Zhang B, Zhai FY, Du SF, et al. The China Health and Nutrition Survey, 1989–2011. Obes Rev. 2014;15(Suppl 1):2–7.

    Article  PubMed  Google Scholar 

  27. Popkin BM, Du S, Zhai F, et al. Cohort Profile: the China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010;39(6):1435–40.

    Article  PubMed  Google Scholar 

  28. Cheung C-L, Cheung TT, Lam KSL, et al. High ferritin and low transferrin saturation are associated with pre-diabetes among a national representative sample of U.S. adults. Clin Nutr. 2013;32(6):1055–60.

    Article  PubMed  CAS  Google Scholar 

  29. Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among u.S. Adults [J] Diabetes Care. 1999;22(12):197.

    Google Scholar 

  30. Kato I, Dnistrian AM, Schwartz M et al. Risk of iron overload among middle aged women[J]. Int J Vitam Nutr Res 2000,70(3):119–25.

  31. Jian J, Pelle E, Huang X. Iron and menopause:does increased iron affect the health of postmenopausal women?[J]. Antioxid Redox Signal. 2009;11:2939–43.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Mackenzie EL, Iwasaki K, Tsuji Y. Intracellular iron transport and storage:from molecular mechanisms to health implications[J]. Antioxid Redox Signal. 2008;10:997–1030.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Yanwei Z, Minfang T, Jiangshan H, et al. Investigation on menopause clinic in Shanghai [J]. China Maternal Child Health Care. 2019;34(08):1805–7.

    Google Scholar 

Download references

Acknowledgements

The present study uses data from the CHNS. We thank all of the participants and staff involved in the surveys.

Funding

This work was supported by the National Natural Science Foundation of China (81874263).

Author information

Authors and Affiliations

  1. Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, 710061, China

    Jintao Li, Guohua Li, Xintian Liu & Xiaoqin Luo

  2. School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China

    Chenyu Yang

  3. Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, 710061, China

    Chenyu Yang, Chao Li, Jinyu Yang & Yanpei Gao

Authors
  1. Chenyu Yang
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Jintao Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Chao Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Jinyu Yang
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Yanpei Gao
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Guohua Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Xintian Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Xiaoqin Luo
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

YCY was responsible for drafting the article and for overall content. LJT assisted with the drafting and revision of the article. YJY, GYP, LGH, LXT provided input to the study concept and design, critically reviewed the results of analyses, and reviewed and contributed significantly to article revision. Statistical analyses were performed by LC and YCY, and LXQ provided full access to the study data as well as study oversight and article revision. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Xiaoqin Luo.

Ethics declarations

Ethics approval and consent to participate

The analysis was based on the publicly available database CHNS. The CHNS was approved by the Institutional Review Committees of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention. All participants provided informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Supplementary Material 3

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, C., Li, J., Li, C. et al. Threshold-effect of ferritin levels with pathoglycemia in Chinese adults: a cross-sectional study based on China health and nutrition survey data. BMC Endocr Disord 25, 4 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01822-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01822-y

Keywords

BMC Endocrine Disorders

ISSN: 1472-6823

Contact us