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May 26, 2004

Iron Stores as a Risk Factor for Diabetes in Women—Reply

JAMA. 2004;291(20):2428-2429. doi:10.1001/jama.291.20.2428-c

In Reply: In response to Dr Trotter, our study used a prospective nested case-control design, in which healthy controls were selected at random using risk-set sampling (ie, controls were selected at the time when diabetes cases occurred) and matched to the cases by age, race, and fasting status. By design, the cases were expected to have higher prevalence of diabetes risk factors, such as family history of diabetes, high body mass index, lower physical activity levels, and higher levels of fasting insulin and C-peptide, because these variables are established risk factors for type 2 diabetes. The question is whether the observed association between iron overload and diabetes can be explained by these factors. We used 2 analytic strategies to address this question. First, we adjusted for these covariates in our multivariate analyses. Second, we conducted stratified analyses according to levels of major diabetes risk factors. Both analyses indicated that iron overload was a robust and independent risk factor for the development of type 2 diabetes in our cohort.

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