Next Article in Journal
Health Benefits, Food Applications, and Sustainability of Microalgae-Derived N-3 PUFA
Next Article in Special Issue
Describing the Sensory Complexity of Italian Wines: Application of the Rate-All-That-Apply (RATA) Method
Previous Article in Journal
Experimental and Numerical Study of a Turbulent Air-Drying Process for an Ellipsoidal Fruit with Volume Changes
Previous Article in Special Issue
Bioactive Compounds and Antioxidant Activity of Red and White Wines Produced from Autochthonous Croatian Varieties: Effect of Moderate Consumption on Human Health
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Foods
Volume 11
Issue 13
10.3390/foods11131881
foods-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Effects of Moderate Consumption of Red Wine on Hepcidin Levels in Patients with Type 2 Diabetes Mellitus

by
Jurica Nazlić
1,
Diana Jurić
2,*,
Ivana Mudnić
2,
Zvonimir Boban
3,
Ana Marija Dželalija
2,
Leida Tandara
4,5,
Daniela Šupe-Domić
4,6,
Katarina Gugo
4 and
Mladen Boban
2
1
Department of Intensive Medicine and Clinical Pharmacology, University Hospital of Split, Šoltanska 1, 21000 Split, Croatia
2
Department of Pharmacology, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
3
Department of Medical Physics and Biophysics, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
4
Department of Medical Laboratory Diagnostics, University Hospital of Split, Šoltanska 1, 21000 Split, Croatia
5
Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
6
University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000 Split, Croatia
*
Author to whom correspondence should be addressed.
Foods 2022, 11(13), 1881; https://doi.org/10.3390/foods11131881
Submission received: 17 May 2022 / Revised: 17 June 2022 / Accepted: 21 June 2022 / Published: 25 June 2022
(This article belongs to the Special Issue Grape Wine: Physicochemical Properties, Sensory Attributes and Health Benefits)
Browse Figures
Versions Notes

Abstract

:
Iron overload is often associated with type 2 diabetes (T2D), indicating that hepcidin, the master regulator of iron homeostasis, might be involved in diabetes pathogenesis. Alcohol consumption may also result in increased body iron stores. However, the moderate consumption of wine with meals might be beneficial in T2D. This effect has been mainly attributed to both the ethanol and the polyphenolic compounds in wine. Therefore, we examined the effects of red wine on hepcidin in T2D patients and non-diabetic controls. The diabetic patients (n = 18) and age- and BMI-matched apparently healthy controls (n = 13) were men, aged 40–65 years, non-smoking, with BMI < 35 kg/m2. Following a 2-week alcohol-free period, both groups consumed 300 mL of red wine for 3 weeks. The blood samples for the iron status analysis were taken at the end of each period. The red wine intake resulted in a decrease in serum hepcidin in both the diabetic subjects (p = 0.045) and controls (p = 0.001). The levels of serum ferritin also decreased after wine in both groups, reaching statistical significance only in the control subjects (p = 0.017). No significant alterations in serum iron, transferrin saturation, or soluble transferrin receptors were found. The suppression of hepcidin, a crucial iron-regulatory hormone and acute-phase protein, in T2D patients and healthy controls, is a novel biological effect of red wine. This may deepen our understanding of the mechanisms of the cardiometabolic effects of wine in T2D.

Graphical Abstract

1. Introduction

Diabetes is a growing global health emergency, with a prevalence in the adult population estimated to be 10.5% in 2021 worldwide [1]. Evidence associating iron overload with insulin resistance and type 2 diabetes mellitus (T2D) implies the potential role of hepcidin, the iron-regulatory hormone, in the etiopathogenesis of T2D [2]. This 25-amino-acid peptide is predominantly secreted by hepatocytes, in response to iron burden and inflammation [3,4]. Hepcidin reduces iron bioavailability by triggering the internalization and degradation of ferroportin, the only iron exporter identified so far [5]. When iron efflux from absorptive enterocytes, macrophages, and hepatocytes is repressed, serum iron levels are decreased and intracellular sequestration is enhanced [5,6]. Since iron is essential for living but also potentially toxic, its amount is precisely regulated at both cellular and systemic levels [7]. DNA synthesis and repair, oxygen transport, and cellular respiration are all vital processes demanding iron [8]. However, excess labile cell iron can catalyze the generation of reactive oxygen species (ROS) via the Fenton reaction, causing oxidative tissue damage [9,10]. If pancreatic islet β-cells are affected, insulin secretion could be impaired, and the risk of insulin resistance increased [11,12].
Hepcidin is classified as a type II acute-phase protein [3], with IL-6 being the most dominant inducer of its production [13]. In various inflammatory states, hepcidin is found to be elevated, with the potential to cause anemia or inflammation [6]. Type 2 diabetes is typically associated with chronic low-grade inflammation [14,15], and acute-phase serum protein elevation [14,16]. However, the kinetics of hepcidin in patients with type 2 diabetes remain unclear. Recently published meta-analyses and systematic reviews found no difference [11,17] or only a slight increase in hepcidin in T2D patients compared to controls [18]. However, these inconsistent findings could be partially explained by the use of different and non-standardized assays, as well as a variable consideration of factors that may influence hepcidin expression.
It has been indicated that different food ingredients, including alcohol [19,20,21], might affect hepcidin expression and its levels in serum. On the other hand, the moderate consumption of wine, an important component of the Mediterranean diet [22], has been proven by both observational and interventional trials to reduce cardiometabolic risk and the incidence of type 2 diabetes [23,24,25,26,27]. These beneficial effects have been attributed to both ethanol and polyphenolic compounds [28], which are abundantly present in red wine.
The effect of red wine on serum hepcidin levels in humans is practically unknown. Therefore, the aim of our study was to examine the effects of the moderate consumption of red wine on hepcidin levels in patients with type 2 diabetes mellitus and their non-diabetic controls.

2. Materials and Methods

2.1. Study Design

Recruitment of participants was conducted through the family medicine practices in the city of Split (Croatia) and within the Department of Endocrinology at the University Hospital of Split during their outpatient visit. Inclusion criteria for both control subjects and patients with type 2 diabetes were the following: (1) males, (2) aged between 40 and 65 years, (3) non-severely obese (BMI < 35 kg/m2), (4) non-smokers, and (5) willing to give consent and carry out all study-related procedures.
In addition, control subjects were matched for age and BMI with T2D subjects, in good general health, as determined by screening medical history and clinical examination, and with fasting plasma glucose ≤ 6.9 mmol/L [29]. Diabetic subjects were eligible if they had controlled glycemia (HbA1c value ≤ 7.5% (58 mmol/mol)), received treatment with metformin alone or in combination with other oral antidiabetics.
Both control and diabetic subjects were excluded in cases of: (1) atherosclerotic cardiovascular disease or venous thromboembolism in their medical history, (2) current evidence of acute or chronic inflammatory or infective disease, (3) liver disease, (4) malignancy, (5) dysregulation of iron homeostasis (anemia or hereditary hemochromatosis), (6) previous alcohol or substance abuse, and (7) introduction of new pharmacological agent during the study period.
After a drive-in period of 2 weeks, in which consumption of any alcoholic beverage was prohibited, subjects in both groups started to drink 300 mL of red wine daily for 3 weeks (Figure 1). This amount had to be split between lunch and dinner and consumed during meals [30]. At the end of the drive-in period, the participants were provided with 9 standard wine bottles of 750 mL. The participants were instructed to maintain their eating and lifestyle habits, including physical activity, during both the drive-in and intervention period. A total of 31 participants completed the study protocol: 18 with type 2 diabetes mellitus and 13 control subjects.

2.2. Wine Intervention

Red wine was produced from the Croatian autochthonous red cultivar Plavac mali (Vitis vinifera L.) at the Volarević winery, Croatia, 2016. Basic oenological parameters of the used wine are shown in Table S1. Because the composition of phenolic compounds may influence biological effects of wine [31], the results of the analysis of wine used in our study are provided in Table S2.

2.3. Anthropometric Assessments and Blood Sampling

At the end of the drive-in and intervention period, participants’ weight, height, and body circumferences were measured. Body mass index (BMI) was calculated as the ratio of weight and the square of height (kg/m2). Fasting blood samples were obtained early in the morning and, depending on the type of laboratory parameter, were analyzed the same day or stored at −80 °C for later analysis. In order to prevent the possible influence of diurnal fluctuations in serum hepcidin level, blood collection time was standardized [32]. Three types of vacutainers were used: (1) with K3EDTA, to determine the complete blood count and HbA1c, (2) with fluoride/EDTA, to estimate fasting plasma glucose concentration, and (3) with silica (clot activator)/gel, to separate serum required for the analysis of liver function, inflammation, and serum-based indicators of iron status (UIBC, TIBC, iron, hepcidin, ferritin, soluble transferrin receptors) and glycemic control (fructosamine). Levels of soluble transferrin receptors (sTfR), which reflect the availability of functional iron, were measured using a nephelometric method on a BN ProSpec analyzer (Siemens, ProSpec, Erlangen, Germany). Serum hepcidin was quantified according to the manufacturers’ instructions in a commercially available competitive ELISA kit (Hepcidin 25 (bioactive) HS, DRG Instruments GmbH, Marburg, Germany). All measurements were performed in the Laboratory for Experimental Pharmacology at the University of Split School of Medicine and the Department of Medical Laboratory Diagnostics at the University Hospital of Split.

2.4. Statistical Analysis

The data were presented as a mean ± standard deviation (SD) or a median with 95% confidence interval (CI), depending on the data distribution; the normality of distribution was checked using the Shapiro–Wilk test. The significance of differences was assessed using the t-test for normally distributed data or the Mann–Whitney test for deviations from normality. Welch’s correction was used if the assumption of homogeneity of variance was violated. Pearson correlation coefficient was calculated to evaluate the relationship between the BMI value and hepcidin level change. p-values less than 0.05 were considered statistically significant. The R programming language for statistical computing version 4.0.2 was used for all statistical analyses.

2.5. Ethics Approval

This study complied with the Declaration of Helsinki and its amendments, and was approved by the Ethics Committee of the University of Split School of Medicine, Croatia (no. 2181-198-03-04-13-0042). All subjects gave written informed consent to the sample collection, analysis, and use of the data for publication.

3. Results

General characteristics of all participants, along with glucose levels and metabolic parameters related to liver function and the grade of inflammation at the baseline, are shown in Table 1. The mean age of the participants was 52.8 ± 6.3 years, and there was no significant difference between the groups (p = 0.075). Subjects with type 2 diabetes and control subjects were also comparable regarding the weight, height, BMI value, waist, and hip circumference.
As expected, T2D subjects showed higher fasting glucose levels in comparison to controls (p < 0.0001). Average values of hepatic function parameters, including liver enzymes, albumin, and total bilirubin, were within the reference range in both groups. Similarly, the groups did not differ in hsCRP levels (p = 0.317, Table 1).
Hematological and biochemical markers of iron status in the diabetic and control group, at the baseline and post-intervention, are presented in Table 2.
After 3 weeks of red wine consumption, a significant decrease in hepcidin levels occurred within both groups (p = 0.045 and p = 0.001 for control and diabetic group, respectively, Table 2, Figure 2). No significant linear relationship between BMI and hepcidin change was observed (Pearson’s r = 0.382, p = 0.220 for C; r = 0.037, p = 0.883 for diabetic subjects). The decline in serum hepcidin was not mirrored in serum iron, since its levels were not altered following the wine consumption within both groups (p = 0.328 and p = 0.177 for control and diabetic group, respectively, Table 2). Furthermore, the other standard Fe-related parameters remained largely unchanged after the intervention, except for the ferritin in the control group.
Along with the decrease in hepcidin, a significant decrease in serum ferritin was observed in the control subjects following the red wine intake (p = 0.017, Table 2, Figure 2). It should be noted that the hepcidin and ferritin showed the same pattern of change in the diabetic group as well, but in the diabetic patients, the ferritin values around the mean had a wider spread, and statistical significance was not reached.
Regarding the assessment of glycemic control in the diabetic subjects, neither fasting glucose (7.5 ± 1.4 vs. 7.3 ± 1.4 mmol/L, p = 0.294), nor HbA1c values (6.2 (5.9 to 6.7) vs. 6.4 (5.9 to 6.8) %, p = 0.322) were affected by the red wine intake. Moreover, the fructosamine levels, which better reflected the average blood glucose concentration over the previous 3 weeks, remained similar before and after intervention (289.0 (270.8 to 294.8) vs. 286.0 (273.0 to 294.8) µmol/L, p = 0.524). Glycemic control in the subjects with T2D was achieved with different antidiabetic treatment approaches, which are presented in Table S3. There was no statistical significance in the hepcidin changes in response to red wine consumption between the diabetic patients taking metformin only and those who took metformin in combination with other oral antidiabetics (p = 0.062, Figure 3).

4. Discussion

The key finding of our study is that a moderate consumption of red wine for 3 weeks is associated with a decrease in serum hepcidin levels in both apparently healthy and in type 2 diabetic patients. To the best of our knowledge, this is the first study to assess the effect of red wine consumption on hepcidin, the iron-regulatory hormone, in human subjects.
The effects of wine on iron status in general have been a matter of discussion. A population-based study showed that there is a dose-response relationship between the chronic daily intake of alcoholic beverages and body iron stores, as determined by serum iron, ferritin, and transferrin saturation (TS) [33]. The decrease in hepcidin levels demonstrated in our study is in line with the findings on the down-regulation of hepcidin expression in in vitro and in vivo models of ethanol ingestion [34,35,36]. As hepcidin falls, ferroportin-mediated iron transport is facilitated, resulting in an increased intestinal iron absorption and iron export from the storage cells. It has been hypothesized that the ethanol-mediated increase in intestinal iron uptake is responsible for elevated body iron indices [19]. However, the suppression of hepcidin levels observed in our study should not be attributed only to the ethanol. Rather, it should be interpreted in the context of the complex chemical composition of wine. Namely, wine phenolics have been shown to inhibit the absorption of dietary iron in the duodenum, presumably due to their iron-chelating ability [37]. Other regulatory pathways might be included as well. For example, the decreased expression of duodenal ferroportin was found in rats treated with quercetin, a well-known flavonoid [38]. In a study with human volunteers, polyphenol-rich red wine, similar to the wine used in our study, was 2- to 3-fold more potent at inhibiting iron absorption than white wine with low polyphenolic content and water [39]. Furthermore, the study indicated that the inhibitory effect on iron absorption could be enhanced if wine is taken with meals [39], which was the method of consumption in our study. Polyphenols were found to form a less soluble complex with iron in the presence of protein-digestion products [39,40]. However, the understanding of the mechanisms of interaction between wine phenolics, ethanol, and iron homeostasis is still limited, and further studies are warranted. The impairment of intestinal iron absorption because of flavonoids and the facilitated export from storage cells due to hepcidin decrease could be an explanation for why changes in serum iron after wine were not found in our study. The other possibility might be that 3 weeks of wine consumption simply was not a sufficiently long period to result in potential changes in iron stores.
Despite the expected release of iron into circulation due to hepcidin decreases [41], we did not find an increase in transferrin saturation. Moreover, the TS in both groups was markedly below 70%, the most frequently considered threshold after which non-transferrin-bound iron (NTBI) could be detected [42]. This iron could induce ROS production and may be implicated in different pathologies, such as vasculotoxicity and atherosclerosis [43]. Hence, the moderate consumption of wine might play a role in maintaining the balance of hepcidin levels needed to prevent iron-induced oxidative stress.
A number of studies indicate that the health-promoting properties of wine in different pathological conditions may include the reduction in inflammation [44,45,46]. When interpreting the concomitant decrease in hepcidin and ferritin observed in our study, it is important to mention that both are regarded as acute-phase proteins, whose levels can rise due to various conditions. Some authors propose that ferritin arises in serum by leaking from damaged cells during inflammation [47]. Serum ferritin can also be elevated due to other pathophysiological components of T2D that are not directly related to iron overload [48], such as insulin resistance [49] and metabolic syndrome [50,51]. In our study, the mean levels of serum ferritin decreased after red wine consumption in both groups, with statistical significance reached only in the controls. This was probably due to the fact that the diabetic group was not large enough to compensate for the wider distribution of the ferritin values observed in the participants with T2D. The parallel decrease in serum hepcidin and ferritin described here is in accordance with other studies demonstrating a linear relationship between serum hepcidin and ferritin [6,41]. The increased export of iron may be associated with decreased ferritin production, which in turn results in decreased circulating ferritin [52]. However, since there is increasing evidence that serum ferritin is not an ideal indicator of body iron status, its serum levels should be cautiously interpreted [48,53,54]. As indicated by the concentration of soluble transferrin receptors (sTfR) [55], the cellular iron demands were unchanged in both groups following the red wine intake. In contrast to ferritin, circulating sTfR is considered a biochemical marker of iron status that is insensitive to inflammation [56].
It has been shown that obesity may also influence hepcidin levels [18,57,58]. Therefore, the participants in our study were matched regarding their BMI values. Our results indicated no correlation between BMI < 35 kg/m2 and the hepcidin changes in either the control or the diabetic group. This is in line with the study by Vuppalanchi et al., who showed that elevated hepcidin levels were primarily observed in subjects with BMI ≥ 35 kg/m2 [59]. Antidiabetic therapy could also influence the interrelation between iron metabolism and glucose homeostasis [18]. In the studies evaluating hepcidin levels in patients with T2D, information about their antidiabetic therapy is often insufficient [11,17,18]. It has been shown that metformin may suppress hepcidin production [60]. The potential influence of other oral antidiabetic agents on hepcidin levels is practically unexplored. Because we found no difference in hepcidin level changes between the diabetic patients who took metformin alone and those who took metformin in combination with other oral antidiabetics, it is suggestive that these drugs have no opposing effects on hepcidin. The fact that the hepcidin serum levels were also similarly reduced in the non-diabetic control subjects indicates that the hepcidin suppression was primarily mediated by the moderate intake of red wine.

5. Conclusions

In conclusion, our study provides experimental evidence of a novel biological effect of moderate red wine consumption that is present in both patients with type 2 diabetes and their apparently healthy controls. The understanding of the effects of red wine on hepcidin, a crucial regulator of iron metabolism and acute-phase protein, may deepen insights into and broaden the understanding of the mechanisms behind the cardiometabolic benefits of the moderate consumption of wine, particularly in diabetic patients. To bring required improvements in diabetes lifestyle guidelines another step closer, further studies assessing the long-term intake of red wine on hepcidin and iron status in larger samples are warranted.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/foods11131881/s1. Table S1: Physicochemical properties of red wine Plavac mali. Table S2: Monomeric and oligomeric tannins (mg/L) in Plavac mali. Table S3: Antidiabetic pharmacotherapy used by 18 patients with type 2 diabetes mellitus who completed the study.

Author Contributions

J.N., I.M., L.T. and M.B. designed the study. J.N., D.J., I.M. and A.M.D. were involved in the organization of the study, including the recruitment of the participants, their follow-up, and ensuring their compliance with the study protocol, blood sampling, and anthropometric measurements. L.T., D.Š.-D. and K.G. conducted the required laboratory analyses. Z.B. undertook the statistical analyses and graphical presentation of the results. J.N. and D.J. wrote the initial draft of the paper, and M.B. critically revised the manuscript for important intellectual content. All the authors read and approved the submitted version. M.B. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and agreed to the published version of the manuscript.

Funding

This study was funded by the Croatian Science Foundation (“Biological effects of wine: the influence of vinification technology, dealcoholisation and aging of wine”) under project no. IP-2013-11-8652, with M.B. as the project leader. The funder had no role in the design of this study, its execution, the analyses, the interpretation of the data, or the decision to submit the results.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the University of Split School of Medicine, Croatia (no. 2181-198-03-04-13-0042, 6 December 2013).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Conflicts of Interest

The authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this paper.

References

  1. International Diabetes Federation Diabetes Atlas, 10th ed. 2021. Available online: www.diabetesatlas.org (accessed on 23 February 2022).
  2. Aregbesola, A.; Voutilainen, S.; Virtanen, J.K.; Aregbesola, A.; Tuomainen, T.P. Serum hepcidin concentrations and type 2 diabetes. World J. Diabetes 2015, 6, 978–982. [Google Scholar]
  3. Nemeth, E.; Valore, E.V.; Territo, M.; Schiller, G.; Lichtenstein, A.; Ganz, T. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Blood 2003, 101, 2461–2463. [Google Scholar]
  4. Armitage, A.E.; Eddowes, L.A.; Gileadi, U.; Cole, S.; Spottiswoode, N.; Selvakumar, T.A.; Ho, L.P.; Townsend, A.R.; Drakesmith, H. Hepcidin regulation by innate immune and infectious stimuli. Blood 2011, 118, 4129–4139. [Google Scholar]
  5. Nemeth, E.; Tuttle, M.S.; Powelson, J.; Vaughn, M.B.; Donovan, A.; Ward, D.M.V.; Ganz, T.; Kaplan, J. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science 2004, 306, 2090–2093. [Google Scholar]
  6. Ganz, T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003, 102, 783–788. [Google Scholar]
  7. Camaschella, C.; Nai, A.; Silvestri, L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica 2020, 105, 260–272. [Google Scholar]
  8. Abbaspour, N.; Hurrell, R.; Kelishadi, R. Review on iron and its importance for human health. J. Res. Med. Sci. 2014, 19, 164–174. [Google Scholar]
  9. Kakhlon, O.; Cabantchik, Z.I. The labile iron pool: Characterization, measurement, and participation in cellular processes. Free Radic. Biol. Med. 2002, 33, 1037–1046. [Google Scholar]
  10. Cabantchik, Z.I. Labile iron in cells and body fluids: Physiology, pathology, and pharmacology. Front. Pharmacol. 2014, 5, 45. [Google Scholar]
  11. Liu, J.F.; Li, Q.X.; Yang, Y.X.; Ma, L.H. Iron metabolism and type 2 diabetes mellitus: A meta-analysis and systematic review. J. Diabetes Investig. 2020, 11, 946–955. [Google Scholar]
  12. Lee, H.J.; Choi, J.S.; Lee, H.J.; Kim, W.H.; Park, S.I.; Song, J. Effect of excess iron on oxidative stress and gluconeogenesis through hepcidin during mitochondrial dysfunction. J. Nutr. Biochem. 2015, 26, 1414–1423. [Google Scholar]
  13. Wrighting, D.M.; Andrews, N.C. Interleukin-6 induces hepcidin expression through STAT3. Blood 2006, 108, 3204–3209. [Google Scholar]
  14. Donath, M.Y.; Shoelson, S.E. Type 2 diabetes as an inflammatory disease. Nat. Rev. Immunol. 2011, 11, 98–107. [Google Scholar]
  15. Sharif, S.; Van der Graaf, Y.; Cramer, M.J.; Kapelle, L.J.; de Borst, G.J.; Visseren, F.L.J.; Westerink, J.; SMART Study Group. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes. Cardiovasc. Diabetol. 2021, 20, 220. [Google Scholar]
  16. McMillan, D.E. Increased levels of acute-phase serum proteins in diabetes. Metabolism 1989, 38, 1042–1046. [Google Scholar]
  17. Karamzad, N.; Eftekhari, A.; Ashrafi-Asgarabad, A.; Sullman, M.J.M.; Sahebkar, A.; Safiri, S. Serum hepcidin, the hepcidin/ferritin ratio and the risk of type 2 diabetes: A systematic review and meta-analysis. Curr. Med. Chem. 2021, 28, 1224–1233. [Google Scholar]
  18. Ndevahoma, F.; Mukesi, M.; Dludla, P.V.; Nkambule, B.B.; Nepolo, E.P.; Nyambuya, T.M. Body weight and its influence on hepcidin levels in patients with type 2 diabetes: A systematic review and meta-analysis of clinical studies. Heliyon 2021, 7, e06429. [Google Scholar]
  19. Harrison-Findik, D.D. Role of alcohol in the regulation of iron metabolism. World J. Gastroenterol. 2007, 13, 4925–4930. [Google Scholar]
  20. Milman, N.T. A review of nutrients and compounds, which promote or inhibit intestinal iron absorption: Making a platform for dietary measures that can reduce iron uptake in patients with genetic haemochromatosis. J. Nutr. Metab. 2020, 2020, 7373498. [Google Scholar]
  21. Omena, J.; Curioni, C.; Cople-Rodrigues, C.D.; Citelli, M. The effect of food and nutrients on iron overload: What do we know so far? Eur. J. Clin. Nutr. 2021, 75, 1771–1780. [Google Scholar]
  22. Eleftheriou, D.; Benetou, V.; Trichopoulou, A.; La Vecchia, C.; Bamia, C. Mediterranean diet and its components in relation to all-cause mortality: Meta-analysis. Br. J. Nutr. 2018, 120, 1081–1097. [Google Scholar]
  23. Martin, M.A.; Goya, L.; Ramos, S. Protective effects of tea, red wine and cocoa in diabetes. Evidences from human studies. Food Chem. Toxicol. 2017, 109, 302–314. [Google Scholar]
  24. Blomster, J.I.; Zoungas, S.; Chalmers, J.; Li, Q.; Chow, C.K.; Woodward, M.; Mancia, G.; Poulter, N.; Williams, B.; Harrap, S.; et al. The relationship between alcohol consumption and vascular complications and mortality in individuals with type 2 diabetes. Diabetes Care 2014, 37, 1353–1359. [Google Scholar]
  25. Gepner, Y.; Golan, R.; Harman-Boehm, I.; Henkin, Y.; Schwarzfuchs, D.; Shelef, I.; Durst, R.; Kovsan, J.; Bolotin, A.; Leitersdorf, E.; et al. Effects of initiating moderate alcohol intake on cardiometabolic risk in adults with type 2 diabetes: A 2-year randomized, controlled trial. Ann. Intern. Med. 2015, 163, 569–579. [Google Scholar]
  26. Golan, R.; Shelef, I.; Shemesh, E.; Henkin, Y.; Schwarzfuchs, D.; Gepner, Y.; Harman-Boehm, I.; Witkow, S.; Friger, M.; Chassidim, Y.; et al. Effects of initiating moderate wine intake on abdominal adipose tissue in adults with type 2 diabetes: A 2-year randomized controlled trial. Public Health Nutr. 2017, 20, 549–555. [Google Scholar]
  27. Beulens, J.W.; van der Schouw, Y.T.; Bergmann, M.M.; Rohrmann, S.; Schulze, M.B.; Buijsse, B.; Grobbee, D.E.; Arriola, L.; Cauchi, S.; Tormo, M.J.; et al. Alcohol consumption and risk of type 2 diabetes in European men and women: Influence of beverage type and body size The EPIC-InterAct study. J. Intern. Med. 2012, 272, 358–370. [Google Scholar]
  28. Golan, R.; Gepner, Y.; Shai, I. Wine and health—New evidence. Eur. J. Clin. Nutr. 2019, 72, 55–59. [Google Scholar]
  29. American Diabetes Association Professional Practice Care. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2022. Diabetes Care 2022, 45 (Suppl. 1), S17–S38. [Google Scholar]
  30. Boban, M.; Stockley, C.; Teissedre, P.L.; Restani, P.; Fradera, U.; Stein-Hammer, C.; Ruf, J.C. Drinking pattern of wine and effects on human health: Why should we drink moderately and with meals? Food Funct. 2016, 7, 2937–2942. [Google Scholar]
  31. Mollica, A.; Scioli, G.; Della Valle, A.; Cichelli, A.; Novellino, E.; Bauer, M.; Kamysz, W.; Llorent-Martínez, E.J.; Córdova, M.L.F.-D.; Castillo-López, R.; et al. Phenolic analysis and in vitro biological activity of red wine, pomace and grape seeds oil derived from Vitis vinifera L. cv. Montepulciano d’Abruzzo. Antioxidants 2021, 10, 1704. [Google Scholar]
  32. Busbridge, M.; Griffiths, C.; Ashby, D.; Gale, D.; Jayantha, A.; Sanwaiya, A.; Chapman, R.S. Development of a novel immunoassay for the iron regulatory peptide hepcidin. Brit. J. Biomed. Sci. 2009, 66, 150–157. [Google Scholar]
  33. Ioannou, G.N.; Dominitz, J.A.; Weiss, N.S.; Heagerty, P.J.; Kowdley, K.V. The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia. Gastroenterology 2004, 126, 1293–1301. [Google Scholar]
  34. Harrison-Findik, D.D.; Schafer, D.; Klein, E.; Timchenko, N.A.; Kulaksiz, H.; Clemens, D.; Fein, E.; Andriopoulos, B.; Pantopoulos, K.; Gollan, J. Alcohol metabolism-mediated oxidative stress down-regulates hepcidin transcription and leads to increased duodenal iron transporter expression. J. Biol. Chem. 2006, 281, 22974–22982. [Google Scholar]
  35. Harrison-Findik, D.D.; Klein, E.; Crist, C.; Evans, J.; Timchenko, N.; Gollan, J. Iron-mediated regulation of liver hepcidin expression in rats and mice is abolished by alcohol. Hepatology 2007, 46, 1979–1985. [Google Scholar]
  36. Ohtake, T.; Saito, H.; Hosoki, Y.; Inoue, M.; Miyoshi, S.; Suzuki, Y.; Fujimoto, Y.; Kohgo, Y. Hepcidin is down-regulated in alcohol loading. Alcohol. Clin. Exp. Res. 2007, 31, 2S–8S. [Google Scholar]
  37. Wang, X.M.; Li, Y.; Han, L.; Li, J.; Liu, C.; Sun, C.G. Role of flavonoids in the treatment of iron overload. Front. Cell Dev. Biol. 2021, 9, 685364. [Google Scholar]
  38. Lesjak, M.; Hoque, R.; Balesaria, S.; Skinner, V.; Debnam, E.S.; Srai, S.K.S.; Sharp, P.A. Quercetin inhibits intestinal iron absorption and ferroportin transporter expression in vivo and in vitro. PLoS ONE 2014, 9, e102900. [Google Scholar]
  39. Cook, J.D.; Reddy, M.B.; Hurrell, R.F. The effect of red and white wines on nonheme-iron absorption in humans. Am. J. Clin. Nutr. 1995, 61, 800–804. [Google Scholar]
  40. Arfaoui, L. Dietary plant polyphenols: Effects of food processing on their content and bioavailability. Molecules 2021, 26, 2959. [Google Scholar]
  41. Galesloot, T.E.; Vermeulen, S.H.; Geurts-Moespot, A.J.; Klaver, S.M.; Kroot, J.J.; Van Tienoven, D.; Wetzels, J.F.M.; Kiemeney, L.A.L.M.; Sweep, F.C.; Heijer, M.D.; et al. Serum hepcidin: Reference ranges and biochemical correlates in the general population. Blood 2011, 117, e218–e225. [Google Scholar]
  42. Sugiura, T.; Dohi, Y.; Takase, H.; Fujii, S.; Seo, Y.; Ohte, N. Analytical evaluation of serum non-transferrin-bound iron and its relationships with oxidative stress and cardiac load in the general population. Medicine 2021, 100, e24722. [Google Scholar]
  43. Vinchi, F. Non-transferrin-bound iron in the spotlight: Novel mechanistic insights into the vasculotoxic and atherosclerotic effect of iron. Antioxid. Redox Signal. 2021, 35, 387–414. [Google Scholar]
  44. Van Bussel, B.C.T.; Henry, R.M.A.; Schalkwijk, C.G.; Dekker, J.M.; Nijpels, G.; Feskens, E.J.M.; Stehouwer, C.D.A. Alcohol and red wine consumption, but not fruit, vegetables, fish or dairy products, are associated with less endothelial dysfunction and less low-grade inflammation: The Hoorn Study. Eur. J. Nutr. 2018, 57, 1409–1419. [Google Scholar]
  45. Imhof, A.; Woodward, M.; Doering, A.; Helbecque, N.; Loewel, H.; Amouyel, P.; Lowe, G.; Koenig, W. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: Results from three MONICA samples (Augsburg, Glasgow, Lille). Eur. Heart J. 2004, 25, 2092–2100. [Google Scholar]
  46. Li, J.; Lee, D.H.; Hu, J.; Tabung, F.K.; Li, Y.; Bhupathiraju, S.N.; Rimm, E.B.; Rexrode, K.M.; Manson, J.E.; Willett, W.C.; et al. Dietary inflammatory potential and risk of cardiovascular disease among men and women in the US. J. Am. Coll. Cardiol. 2020, 76, 2181–2193. [Google Scholar]
  47. Kell, D.B.; Pretorius, E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 2014, 6, 748–773. [Google Scholar]
  48. Adams, P.C. Diabetes: Serum ferritin levels and T2DM—Are body iron stores elevated? Nat. Rev. Endocrinol. 2012, 8, 573–575. [Google Scholar]
  49. Pham, N.M.; Nanri, A.; Yi, S.; Kurotani, K.; Akter, S.; Foo, L.H.; Nishi, N.; Sato, M.; Hayabuchi, H.; Mizoue, T. Serum ferritin is associated with markers of insulin resistance in Japanese men but not in women. Metabolism 2013, 62, 561–567. [Google Scholar]
  50. Vari, I.S.; Balkau, B.; Kettaneh, A.; André, P.; Tichet, J.; Fumeron, F.; Caces, E.; Marre, M.; Grandchamp, B.; Ducimetière, P.; et al. Ferritin and transferrin are associated with metabolic syndrome abnormalities and their change over time in a general population—Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetes Care 2007, 30, 1795–1801. [Google Scholar]
  51. Park, S.K.; Kim, M.G.; Ryoo, J.H.; Shin, J.Y. Association of serum ferritin and the development of metabolic syndrome in middle-aged Korean men: A 5-year follow-up study. Diabetes Care 2012, 35, 2521–2526. [Google Scholar]
  52. Peng, Y.Y.; Uprichard, J. Ferritin and iron studies in anaemia and chronic disease. Ann. Clin. Biochem. 2017, 54, 43–48. [Google Scholar]
  53. Justin, C.L.; Stevic, I.; Chan, A.; Lau, K.K.H.; Chan, H.H.W. Serum ferritin is not sensitive or specific for the diagnosis of iron deficiency in patients with normocytic anemia. Blood 2015, 126, 955. [Google Scholar]
  54. Garcia-Casal, M.N.; Pena-Rosas, J.P.; Pasricha, S.R. Rethinking ferritin cutoffs for iron deficiency and overload. Lancet Haematol. 2014, 1, E92–E94. [Google Scholar]
  55. Speeckaert, M.M.; Speeckaert, R.; Delanghe, J.R. Biological and clinical aspects of soluble transferrin receptor. Crit. Rev. Clin. Lab. Sci. 2010, 47, 213–228. [Google Scholar]
  56. Skikne, B.S.; Punnonen, K.; Caldron, P.H.; Bennett, M.T.; Rehu, M.; Gasior, G.H.; Chamberlin, J.S.; Sullivan, L.A.; Bray, K.R.; Southwick, P.C. Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index. Am. J. Hematol. 2011, 86, 923–927. [Google Scholar]
  57. Andrews, M.; Soto, N.; Arredondo-Olguin, M. Association between ferritin and hepcidin levels and inflammatory status in patients with type 2 diabetes mellitus and obesity. Nutrition 2015, 31, 51–57. [Google Scholar]
  58. Coimbra, S.; Catarino, C.; Santos-Silva, A. The role of adipocytes in the modulation of iron metabolism in obesity. Obes. Rev. 2013, 14, 771–779. [Google Scholar]
  59. Vuppalanchi, R.; Troutt, J.S.; Konrad, R.J.; Ghabril, M.; Saxena, R.; Bell, L.N.; Kowdley, K.V.; Chalasani, N. Serum hepcidin levels are associated wih obesity but not liver disease. Obesity 2014, 22, 836–841. [Google Scholar]
  60. Hawula, Z.J.; Wallace, D.F.; Subramaniam, V.N.; Rishi, G. Therapeutic advances in regulating the hepcidin/ferroportin axis. Pharmaceuticals 2019, 12, 170. [Google Scholar]
Foods 11 01881 g001 550
Figure 1. CONSORT flow diagram showing the recruitment processes and study protocol.
Figure 1. CONSORT flow diagram showing the recruitment processes and study protocol.
Foods 11 01881 g001
Foods 11 01881 g002 550
Figure 2. Value changes in hepcidin and ferritin in patients with type 2 diabetes and their age- and BMI-matched controls after 3-week moderate consumption of red wine. The abbreviation n.s. indicates p > 0.05, whilst symbols * and ** indicate p < 0.05 and p < 0.01, respectively.
Figure 2. Value changes in hepcidin and ferritin in patients with type 2 diabetes and their age- and BMI-matched controls after 3-week moderate consumption of red wine. The abbreviation n.s. indicates p > 0.05, whilst symbols * and ** indicate p < 0.05 and p < 0.01, respectively.
Foods 11 01881 g002
Foods 11 01881 g003 550
Figure 3. Value changes in hepcidin after 3-week moderate intake of red wine in the patients with type 2 diabetes taking only metformin (n = 10) and those taking metformin with other oral antidiabetic agents (n = 8). The abbreviation n.s. indicates p > 0.05.
Figure 3. Value changes in hepcidin after 3-week moderate intake of red wine in the patients with type 2 diabetes taking only metformin (n = 10) and those taking metformin with other oral antidiabetic agents (n = 8). The abbreviation n.s. indicates p > 0.05.
Foods 11 01881 g003
Table
Table 1. Anthropometrical and biochemical data of participants with type 2 diabetes mellitus and control subjects at the baseline.
Table 1. Anthropometrical and biochemical data of participants with type 2 diabetes mellitus and control subjects at the baseline.
ParameterControl Group (n = 13)T2D Group
(n = 18)		p-Value
Age (years)50.5 ± 5.954.6 ± 6.20.075
Age at T2D onset (years)N/A50.6 ± 6.7N/A
Weight (kg)100.3 (84.7–105.5)98.5 (87.2–107.0)0.617
Height (cm)186.8 ± 5.6184.5 ± 10.10.427
Waist circumference (cm)106.0 (95.8–109.5)107.0 (98.8–112.4)0.458
Hip circumference (cm)108.0 ± 5.6105.0 ± 7.50.237
Upper arm circumference (cm)35.2 ± 2.932.2 ± 3.40.015
Neck circumference (cm)42.0 (40.3–44.0)38.5 (37.0–41.2)0.051
BMI (kg/m2)27.2 ± 2.729.8 ± 4.10.062
Fasting glucose (mmol/L)5.3 ± 0.47.5 ± 1.4<0.0001
AST (IU/L)27.1 ± 7.122.1 ± 4.90.029
ALT (IU/L)25.0 (19.5–39.2)25.5 (16.4–29.6)0.674
GGT (IU/L)28.0 (23.5–43.7)25.5 (20.0–32.2)0.307
Albumin (g/L)45.0 (45.0–46.0) *43.0 (41.4–44.0)0.002
Total bilirubin (µmol/L)13.8 ± 4.0 †12.4 ± 4.60.388
Urates (µmol/L)328.9 ± 43.8359.6 ± 81.20.188
hsCRP (mg/L)1.3 (0.7–1.9)1.5 (0.8–2.9)0.317
Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase; BMI, body mass index; GGT, gamma-glutamyl transferase; hsCRP, high-sensitivity C-reactive protein; N/A, not applicable; T2D, type 2 diabetes. Normally distributed variables are presented as mean ± SD, whilst non-normally distributed variables are presented as median with 95% CIs. * One control participant was excluded from the albumin analysis due to a lack of data for second measurement. † Two control participants were excluded from the total bilirubin analysis due to a lack of data for second measurement.
Table
Table 2. Laboratory indicators of the iron status of participants with type 2 diabetes mellitus and control subjects and at pre- and post-intervention.
Table 2. Laboratory indicators of the iron status of participants with type 2 diabetes mellitus and control subjects and at pre- and post-intervention.
Laboratory ParameterControl Group (n = 13)T2D Group (n = 18)
After
Drive-In		After
Red Wine		p-ValueAfter
Drive-In		After
Red Wine		p-Value
RBC (×1012/L)5.2 ± 0.55.1 ± 0.40.0775.0 ± 0.34.9 ± 0.30.888
Hematocrit (L/L)0.45 ± 0.0390.45 ± 0.0340.3880.44 ± 0.0190.44 ± 0.0210.749
Hemoglobin (g/L)154.2 ± 12.6153.0 ± 10.60.348151.4 ± 6.2151.5 ± 6.50.969
RDW (%)13.0 ± 0.513.2 ± 0.50.01313.5 ± 0.413.6 ± 0.50.033
MCH (pg)29.6 ± 1.029.9 ± 1.00.04730.7 ± 1.330.7 ± 1.40.709
MCHC (g/L)337.5 ± 7.3339.5 ± 8.80.261341.4 ± 5.5342.7 ± 6.80.349
MCV (fL)87.1 (84.9–90.1)87.2 (85.2–91.5)0.67589.8 ± 3.689.6 ± 3.50.495
Serum iron (µmol/L)21.8 ± 7.119.6 ± 6.90.32815.0 (13.8–18.7)16.4 (14.6–20.9)0.177
TIBC (µmol/L)54.2 ± 9.353.8 ± 12.10.76757.8 ± 7.258.2 ± 7.60.434
UIBC (µmol/L)31.6 ± 11.634.2 ± 11.40.10939.4 (37.5–45.5)41.6 (36.8–46.5)0.453
Transferrin saturation (%) *40.6 ± 12.937.0 ± 11.30.30726.7 (22.6–29.9)29.3 (24.5–32.7)0.265
sTfR (mg/L) †1.20 ± 0.221.24 ± 0.250.7341.05 ± 0.171.04 ± 0.200.830
Ferritin (ng/mL)173.0 (126.4–259.8)118.0 (90.5–232.6)0.017209.5 ± 141.5198.8 ± 139.40.215
Hepcidin (ng/mL) ‡30.0 ± 17.321.0 ± 12.10.04517.9 (11.9–25.2)13.2 (8.2–18.3)0.001
Abbreviations: MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; RDW, red-cell distribution width; RBC, red blood cell; sTFR, soluble transferrin receptor; TIBC, total iron-binding capacity; T2D, type 2 diabetes; UIBC, unsaturated iron-binding capacity. Normally distributed variables are presented as mean ± SD, whilst non-normally distributed variables are presented as median with 95% CIs. * Transferrin saturation percentage calculated as 100 × serum iron/TIBC. † One control participant had undetectable levels of sTfR, and was thus excluded from the analysis. ‡ One control participant had undetectable levels of hepcidin, and was thus excluded from the analysis.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Nazlić, J.; Jurić, D.; Mudnić, I.; Boban, Z.; Dželalija, A.M.; Tandara, L.; Šupe-Domić, D.; Gugo, K.; Boban, M. Effects of Moderate Consumption of Red Wine on Hepcidin Levels in Patients with Type 2 Diabetes Mellitus. Foods 2022, 11, 1881. https://doi.org/10.3390/foods11131881

AMA Style

Nazlić J, Jurić D, Mudnić I, Boban Z, Dželalija AM, Tandara L, Šupe-Domić D, Gugo K, Boban M. Effects of Moderate Consumption of Red Wine on Hepcidin Levels in Patients with Type 2 Diabetes Mellitus. Foods. 2022; 11(13):1881. https://doi.org/10.3390/foods11131881

Chicago/Turabian Style

Nazlić, Jurica, Diana Jurić, Ivana Mudnić, Zvonimir Boban, Ana Marija Dželalija, Leida Tandara, Daniela Šupe-Domić, Katarina Gugo, and Mladen Boban. 2022. "Effects of Moderate Consumption of Red Wine on Hepcidin Levels in Patients with Type 2 Diabetes Mellitus" Foods 11, no. 13: 1881. https://doi.org/10.3390/foods11131881

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop