Dietary advice is the cornerstone in first-line treatment of metabolic diseases. Nutritional interventions directed at these clinical conditions mainly aim to (a) improve insulin resistance by reducing energy-dense macronutrient intake to obtain weight loss and (b) reduce fluctuations in insulin secretion through avoidance of rapidly absorbable carbohydrates. However, even in the majority of motivated patients selected for clinical trials, massive efforts using this approach have failed to achieve lasting efficacy. Less attention has been given to the role of micronutrients in metabolic diseases. Here, we review the evidence that highlights (a) the importance of iron in pancreatic beta-cell function and dysfunction in diabetes and (b) the integrative pathophysiological effects of tissue iron levels in the interactions among the beta cell, gut microbiome, hypothalamus, innate and adaptive immune systems, and insulin-sensitive tissues. We propose that clinical trials are warranted to clarify the impact of dietary or pharmacological iron reduction on the development of metabolic disorders.

中文翻译：

---

铁调节胰腺β细胞功能和氧化应激。

饮食建议是一线治疗代谢性疾病的基石。针对这些临床状况的营养干预措施主要旨在（a）通过减少能量密集的大量营养素摄入以减轻体重来改善胰岛素抵抗，以及（b）通过避免快速吸收碳水化合物来减少胰岛素分泌的波动。但是，即使在大多数选择进行临床试验的积极性患者中，使用这种方法的大量努力也未能获得持久的疗效。微量营养素在代谢性疾病中的作用已较少受到关注。在这里，我们回顾了以下证据，这些证据凸显了（a）铁在糖尿病胰岛β细胞功能和功能障碍中的重要性，以及（b）组织铁水平在β细胞之间相互作用中的综合病理生理作用，肠道微生物组，下丘脑，先天性和适应性免疫系统以及胰岛素敏感性组织。我们建议进行临床试验以阐明饮食中铁或药理学上的铁减少对代谢性疾病发展的影响。