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Background: Emerging scientific evidence has disclosed a correlation between iron metabolism and type 2 diabetes (T2D). Objective: The objective of this study was to test the hypothesis that body iron stores are higher in a Chinese population with altered glucose homeostasis. Design: Serum iron, ferritin, and soluble transferrin receptor con- centrations were measured in 298 subjects, including 70 subjects with nonnal glucose tolerance (NOT group), 60 subjects with pre- diabetes (prediabetes group), and 168 subjects with T2D (T2D group). Hepatic iron stores in 88 subjects were assessed by using a magnetic resonance imaging (MRI) T2* gradient-recalled-echo technique. A general linear model ANOVA was perfonned for com- parisons between groups after adjustment for age and BMI. Step- wise multiple linear regression analysis was used to identify factors associated with the MRI-estimated hepatic iron concentration (M-HIC). Results: Mean (±SD) M-HIC and R2* values in the prediabetes and T2D groups were significantly higher than in the NOT group (M-HIC: 40.6 ± 8.6 and 39.3 ± 10.7 μmol/g compared with 27.8 ± 9.1 μmolg; R2* values: 47.9 ± 11.9 and 47.3 ± 11.5 s-1 compared with 34.9 ± 7.0s -1; all P < 0.01). No significant difference was shown in M-HIC and R2* values between prediabetes and T2D groups. The M-HIC independently contributed to 43.3% of the glycated hemoglobin variance after adjustment for main clinical indexes (P < 0.001). The proportions of subjects with mild hepatic iron overload in the NGT, prediabetes, and T2D groups were 12.5%, 70.6%, and 63.6%, respectively. Conclusions: To our knowledge, our findings provide novel evidence to support the hypothesis of a mild iron overload in patients with prediabetes and T2D. A cohort study concerned with the effect of the attenuation of excess iron on glucose metabolism in a prediabetic population is warranted. [ABSTRACT FROM AUTHOR]