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      The association between the neutrophil-to-lymphocyte ratio and type 2 diabetes mellitus: a cross-sectional study

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          Abstract

          Background

          Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease often accompanied by low-grade inflammation. Recently, the neutrophil-to-lymphocyte ratio (NLR) has garnered researchers’ interest as an emerging inflammation biomarker. This study aimed to comprehensively explore the relationship between NLR and T2DM using the National Health and Nutrition Examination Survey (NHANES) database.

          Method

          We employed a cross-sectional study design to analyze data from five NHANES cycles from 2007 to 2016, excluding individuals with incomplete data. This study utilized a weighted logistic regression model, subgroup analyses, and restricted cubic spline (RCS) analysis to assess the potential relationship between NLR and T2DM.

          Results

          A total of 9903 participants were eligible for the analysis, of which 1280 were diagnosed with T2DM. The T2DM group exhibited significantly higher NLR levels than the non-T2DM group. After adjusting for potential confounders, elevated NLR levels were associated with an increased risk of developing T2DM, indicated by an odds ratio (OR) of 1.14, 95% CI: (1.05,1.24), P = 0.003. The results of the subgroup analyses revealed a significant interaction effect between NLR and T2DM concerning race and hypertension ( P for interaction < 0.05). In contrast, no significant interactions were found for age, sex, education level, body mass index (BMI), smoking status, recreational activities, and alcohol drinker ( P for interaction > 0.05). RCS analysis showed a significant non-linear relationship between NLR and T2DM, with an inflection point at 2.27 (all P for non-linearity < 0.05).

          Conclusion

          Our study indicates that an elevated neutrophil-to-lymphocyte ratio is associated with a higher risk of T2DM.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12902-024-01637-x.

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          Most cited references41

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          IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

          Hong Sun, Pouya Saeedi, Suvi Karuranga … (2022)
          To provide global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045.
          Article 0 comments Cited 1843 times – based on 0 reviews     Review now
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            Type 2 diabetes mellitus

            Ralph A. DeFronzo, Ele Ferrannini, Leif Groop … (2015)
            Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity. Individuals with T2DM are at high risk for both microvascular complications (including retinopathy, nephropathy and neuropathy) and macrovascular complications (such as cardiovascular comorbidities), owing to hyperglycaemia and individual components of the insulin resistance (metabolic) syndrome. Environmental factors (for example, obesity, an unhealthy diet and physical inactivity) and genetic factors contribute to the multiple pathophysiological disturbances that are responsible for impaired glucose homeostasis in T2DM. Insulin resistance and impaired insulin secretion remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. The multiple pathogenetic disturbances present in T2DM dictate that multiple antidiabetic agents, used in combination, will be required to maintain normoglycaemia. The treatment must not only be effective and safe but also improve the quality of life. Several novel medications are in development, but the greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications. For an illustrated summary of this Primer, visit: http://go.nature.com/V2eGfN.
            Article 0 comments Cited 505 times – based on 0 reviews     Review now
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              Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus

              Alexandra Kautzky-Willer, Jürgen Harreiter, Giovanni Pacini (2016)
              The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.
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                Author and article information

                Contributors
                Ze He: heze@ccucm.edu.cn
                Journal
                Journal ID (nlm-ta): BMC Endocr Disord
                Journal ID (iso-abbrev): BMC Endocr Disord
                Title: BMC Endocrine Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6823
                Publication date (Electronic): 9 July 2024
                Publication date PMC-release: 9 July 2024
                Publication date Collection: 2024
                Volume: 24
                Electronic Location Identifier: 107
                Affiliations
                [1 ]Changchun University of Traditional Chinese Medicine, ( https://ror.org/02an57k10) 1035 Bo shuo Road, Changchun, Jilin 130117 China
                [2 ]GRID grid.430605.4, ISNI 0000 0004 1758 4110, Department of Endocrinology, , The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, ; 1478 Gong nong Road, Changchun, Jilin 130021 China
                Article
                Publisher ID: 1637
                DOI: 10.1186/s12902-024-01637-x
                PMC ID: 11232124
                PubMed ID: 38982402
                SO-VID: 4c2ffd64-b3bb-48b3-8285-e6339381b2ff
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, 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 changes were made. 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/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 7 May 2024
                Date accepted : 1 July 2024
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: neutrophil-to-lymphocyte ratio,inflammation,type 2 diabetes mellitus,cross-sectional study
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: neutrophil-to-lymphocyte ratio, inflammation, type 2 diabetes mellitus, cross-sectional study

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