HOW ARE NEW CARDIOVASCULAR RISK MARKERS PLASMA ATEROGENIC INDEX, NEUTROPHIL / LYMPHOCYTE RATIO AND MONOCYTE HDL RATIO AFFECTED IN OBESITY? A CROSS-SECTIONAL RETROSPECTIVE STUDY

Yıl 2022, , 1 - 6, 17.01.2022

İbrahim Ersoy , Pınar Ersoy

https://doi.org/10.18229/kocatepetip.793923

Öz

OBJECTIVE: In World Health Organization (WHO) definition, body mass index (BMI) 25 and over is classified as slightly overweight, 30 and over classified as obese, and obesity has increasing prevalence worldwide. Obesity has become an epidemic and an important in public health problem. In our study, we aimed to investigate the relationship among obesity, a chronic inflammatory and epidemic disease, with the parameters of Neutrophil to lymphocyte ratio (NLR), monocyte to low-density lipoprotein (HDL) ratio (MHR) and atherogenic index of plasma (PAI), which are defined as new inflammation and cardiovascular disease risk markers.
MATERIAL AND METHODS:
A total of 536 consecutive patients who applied to the primary health care center between 01.12.2018 and 31.04.2019 were evaluated with a retrospective cross-sectional design. The demographic characteristics of the patients, chronic disease characteristics and laboratory, height, weight, waist and hip circumference were obtained from the patient registry database. The patients who admitted participating in the study were divided into four groups according to their BMI as normal weight (18.5-24.9), overweight (25-29.9), obese (30-34.9), and morbidly obese (35 and above). Intergroup variables were evaluated.
RESULTS: In the study, the population mean age was 34(IQR 25-42), 84,5% (452) were female. Of the study population 18% (97) were normal weight, 26.5% (142) were slightly overweight, 27.5% (147) were obese, 28.2% (151) were morbidly obese. As obesity was increasing, age(p<0.001), hypertension history(p=0.003) increased significantly. When laboratory parameters were examined, fasting blood glucose level, insulin resistance, C-reactive protein (CRP), ferritin levels increased with obesity severity, while HDL cholesterol was reduced (p<0.001). NLR, MHR, and PAI all parameters increased with obesity, but only PAI reached statistical significance (p<0.001). There was no significant difference between obesity groups in hemoglobin, platelet, vitamin D, vitamin B12 variables. A strong correlation was found between obesity and age, CRP and PAI in the linear regression model.
CONCLUSIONS: PAI, one of the parameters we investigated, can be used in clinical practice as a cheap and practical marker to assess cardiovascular disease risk in obese patients. NLR and MHR increased with obesity but did not reach statistical significance.

Anahtar Kelimeler

Obesity, Monocyte to HDL ratio, Neutrophil to lymphocyte ratio, Atherogenic index of plasma

YENİ KARDİYOVASKÜLER RİSK BELİRTEÇLERİ PLAZMA ATEROJENİK İNDEKSİ, NÖTROFİL / LENFOSİT ORANI VE MONOSİT HDL ORANI OBEZİTEDE NASIL ETKİLENMEKTEDİR ? KESİTSEL RETROSPEKTİF BİR ÇALIŞMA

Öz

AMAÇ: Dünya Sağlık Örgütünün(DSÖ) tanımlamasında; vücut kitle indeksi (VKİ) 25 ve üzeri olanları hafif kilolu, 30 ve üzeri olanları obez olarak sınıflandırmıştır ve obezitenin dünya genelinde prevalansı giderek artmaktadır. Obezite, artık epidemi ve önemli bir halk sağlığı problemi haline gelmiştir. Çalışmamızda kronik inflamatuvar ve epidemik bir hastalık olan obezitenin yeni inflamasyon ve kardiyovasküler hastalık risk belirteci olarak tanımlanmış nötrofil/lenfosit oranı (NLR), monosit düşük yoğunluklu lipoprotein (HDL) oranı (MHR) ve plazma aterojenik indeksi (PAI) parametreleriyle ilişkisini araştırmak amaçlanmıştır.
GEREÇ VE YÖNTEM: Birinci basamak sağlık merkezine 01.12.2018 ile 31.04.2019 tarihleri arasında ardışık başvuran toplam 536 hasta retrospektif kesitsel tasarımla değerlendirildi. Hastaların demografik özellikleri, kronik hastalık karakterleri ve laboratuvar, boy, kilo, bel ve kalça çevreleri hasta kayıt veri tabanından temin edildi. Başvuran hastalar, VKİ’ne göre normal kilolu (18,5-24,9), hafif kilolu(25-29,9), obez (30-34,9) ve morbid obez(35 ve üzeri) olarak dört gruba ayrıldı. Gruplar arası değişkenler değerlendirildi.
BULGULAR: Çalışmada yaş ortalaması 34 (IQR 25-42)’tü ve %84,5’i(452) kadın cinsiyetteydi. Çalışma popülasyonunun %18(97)’si normal kilolu, %26,5 (142)’si hafif kilolu, %27,5(147)’si obez, %28,2 (151)’si morbid obezdi. Obezite derecesi arttıkça yaş (p<0.001), hipertansiyon öyküsü(p=0.003) anlamlı olarak artmaktaydı. Laboratuvar parametreleri incelendiğinde, açlık kan şekeri düzeyi, insülin direnci,C-reaktif protein (CRP), ferritin düzeyleri obezite derecesi ile artmıştı (p<0.001) ancak HDL kolesterol azalmıştı (p<0.001). NLR, MHR ve PAI de obeziteyle artış gösterdi ancak istatistiksel anlamlılığa sadece PAI ulaştı (p<0.001). Hemoglobin, platelet, D vitamini, B12 vitamini değişkenlerinde obezite grupları arasında anlamlı farklılık yoktu. Lineer regresyon modelinde obezite ile yaş, CRP ve PAI arasında kuvvetli ilişki saptandı.
SONUÇ: Araştırdığımız parameterlerden PAI, obez hastalarda kardiyovasküler hastalık riski değerlendirmek için ucuz ve pratik bir belirteç olarak klinik pratikte kullanılabilir. NLR ve MHR obezite ile artmış ancak istatiksel anlamlılığa ulaşmamıştır.

Anahtar Kelimeler

Obezite, Monosit HDL oranı, Nötrofil lenfosit oranı, Plazma aterojenik indeksi

Kaynakça

• 1. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. Journal of clinical epidemiology. 1988;41(2):105-14.
• 2. Atmaca HU, Akbaş F, Ökten İN, et al. Can Neutrophil-to-Lymphocyte Ratio Serve as an Inflammatory Marker in Obesity? IMJ. 2014;15(4):216-220
• 3. Furuncuoğlu Y, Tulgar S, Dogan A, et al. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. European review for medical and pharmacological sciences. 2016;20(7):1300-6.
• 4. Aydin M, Yilmaz A, Donma MM, et al. Neutrophil/lymphocyte ratio in obese adolescents. Northern Clinics of Istanbul. 2015;2(2):87.
• 5. Ryder E, Diez-Ewald M, Mosquera J, et al. Association of obesity with leukocyte count in obese individuals without metabolic syndrome. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2014;8(4):197-204.
• 6. Wabitsch M, Jensen PB, Blum WF, et al. Insulin and cortisol promote leptin production in cultured human fat cells. Diabetes. 1996;45(10):1435-8.
• 7. Ghigliotti G, Barisione C, Garibaldi S, et al. Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions. Inflammation. 2014;37(4):1337-53.
• 8. Vieira‐Potter VJ. Inflammation and macrophage modulation in adipose tissues. Cellular microbiology. 2014;16(10):1484-92.
• 9. Vuong J, Qiu Y, La M, Clarke G, Swinkels DW, Cembrowski G. Reference intervals of complete blood count constituents are highly correlated to waist circumference: should obese patients have their own “normal values?”. American Journal of Hematology. 2014;89(7):671-7.
• 10. Dixon JB, O'Brien PE. Obesity and the white blood cell count: changes with sustained weight loss. Obesity surgery. 2006;16(3):251-7.
• 11. Bahadır A, Baltacı D, Türker Y, et al. Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome? Anatolian Journal of Cardiology. 2015;15(10):816.
• 12. Xu X, Su S, Wang X, et al. obesity is associated with more activated neutrophils in African American male youth. International Journal of Obesity. 2015;39(1):26-32.
• 13. Hofmann MA, Schiekofer S, Kanitz M, et al. Insufficient glycemic control increases nuclear factor-κB binding activity in peripheral blood mononuclear cells isolated from patients with type 1 diabetes. Diabetes Care. 1998;21(8):1310-6.
• 14. Yilmaz H, Ucan B, Sayki M, et al. Usefulness of the neutrophil-to-lymphocyte ratio to prediction of type 2 diabetes mellitus in morbid obesity. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2015;9(4):299-304.
• 15. Valerius N, Eff C, Hansen N, et al. Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Medica Scandinavica. 1982;211(6):463-7.
• 16. Mraz M, Haluzik M. The role of adipose tissue immune cells in obesity and low-grade inflammation. Journal of Endocrinology. 2014;222(3):R113-R27.
• 17. Johnsen SH, Fosse E, Joakimsen O, et al. Monocyte count is a predictor of novel plaque formation: a 7-year follow-up study of 2610 persons without carotid plaque at baseline the Tromsø Study. Stroke. 2005;36(4):715-9.
• 18. Murphy A, Chin-Dusting J, Sviridov D, et al. KJ. The anti inflammatory effects of high density lipoproteins. Current Medicinal Chemistry. 2009;16(6):667-75.
• 19. Usta A, Avci E, Bulbul CB, et al. The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome. Reproductive Biology and Endocrinology. 2018;16(1):34.
• 20. Parthasarathy S, Barnett J, Fong LG. High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. Biochimica et Biophysica Acta (BBA)-Lipids and Lipid Metabolism. 1990;1044(2):275-83.
• 21. Akboga MK, Balci KG, Maden O, et al. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomarkers in Medicine. 2016;10(4):375-83.
• 22. Shen S-W, Lu Y, Li F, et al. Atherogenic index of plasma is an effective index for estimating abdominal obesity. Lipids in Health and Disease. 2018;17(1):11.
• 23. Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, et al. Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease. Medical Journal of the Islamic Republic of Iran. 2015;29:240.
• 24. Shen S, Lu Y, Qi H, et al. Association between ideal cardiovascular health and the atherogenic index of plasma. Medicine. 2016;95(24):1-7.
• 25. Onat A, Can G, Kaya H, et al. "Atherogenic index of plasma”(log10 triglyceride/high-density lipoprotein− cholesterol) predicts high blood pressure, diabetes, and vascular events. Journal of Clinical Lipidology. 2010;4(2):89-98.
• 26. Zhu X, Yu L, Zhou H, et al. Atherogenic index of plasma is a novel and better biomarker associated with obesity: a population-based cross-sectional study in China. Lipids in Health and Disease. 2018;17(1):1-6