The Evaluation of Complete Blood Cell Count-Based Inflammatory Markers in Pediatric Obesity and Metabolic Syndrome

Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.

[1] T. Osadnik, K. Bujak, K. Osadnik, H. Czarnecka, N. Pawlas, R. Regula, M. Fronczek, M. Lejawa, M. Gawlita, M. Gonera, M. Goral, J. K. Strzelczyk, M. Gierlotka, A. Lekston, J. Kasperczyk, L. Polonski, and M. Gasior, “Novel inflammatory biomarkers may reflect subclinical inflammation in young healthy adults with obesity,” Endokrynologia Polska, vol.70, no.2, 2019
[2] J. Y. Yu, W.-J. Choi, H.-S. Lee, and J.-W. Lee, “Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults. An observational study, ” Medicine, vol. 98, no.9, pp. e14740, March 2019.
[3] M. E. Afari, and T. Bhat, “Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases : an update, ” Expert Rev. Cardiovasc. Ther., vol. 14, no.5, pp.573-577, Mar. 2016.
[4] R. C. Bowen, N. A. B. Little, J. R. Harmer, J. Ma, L. G. Mirabelli, K. D. Roller, A. M. Breivik, E. Signor, A. B. Miller, and H. T. Khong, “ Neutrophil to lymphocyte ratio as prognostic indicator in gastrointestinal cancers : a systematic review and meta-analysis, ” Oncotarget, vol.8, no. 19, pp.32171-32189, May 2017.
[5] H. Ozturk, B. Ozen, G. Catli, and B. Dundar, “ Relations of macular variability with anthropometric measurements, metabolic parameters and inflammatory markers in children and adolescents with metabolic syndrome : A cross-sectional study, ” Clin. Res. Pediatr. Endocrinol., Aug 2019 Epub ahead of print.
[6] M. Aydın, A. Yılmaz, M. M. Donma, F. Tulubas, M. Demirkol, M. Erdogan, and A. Gurel, “Neutrophil/lymphocyte ratio in obese adolescents, North. Clin. Istanb., vol. 2, no. 2, pp. 87-91, Sept. 2015.
[7] C. O. Marginean, L. E. Melit, D. V. Ghiga, and M. O. Marginean, “Early inflammatory status related to pediatric obesity, ” Front Pediatr., vol.7, pp. 241, Jun 2019.
[8] V. Pergialiotis, E. Trakakis, C. Parthenis, E. Hatziagelaki, C. Chrelias, N. Thomakos, and N. Papantoniou, “Correlation of platelet to lymphocyte and neutrophil to lymphocyte ratio with hormonal and metabolic parameters in women with PCOS, ” Horm. Mol. Biol. Clin. Investig., vol. 34, no.3, pp. , Apr. 2018.
[9] E. N. Tola, “The association between in vitro fertilization outcome and the inflammatory markers of complete blood count among nonobese unexplained infertile couples,” J. Obstet. Gynecol., vol. 57, no. 2, pp. 289-294, Apr. 2018.
[10] C. Yucel, M. Z. Keskin, O. Cakmak, B. Ergani, C. Kose, O. Celik, E. Islamoglu, M. Ucar, G. Koc, and Z. Kozacioglu, “Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction : a pilot study,” Andrology, vol. 5, no.6, pp. 1100-1104, Nov. 2017.
[11] I. Erdim, O. Erdur, F. Oghan, F. Mete, and M. Celik, “Blood count values and ratios for predicting sleep apnea in obese children,” Int. J. Pediatr. Otorhinolaryngol., vol. 98, pp. 85-90, Jul. 2017.
[12] Y. Cakiroglu, F. Vural, and B. Vural, “The inflammatory markers in polycystic ovary syndrome : association with obesity and IVF outcomes,” J. Endocrinol. Invest., vol. 39, no. 8, pp. 899-907, Aug. 2016.
[13] A. Zhang, L. Ning, J. Han, Y. Ma, Y. Ma, W. Cao, X. Sun and S. Li, “Neutrophil-to-lymphocyte ratio as a potential biomarker of neovascular glaucoma,” Ocul. Immunol. Inflamm., Oct. 2019.
[14] K. J. Li, X. F. Xia, M. Su,H. Zhang, W. H. Chen, and C. L. Zhou, “Predictive values of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to- lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy,” BMC Cancer, vol. 19, pp. 1004, Oct. 2019.
[15] A. Dirican, B. B. Kucukzeybek, A. Alacacıoglu, Y. Kucukzeybek, C. Erten, U. Varol, I. Somali, L. Demir, I. V. Bayoglu, Y. Yildiz, M. Akyol, B. Koyuncu, E. Coban, E. Ulger, F. C. Unay, and M. O. Tarhan, “Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer?, ” Int. J. Clin. Oncol., vol. 20, no. 1, pp. 70-81, Feb. 2015.
[16] G. Wood, T. Grenader, S. Nash, R. Adams, R. Kaplan, D. Fisher, T. Maughan, and J. Bridgewater, “Derived neutrophil to lymphocyte ratio as a prognostic factor in patients with advanced colorectal cancer according to RAS and BRAF status: a post-hoc analysis of the MRC COIN study,” Anticancer Drugs, vol. 28, no. 5, pp. 546-550, Jun. 2017.
[17] E. Erdal, and M. Inanır, “Platelet-to-lymphocyte ratio (PLR) and plateletcrit (PCT) in young patients with morbid obesity,” Rev. Asoc. Med. Bras., vol. 65, no.9, pp. 1182-1187, Sept. 2019.
[18] S. Raungkaewmanee, S. Tangjitgamo, S. Manusirivithaya, S. Srijaipracharoen, and T. Thavaramara, “Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer,” J. Gynecol. Oncol., vol. 23, no. 4, pp. 265-273, Oct.2012.
[19] B. Azab, N. Shah, M. Akerman, and J. T. McGinn, “Value of platelet/ lymphocyte ratio as a predictor of all-cause mortality after non-ST elevation myocardial infarction,” J. Thromb. Thrombolysis, vol. 34, no. 3, pp. 326-334, Oct. 2012.
[20] Y. L. Qi, Y. Zhang, L. D. Zhao, A. X. Wang, Z. B. Wang, and Q. L. Gao, “Platelet to lymphocyte ratio in peripheral blood and body mass index : novel independent prognostic factors in patients with melanoma, ” Zhonghua Za Zhi, vol.97, no.47, pp.3704-3710, Dec. 2017.
[21] L. Song, J Zhu, Z. Li, T. Wei, R. Gong, and J Lei, “The prognostic value of the lymphocyte-to-monocyte ratio for high-risk papillary thyroid carcinoma,” Cancer Manag. Res., vol.11, pp. 8451-8462, Sep. 2019.
[22] A. Usta, E. Avci, C. B. Bulbul, H. Kadi, and E. Adali, “The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome,” Reprod. Biol. Endocrinol., vol. 16, pp. 34, Apr. 2018.
[23] M. Yilmaz, and H. Kayancicek, “A new inflammatory marker : Elevated monocyte to HDL cholesterol ratio associated with smoking,” J. Clin. Med., vol.7, no. 4, pp.76, Apr. 2018.
[24] S. Ganjali, A. M. Gotto, M. Ruscica, S. L. Atkin, A. E. Butler, M. Banach, and A. Sahebkar, “Monocyte-to-HDL cholesterol ratio as a prognostic marker in cardiovascular diseases,” J. Cell Physiol., vol. 233, no.12, pp. 9237-9246, Dec. 2018.
[25] J. W. Chen, C. Li, Z. H. Liu, Y. Shen, F. H. Ding, X. Y. Shu, R. Y. Zhang, W. F. Shen, L. Lu, and X. Q. Wang, “The role of monocyte to high-density lipoprotein cholesterol ratio in prediction of carotid intima-media thickness in patients with type 2 diabetes,” Front. Endocrinol.(Lausanne), vol. 10, pp.191, Apr. 2019.
[26] World Health Organization (WHO). The WHO Child Growth Standards. Available at: Accessed on June 10, 2016.
[27] P. Zimmet, K. G. Alberti, F. Kaufman, N. Tajima, M. Silink, S. Arslanian, G. Wong, P. Bennett, J. Shaw, S. Caprio, and IDF consensus group, “The metabolic syndrome in children and adolescents- an IDF consensus report”, Pediatr. Diabetes, vol. 8, no. 5, pp. 299 - 306, Oct. 2007.