The Association Between the Neutrophil-To-lymphocyte Ratio and Health-related Behaviors and Factors in Rural Adults With and Without Cardiometabolic Disease

Abstract

Background

Complete blood count (CBC) is a commonly used and cost-effective blood test in health screenings; however, its potential as a biomarker for early detection of chronic diseases remains underutilized. Previous studies have shown that the neutrophil-to-lymphocyte ratio (NLR) is associated with systemic inflammation and is correlated with cardiometabolic diseases (CMDs). Unhealthy lifestyles can trigger inflammatory responses and contribute to the progression of CMDs. This study aimed to explore the association between NLR levels, cardiometabolic risks, and health-related behaviors.

Methods

A community-based, cross-sectional study was conducted in collaboration with a local hospital as part of an annual health screening for rural adults. The study outcomes included CMDs, health-related behaviors, and NLR levels. A multivariable quantile regression model, adjusted for confounding factors, was used to identify factors associated with NLR levels.

Results

A total of 11,220 participants were enrolled. CMDs prevalence was 25.8%, with hypertension and diabetes being most common. Nearly half of participants reported insufficient exercise, low water intake, and inadequate oral hygiene. Higher NLR was significantly associated with CMDs (p for trend <0.001). Older age (p < .01) and living alone (p < .01) were linked to higher NLR, while adequate water intake (p < .05) and regular exercise (p < .01) were associated with lower NLR levels.

Conclusions

Rural adults demonstrated a high prevalence of CMDs and inadequate health-related behaviors, which were associated with elevated NLR levels. Implementing NLR-guided lifestyle modifications and tailored health promotion programs may serve as innovative strategies to mitigate the progression of CMDs.

Keywords

neutrophil/lymphocyte ratio health-related behaviors oral hygiene cardiometabolic diseases inflammation

Get full access to this article

View all access options for this article.

References

Angkananard

Anothaisintawee

McEvoy

Attia

Thakkinstian

(2018). Neutrophil lymphocyte ratio and cardiovascular disease risk: A systematic review and meta-analysis. BioMed Research International, 2018, Article 2703518. https://doi.org/10.1155/2018/2703518

Arnett

D. K.

Blumenthal

R. S.

Albert

M. A.

Buroker

A. B.

Goldberger

Z. D.

Hahn

E. J.

Himmelfarb

C. D.

Khera

Lloyd-Jones

McEvoy

J. W.

Michos

E. D.

Miedema

M. D.

Muñoz

Smith

S. C.

Jr. Virani

S. S.

Williams

K. A.

Sr. Yeboah

Ziaeian

(2019). ACC/ AHA guideline on the primary prevention of cardiovascular disease: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation, 140(11), e596–e646. https://doi.org/10.1161/CIR.0000000000000678

Buonacera

Stancanelli

Colaci

Malatino

(2022). Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. International Journal of Molecular Sciences, 23(7), Article 3636. https://doi.org/10.3390/ijms23073636

Chan

S. H. T.

Zhang

Chang

L. Y.

Guo

Tam

Lau

A. K. H.

Lao

X. Q.

(2022). Total and differential white blood cell count and cause-specific mortality in 436 750 Taiwanese adults. Nutrition, Metabolism & Cardiovascular Diseases, 32(4), 937–947. https://doi.org/10.1016/j.numecd.2021.11.004

Donath

M. Y.

Meier

D. T.

Böni-Schnetzler

(2019). Inflammation in the pathophysiology and therapy of cardiometabolic disease. Endocrine Reviews, 40(4), 1080–1091. https://doi.org/10.1210/er.2019-00002

Gialluisi

Bonaccio

Di Castelnuovo

Costanzo

De Curtis

Sarchiapone

Cerletti

Donati

M. B.

(2020). Lifestyle and biological factors influence the relationship between mental health and low-grade inflammation. Brain, Behavior, and Immunity, 85, 4–13. https://doi.org/10.1016/j.bbi.2019.04.041

Health Promotion Administration, HPA . (2024). Statistics of health promotion. https://www.hpa.gov.tw/3850/16235/e

Howard

Scheiner

Kanetsky

P. A.

Egan

K. M.

(2019). Sociodemographic and lifestyle factors associated with the neutrophil-to-lymphocyte ratio. Annals of Epidemiology, 38, 11–21. https://doi.org/10.1016/j.annepidem.2019.07.015

Wang

Huan

Zhang

Lin

(2022). Effect of dietary inflammatory potential on the aging acceleration for cardiometabolic disease: A population-based study. Frontiers in Nutrition, 9, Article 1048448. https://doi.org/10.3389/fnut.2022.1048448

10.

Huang

(2020). Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. The American Journal of Emergency Medicine, 38(3), 641–647. https://doi.org/10.1016/j.ajem.2019.10.023

11.

Irwandi

R. A.

Chiesa

S. T.

Hajishengallis

Papayannopoulos

Deanfield

J. E.

D’Aiuto

(2022). The roles of neutrophils linking periodontitis and atherosclerotic cardiovascular diseases. Frontiers in Immunology, 13, Article 915081. https://doi.org/10.3389/fimmu.2022.915081

12.

Jhuang

Y. H.

Kao

T. W.

Peng

T. C.

Chen

W. L.

Y. W.

Chang

P. K.

L. W.

(2019). Neutrophil to lymphocyte ratio as predictor for incident hypertension: A 9-year cohort study in Taiwan. Hypertension Research, 42(8), 1209–1214. https://doi.org/10.1038/s41440-019-0245-3

13.

Koyama

Nawa

Yamaoka

Nishimura

Sonoda

Kuramochi

Fujiwara

(2021). Interplay between social isolation and loneliness and chronic systemic inflammation during the COVID-19 pandemic in Japan: Results from U-CORONA study. Brain, Behavior, and Immunity, 94, 51–59. https://doi.org/10.1016/j.bbi.2021.03.007

14.

J. J.

Liu

H. H.

(2022). Landscape of cardiometabolic risk factors in Chinese population: A narrative review. Cardiovascular Diabetology, 21(1), Article 113. https://doi.org/10.1186/s12933-022-01551-3

15.

Lloyd-Jones

D. M.

Allen

N. B.

Anderson

C. A.

Black

Brewer

L. C.

Foraker

R. E.

Grandner

M. A.

Lavretsky

Perak

A. M.

Sharma

American Heart Association Rosamond

(2022). Life’s essential 8: Updating and enhancing the American heart association’s construct of cardiovascular health: A presidential advisory from the American heart association. Circulation, 146(5), e18–e43. https://doi.org/10.1161/CIR.0000000000001078

16.

Mertoglu

Gunay

(2017). Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes & Metabolic Syndrome, 11(Suppl 1), S127–S131. https://doi.org/10.1016/j.dsx.2016.12.021

17.

Patel

Wallace

Doshi

Gadanya

Ben Yahya

Roseman

Srisilapanan

(2021). Oral health for healthy ageing. The Lancet. Healthy Longevity, 2(8), e521–e527. https://doi.org/10.1016/S2666-7568(21)00142-2

18.

Ramos-Lopez

Martinez-Urbistondo

Vargas-Nuñez

J. A.

Martinez

J. A.

(2022). The role of nutrition on meta-inflammation: Insights and potential targets in communicable and chronic disease management. Current Obesity Reports, 11(4), 305–335. https://doi.org/10.1007/s13679-022-00490-0

19.

Sarejloo

Dehesh

Fathi

Khanzadeh

Lucke-Wold

Ghaedi

Khanzadeh

(2023). Meta-analysis of differences in neutrophil to lymphocyte ratio between hypertensive and non-hypertensive individuals. BMC Cardiovascular Disorders, 23(1), Article 283. https://doi.org/10.1186/s12872-023-03304-w

20.

Seo

I. H.

Lee

Y. J.

(2022). Usefulness of complete blood count (CBC) to assess cardiovascular and metabolic diseases in clinical settings: A comprehensive literature review. Biomedicines, 10(11), Article 2697. https://doi.org/10.3390/biomedicines10112697

21.

Simadibrata

D. M.

Calvin

Wijaya

A. D.

Ibrahim

N. A. A.

(2021). Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. The American Journal of Emergency Medicine, 42, 60–69. https://doi.org/10.1016/j.ajem.2021.01.006

22.

Stanimirovic

Radovanovic

Banjac

Obradovic

Essack

Zafirovic

Gluvic

Gojobori

Isenovic

E. R.

(2022). Role of C-reactive protein in diabetic inflammation. Mediators of Inflammation, 2022, Article 3706508. https://doi.org/10.1155/2022/3706508

23.

Suzuki

Sugihara

Kamijo

Morita

Kawato

Tsuneishi

Kobayashi

Hasuike

Sato

(2022). Reasons for tooth extractions in Japan: The second nationwide survey. International Dental Journal, 72(3), 366–372. https://doi.org/10.1016/j.identj.2021.05.008

24.

Tada

Tano

Miura

(2022). The relationship between tooth loss and hypertension: A systematic review and meta-analysis. Scientific Reports, 12(1), Article 13311. https://doi.org/10.1038/s41598-022-17363-0

25.

Turnbull

Dugal

Gill

Wang

Cross

C. L.

Mubder

(2024). Assessing coronary artery disease severity: Leveraging neutrophil to lymphocyte ratio as a prognostic indicator. Circulation, 150(Suppl_1), Article 4135746.

26.

Wang

T. C.

Tsai

Y. H.

Yang

J. T.

Lin

M. S.

Lin

Y. C.

Huang

T. J.

Chen

M. Y.

(2023). The prevalence of chronic dehydration and associated with cardiometabolic risks among agriculture and aquaculture workers. Frontiers in Public Health, 11, Article 1183557. https://doi.org/10.3389/fpubh.2023.1183557

27.

Watanabe

Okada

Kondo

Matsushita

Nakazawa

Yamazaki

(2020). Oral health for achieving longevity. Geriatrics and Gerontology International, 20(6), 526–538. https://doi.org/10.1111/ggi.13921

28.

Weijdijk

L. P. M.

Ziukaite

Van der Weijden

G. A.

Bakker

E. W. P.

Slot

D. E.

(2022). The risk of tooth loss in patients with diabetes: A systematic review and meta‐analysis. International Journal of Dental Hygiene, 20(1), 145–166. https://doi.org/10.1111/idh.12512

29.

Welsh

Mark

P. B.

Celis-Morales

C. A.

Lewsey

Gray

S. R.

Sattar

(2018). Association of total and differential leukocyte counts with cardiovascular disease and mortality in the UK biobank. Arteriosclerosis, Thrombosis, and Vascular Biology, 38(6), 1415–1423. https://doi.org/10.1161/ATVBAHA.118.310945

30.

World Health Organization, WHO . (2024). Global health estimates: Life expectancy and leading causes of death and disability. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates

31.

Zahorec

(2021). Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratislavske Lekarske Listy, 122(7), 474–488. https://doi.org/10.4149/BLL_2021_078

32.

Zinellu

Mangoni

A. A.

Pau

M. C.

Carru

Pirina

Fois

A. G.

(2022). Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: Present and future. European Respiratory Review, 31(166), Article 220095. https://doi.org/10.1183/16000617.0095-2022

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.19 MB