Correlation of Neutrophil-to-Lymphocyte Ratio with Waist Circumference, Insulin Resistance and Lipid Profile in Metabolic Syndrome and Healthy Controls
NLR Ratio in Metabolic Syndrome
DOI:
https://doi.org/10.70384/jlmdc.v2i01.73Keywords:
Insulin resistance, Chronic inflammation, Neutrophil to lymphocyte ratioAbstract
Background: Metabolic syndrome encompasses a spectrum of interconnected derangements, such as central adiposity, dyslipidemia, insulin resistance and high blood pressure. Low-grade chronic inflammation has a major contribution in the onset and progress of metabolic syndrome. The neutrophil-to-lymphocyte ratio is a well-recognized predictive index for various inflammatory disorders.
Objective: To determine the correlation of neutrophil to lymphocyte ratio with insulin resistance, waist circumference, serum triglycerides and high-density lipoproteins in metabolic syndrome and healthy group.
Methods: This was a cross-sectional study undertaken at University of Health Sciences Lahore, from October 2019 to September 2022. Approval was obtained from the Ethical Board of the University of Health Sciences. . The subject recruitment was from the Endocrine and Diabetes Clinic of Sheikh Zaid Institute, Lahore. Anthropometric measures and biochemical variables were determined. Data was analyzed by the software; SPSS 27.
Results: The present study comprised of 90 patients diagnosed with metabolic syndrome and 50 controls. In both groups, only male patients were present. The median (IQR) age of the participants with and without metabolic syndrome was found to be 44(40-49.5) and 41(43-49) respectively. The waist circumference, systolic as well as diastolic blood pressure was higher substantially in metabolic syndrome group compared with the healthier (p<0.001). Fasting serum glucose, insulin and triglycerides showed a significant difference among both groups statistically (p<0.001). There was a positive correlation of neutrophil to lymphocyte ratio with waist circumference (p=0.006) and HOMA-IR (p=0.005) in metabolic syndrome group and significant inverse relation with high density lipoproteins (p=0.007) in healthier ones.
Conclusion: The positive correlation of neutrophil to lymphocyte ratio with insulin resistance and waist circumference in metabolic syndrome highlights the role of chronic inflammation in the disease process.
References
1. Adil SO, Islam MA, Musa KI, Shafique K, editors. Prevalence of metabolic syndrome among apparently healthy adult population in Pakistan: a systematic review and meta-analysis. Healthcare; 2023: MDPI. DOI: https://doi.org/10.3390/healthcare11040531
2. Jayawardena R, Sooriyaarachchi P, Misra A. Abdominal obesity and metabolic syndrome in South Asians: prevention and management. Expert Rev Endocrinol Metab. 2021;16(6):339–349. doi: org/10.1080/17446651.2021.1982381. DOI: https://doi.org/10.1080/17446651.2021.1982381
3. Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Front Endocrinol (Lausanne). 2023;14:1149239. doi: 10.3389/fendo.2023.1149- 239. DOI: https://doi.org/10.3389/fendo.2023.1149239
4. Khalid M, Alkaabi J, Khan MAB, Adem A. Insulin signal transduction perturbations in insulin resistance. Int J Mol Sci. 2021;22(16):8590. doi: 10.3390/ijms22168590. DOI: https://doi.org/10.3390/ijms22168590
5. Zhu L, Liu Y, Zheng B, Dong D, Xie X, Hu L. Correlation between neutrophil‐to‐lymphocyte ratio and diabetic neuropathy in Chinese adults with type 2 diabetes mellitus using machine learning methods. Int J Endocrinol. 2024;2024(1):7044644. doi:10.1155/2024/7044644. DOI: https://doi.org/10.1155/2024/7044644
6. Zafar U, Ali Z, Khaliq S, Lone KP. Correlation of insulin resistance with neutrophil to lymphocyte ratio and serum ferritin in male patients of metabolic syndrome. J Pak Med Assoc. 2022;72(4):696-701. doi: 10.47391/JPMA.330. DOI: https://doi.org/10.47391/JPMA.3300
7. Karakaya S, Altay M, Efe FK, Karadag I, Unsal O, Bulur O, et al. The neutrophil-lymphocyte ratio and its relationship with insulin resistance in obesity. Turk J Med Sci. 2019;49(1):245-248. doi: 10.3906/sag-1804-68. DOI: https://doi.org/10.3906/sag-1804-68
8. Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome—a new world‐wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469-480. doi: 10.1111/j.1464-5491.2006.01858.x. DOI: https://doi.org/10.1111/j.1464-5491.2006.01858.x
9. Phan HM, Nguyen PB, Van Dinh H, Van La P, Van Nguyen L, Vo TH, et al. The predictive value of body ma ss index, wa ist c ir cumf e r enc e , and triglycerides/high-density lipoprotein cholesterol ratio in assessing severity in patients with knee osteoarthritis and metabolic syndrome. Endocr Metab Sci. 2024;16:100181. doi: 10.1016/j.endmts.- 2024.100181. DOI: https://doi.org/10.1016/j.endmts.2024.100181
10. Matthews DR, Hosker JP, Rudenski AS, Naylor B, Treacher DF, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412- 419. DOI: https://doi.org/10.1007/BF00280883
11. Liu C-C, Ko H-J, Liu W-S, Hung C-L, Hu K-C, Yu LY, et al. Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Ba ltimo r e ). 2 0 1 9 ; 9 8 ( 4 3 ): e 1 7 5 3 7 . d o i: 10.1097/MD.0000000000017537.
12. Sahin M, Oguz A, Tuzun D, Isiktas O, Isiktas S, Ulgen C, et al. A new marker predicting gestational d i a b e t e s m e l l i t u s : F i r s t t r i m e s t e r neutrophil/lymphocyt e r a tio. Medi c ine . 2022;101(36):e30514. DOI: https://doi.org/10.1097/MD.0000000000030511
13. Rodriguez-Rodriguez E, Salas-Gonzalez MD, Ortega RM, Lopez-Sobaler AM. Leukocytes and neutrophil–lymphocyte ratio as indicators of insulin resistance in overweight/obese school-children. Front Nutr. 2022;8:811081. doi: 10.3389/fnut.20- 21.811081. DOI: https://doi.org/10.3389/fnut.2021.811081
14. Adane T, Melku M, Worku YB, Fasil A, Aynalem M, Kelem A, et al. The association between neutrophil‐to‐lymphocyte ratio and glycemic control in type 2 diabetes mellitus: A systematic review and m e t a ‐ a n a l y s i s . J D i a b e t e s R e s . 2023;2023(1):3117396. doi: 10.1155/2023/3117396. DOI: https://doi.org/10.1155/2023/3117396
15. Basaran E, Aktas G. The relationship of vitamin D levels with hemogram indices and metabolic parameters in patients with type 2 diabetes mellitus. AIMS Medical Science. 2024;11(1):47-57. doi: 10.3934/medsci.2024004. DOI: https://doi.org/10.3934/medsci.2024004
16. Orliaguet L, Ejlalmanesh T, Alzaid F. Metabolic and molecular mechanisms of macrophage polarisation and adipose tissue insulin resistance. Int J Mol Sci. 2020;21(16):5731. doi: 10.3390/ijms21165731 DOI: https://doi.org/10.3390/ijms21165731
17. Li H, Meng Y, He S, Tan X, Zhang Y, Zhang X, et al. Macrophages, chronic inflammation, and insulin resistance. Cells. 2022;11(19):3001. doi: 10.3390/cells11193001. DOI: https://doi.org/10.3390/cells11193001
18. Ramirez-Manent JI, Jover AM, Martinez CS, TomasGil P, Marti-Lliteras P, Lopez-Gonzalez AA. Waist circumference is an essential factor in predicting insulin resistance and early detection of metabolic syndrome in adults. Nutrients. 2023;15(2):257. doi: 10.3390/nu15020257. DOI: https://doi.org/10.3390/nu15020257
19. Amisi CA, Ciccozzi M, Pozzilli P. Wrist circumference: a new marker for insulin resistance in African women with polycystic ovary syndrome. World J Diabetes. 2020;11(2):42–51. doi: 10.4239/wjd.v11.i2.42. DOI: https://doi.org/10.4239/wjd.v11.i2.42
20. Ve n u g o p a l A , Ra j S . Co rr e l a t i o n o f Neutrophil–Lymphocyte Ratio with Glycemic Control: An Analytical Cross-sectional Study. International Journal of Diabetes and Technology. 2024;3(1):3-6. doi: 10.4103/ijdt.ijdt_4_2. DOI: https://doi.org/10.4103/ijdt.ijdt_4_24
21. Yang X, Shi Y, Zhang H, Huang L, Zhang J, Min J, et al. Association between neutrophil-to-lymphocyte ratio and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus. Front Endocrinol. 2025;15:1499713. doi: 10.3389/fendo-.2024.1499713. DOI: https://doi.org/10.3389/fendo.2024.1499713
22. Zheng J, Li T, Hu F, Chen B, Xu M, Yan S, et al. Predictive value of peripheral neutrophil count on admission for young patients with acute coronary syndrome. The Am J Med Sci. 2025;369(1):44-52. doi: 10.1016/j.amjms.2024.07.030. DOI: https://doi.org/10.1016/j.amjms.2024.07.030
23. Nawal C, Singh A, Saini HL, Rankawat G. Impact of blood glucose level on hematological indices in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2025;73(2):16-20. doi: 10.59556/japi.73.0851. DOI: https://doi.org/10.59556/japi.73.0851
24. Pradesta R, Kusnadi Y, Kurniati N, Husin S. Neutrophil-lymphocyte ratio as a novel biomarker for diabetic nephropathy in type 2 diabetes mellitus patients: A cross-sectional study. BioSci Med J Biomed Transl Res. 2025;9(3):6831-6843. doi: 10.37275/bsm.v9i3.1235. DOI: https://doi.org/10.37275/bsm.v9i3.1235
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Fareena Ahmad, Hafiz Abdul Rehman, Nida Zubair, Huma Saeed Khan
This work is licensed under a Creative Commons Attribution 4.0 International License.
.