Peripheral differential leukocyte counts in humans vary with hyperlipidemia, smoking, and body mass index

Machine Learning Prediction of Prediabetes in a Young Male Chinese Cohort with 5.8-Year Follow-Up

The identification of risk factors for future prediabetes in young men remains largely unexamined. This study enrolled 6247 young ethnic Chinese men with normal fasting plasma glucose at the baseline (FPGbase), and used machine learning (Mach-L) methods to predict prediabetes after 5.8 years. The study seeks to achieve the following: 1. Evaluate whether Mach-L outperformed traditional multiple linear regression (MLR). 2. Identify the most important risk factors. The baseline data included demographic, biochemistry, and lifestyle information. Two models were built, where Model 1 included all variables and Model 2 excluded FPGbase, since it had the most profound effect on prediction. Random forest, stochastic gradient boosting, eXtreme gradient boosting, and elastic net were used, and the model performance was compared using different error metrics. All the Mach-L errors were smaller than those for MLR, thus Mach-L provided the most accurate results. In descending order of importance, the key factors for Model 1 were FPGbase, body fat (BF), creatinine (Cr), thyroid stimulating hormone (TSH), WBC, and age, while those for Model 2 were BF, white blood cell, age, TSH, TG, and LDL-C. We concluded that FPGbase was the most important factor to predict future prediabetes. However, after removing FPGbase, WBC, TSH, BF, HDL-C, and age were the key factors after 5.8 years.

Moderate-High Blood Eosinophilia Is Associated with Increased Hospitalization and Other Asthma Comorbidities

(1) Background: Eosinophilia has traditionally been linked to eosinophilic asthma, for which it is the gold-standard prognostic biomarker. However, the association between eosinophilia and the presence of other diseases and comorbidities is yet unclear. (2) Methods: For this retrospective study, we reviewed the electronic medical records of 49,909 subjects with blood eosinophilia to gather data on the presence of asthma, COPD, sleep apnea, tuberculosis, dyslipidemia, hypertension, and other cardiovascular diseases and severe CRSwNP among these subjects. Demographic features including age, sex, and smoking habits were collected, as well as the number of hospitalizations and emergency department visits. T-tests, ANOVA, Fisher test, and logistic regression models were used. (3) Results: For all age groups studied, eosinophilia was significantly more prevalent among asthmatic subjects than nonasthmatics, especially in patients also presenting CRSwNP, hypertension, and dyslipidemia. The likelihood of developing asthma, COPD, and CRSwNP, and hospitalization, was increased when BEC was above 600 eosinophils/μL. The association between asthma, CRSwNP, and BEC was corroborated by multiple logistic regressions models. (4) Conclusions: We demonstrated the association of having over 600 blood eosinophils/μL with a higher number of hospitalizations and comorbidities (CRSwNP and COPD), which proves that BEC is a highly useful parameter to consider in subjects who present blood eosinophilia.

Association of Leukocyte, Erythrocyte, and Platelet Counts with Metabolic Syndrome and Its Components in Young Individuals without Overt Signs of Inflammation: A Cross-Sectional Study

The presence of metabolic syndrome (MetS) increases the risk of developing type 2 diabetes, cardiovascular diseases, and mortality. MetS is associated with increased leukocyte or erythrocyte counts. In 16- to 20-year-old males (n = 1188) and females (n = 1231) without signs of overt inflammation, we studied whether the presence of MetS and its components results in elevated blood cell counts. The leukocyte, erythrocyte, and thrombocyte counts significantly but weakly correlated with the continuous MetS score, MetS components, uric acid, and C-reactive protein levels both in males (r = -0.09 to 0.2; p < 0.01) and females (r = -0.08 to 0.2; p < 0.05). Subjects with MetS had higher leukocyte (males: 6.2 ± 1.3 vs. 6.9 ± 1.2 × 109/L; females 6.6 ± 1.5 vs. 7.5 ± 1.6 × 109/L; p < 0.001), erythrocyte (males: 5.1 ± 0.3 vs. 5.3 ± 0.3 × 1012/L; females: 4.5 ± 0.3 vs. 4.8 ± 0.3 × 1012/L; p < 0.001), and platelet counts (males: 245 ± 48 vs. 261 ± 47 × 109/L; females: 274 ± 56 vs. 288 ± 74 × 109/L; p < 0.05) than those without MetS. With the exception of platelet counts in females, the blood counts increased with the number of manifested MetS components. Phenotypes with the highest average leukocyte, erythrocyte, or platelet counts differed between sexes, and their prevalence was low (males: 0.3% to 3.9%; females: 1.2% to 2.7%). Whether functional changes in blood elements accompany MetS and whether the increase in blood counts within the reference ranges represents a risk for future manifestation of cardiometabolic diseases remain unanswered.

The association between eosinophil count, serum lipids and metabolic syndrome in Taiwanese

BACKGROUND

Eosinophil count, dyslipidemia, and metabolic syndrome (MetS) are associated with systemic inflammation. We conducted this large population-based study to investigate the association between elevated eosinophil count, serum lipids, and MetS in the Taiwanese population.

METHODS

A cross-sectional study of 10,357 adults who underwent health checkups at Shin Kong Wu Ho-Su Memorial Hospital in Taiwan between January 2006 and December 2016 was conducted. MetS was defined according to criteria modified by the International Diabetes Federation specifically for the Chinese population. The measurement of serum lipids included high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I (ApoA-I), and apolipoprotein B (ApoB). Pearson's correlation and linear regression were used to determine the association of eosinophil count with waist circumference, blood pressure, fasting glucose, and serum lipids. Multivariate logistic regression analysis was used to determine the odds ratio of MetS and abnormal serum lipid levels in each eosinophil count quartile.

RESULTS

Eosinophil count was positively associated with triglycerides levels and negatively associated with HDL-C levels; however, it was not significantly associated with ApoA-I and ApoB. The odds ratio of MetS increased significantly across eosinophil count quartiles. The adjusted odds ratios of MetS for the second, third, and fourth quartiles were 1.28, 1.38, and 1.42, respectively, with reference to the first quartile.

CONCLUSIONS

High eosinophil count is an independent risk factor for MetS. Hypertriglyceridemia and hypo-HDL-cholesterolemia might partly contribute to this result.

White blood cell count is not associated with flow-mediated vasodilation or nitroglycerine-induced vasodilation

It is well known that white blood cell (WBC) count is an independent predictor of cardiovascular events. However, associations of WBC count and WBC subtypes with endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID) are unclear. The aim of this study was to determine the relationships of WBC count and WBC subtypes with vascular function assessed by FMD and NID. A total of 1351 subjects in whom FMD and NID had been measured were recruited from Hiroshima University Vascular Registry. Mean values were 3.7 ± 2.8% for FMD and 11.8 ± 5.9% for NID. WBC was not correlated with FMD or NID. NID was significantly correlated with lymphocytes in univariate analysis but not with other hematologic parameters. In multiple linear regression analyses, NID was not correlated with lymphocytes. In all subgroups including subgroups of age, gender, body mass index, hypertension, dyslipidemia, diabetes mellitus, smoking and tertile of WBC count, WBC count was not correlated with FMD or NID. WBC count and WBC subtypes were not associated with endothelial function assessed by FMD or vascular smooth muscle function assessed by NID. WBC count and vascular function assessed by FMD and NID may reflect different aspects of atherosclerosis.

Clinical Trial Registration Information: URL for Clinical Trial: http://www.umin.ac.jp Registration Number for Clinical Trial: UMIN000039512.

Peripheral leukocyte counts vary with lipid levels, age and sex in subjects from the healthy population

BACKGROUND AND AIMS

Disorders in blood lipid metabolism and leukocyte-mediated inflammation are considered the main mechanisms of the pathogenesis of atherosclerosis. This study aims to show whether and how peripheral leukocyte counts are associated with serum lipid levels.

METHODS

This is a cross-sectional study of 175,079 subjects from the healthy population.

RESULTS

Age and sex are two key factors dictating the relationship between peripheral leukocyte counts and serum lipid levels. The log-transformed level of triglycerides (LnTG) was positively associated with all leukocyte counts in males except monocyte count in younger subjects. LnTG was positively associated with total leukocyte count in females regardless of age, and it was positively associated with lymphocyte and monocyte counts and neutrophil count only in elderly and young women, respectively. Total cholesterol levels were positively associated with total leukocyte, neutrophil and lymphocyte counts only in young males and with lymphocyte counts only in elderly women. LDL-C was negatively associated with monocyte count in males regardless of age; by contrast, it was positively associated with total leukocyte and lymphocyte counts in females regardless of age range and neutrophil and LnEosinophil counts only in young women. HDL-C was negatively associated with total leukocyte, lymphocyte and monocyte counts in both young men and young women; was negatively associated with monocyte count in elderly men and women; and was negatively associated with LnEosinophil count only in older men.

CONCLUSIONS

Peripheral leukocyte counts are extensively associated with serum lipid levels, with patterns differing by sex, age, lipid and leukocyte subset.

The impact of sample processing on inflammatory markers in serum: Lessons learned

Objectives: To investigate the effect of sample handling on inflammatory cytokines in serum and highlight challenges with using samples pre-collected from biobanks for biomarker research.Methods: Cytokine concentrations (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, and IFNγ) were measured in serum samples of 205 patients with bipoldar disorder (BD) from the Mayo Clinic Bipolar Disorder Biobank and 205 non-psychiatric controls from the Mayo Clinic Biobank. As cytokine concentrations varied by recruitment site, post-hoc models were used to test the effect of clinical variables and pre-processing time on cytokines. To evaluate the effect of pre-processing time experimentally, cytokines were assayed in serum and plasma from 6 healthy volunteers processed at different time points.Results: Cytokine levels were significantly higher in the BD group. However, both cytokine levels and pre-processing times differed by recruitment site, and post-hoc analyses revealed that pre-processing time was significantly associated with several cytokines. An experiment using samples from healthy volunteers confirmed that concentrations for most cytokines increased with longer pre-processing times.Conclusions: Delays in processing influence cytokine concentrations in blood samples. Given the increasing use of biobanks in research, this study highlights the need to carefully evaluate sample collection and handling methods when designing biomarker studies.

White cell counts in relation to mortality in a general population of cohort study in the Netherlands: a mediating effect or not?

BACKGROUND

White cell count (WCC) is a clinical marker of inflammation. Data are limited regarding the association of total and differential WCC with risk of mortality, and its role related with smoking and body mass index (BMI).

METHODS

A total of 14 433 participants (4150 men; 10 283 women; average age 47.3±11.8 years) from the Dutch European Prospective Investigation into Cancer and Nutrition-Netherlands cohort were included. The associations between prediagnostic total WCC and its subtypes and risk of all-cause, cancer and cardiovascular disease (CVD) mortality were assessed. The role of WCC related with smoking and BMI on mortality was further explored. Multivariate Cox regression models were performed to estimate the HR and 95% CI.

RESULTS

After an average follow-up of 15.8 years, a total of 936 death cases were identified (466 cancer; 179 CVD; 291 other causes). Statistically significant graded associations between total WCC, and counts of lymphocytes, monocytes, neutrophils and eosinophils and risk of total mortality were observed. These associations were more apparent in current smokers. Strong associations for all-cause mortality or cancer mortality were observed in subjects with BMI ≥25 kg/m², ever smoking and elevated WCC (HR 3.92, 95% CI 2.76 to 5.57; HR 3.93, 95% CI 2.30 to 6.72). WCC partly mediated the associations between smoking or BMI and all-cause mortality.

CONCLUSIONS

Prediagnostic WCC and its subtypes are associated with all-cause, cancer and CVD mortality risk. It may play a partially mediate role on the association between smoking or obesity and mortality.

Gender Dictates the Relationship between Serum Lipids and Leukocyte Counts in the National Health and Nutrition Examination Survey 1999⁻2004

Dyslipidemias and leukocytosis are associated with cardiovascular disease and immune disorders. Mechanistic studies have shown lipoprotein metabolism to play a significant role in the regulation of atherosclerosis development and leukocyte activation, whereas lipid-lowering treatments have been shown to exert beneficial anti-inflammatory and immunomodulatory effects in clinical trials. However, the relationship between clinical markers of lipid metabolism and leukocyte counts has not been extensively evaluated at the population level. We aimed to determine whether clinical blood lipid measures are associated with leukocyte counts in the general U.S. population represented in the National Health and Nutrition Examination Survey (NHANES) 1999–2004, and whether differences exist between men and women (n = 5647). We observed a strong positive linear trend between serum triglycerides vs. blood lymphocyte and basophil counts in both men and women, whereas a positive trend between monocytes vs. triglycerides and lymphocytes vs. total cholesterol and LDL-cholesterol (LDL-C) was only detected in women. Conversely, HDL-C was inversely associated with a greater number of leukocyte subsets in men, whereas inverse trends between HDL-C vs. lymphocytes were observed in both men and women. In multiple regression models, a 10% increase in total cholesterol, LDL-C, and triglycerides was associated with a predicted 1.6%, 0.6%, and 1.4% increase in blood lymphocyte counts in women, respectively, whereas no relationship was observed in men. In both men and women, a 10% increase in triglycerides was additionally associated with higher lymphocyte, neutrophil, and basophil counts, whereas 10% increases in HDL-cholesterol were associated with significantly lower lymphocyte, neutrophil, eosinophil, and basophil counts in men, in addition to lower lymphocyte and monocyte counts in women. These findings suggest that clinical lipid markers may be used to predict blood leukocyte distributions, and that a gender-specific relationship exists between distinct classes of serum lipids and immune cell subsets.

Relationship of leukocytes, platelet indices and adipocytokines in metabolic syndrome patients

AIMS

The current study aimed to explore the correlation between leukocytes and platelets indices with adipocytokines (leptin and adiponectin) and MetS components.

METHODS

A total of 100 healthy subjects and 200 patients diagnosed with different MetS components were enrolled in the study. Eligible patients were allocated into four groups (50 patients). Group1 include patients with 2 criteria of MetS components, group 2 with 3 criteria, group 3 with 4 criteria and group 4 had patients with 5 criteria.

RESULTS

Regarding white blood cell indices, data showed that total leukocyte and neutrophil count as well as neutrophil/lymphocyte (N/L) ratio were significantly increased in all groups of MetS patients when compared to the healthy group. Additionally, platelets count, platelet distribution width (PDW), and main platelet volume (MPV) levels and platelets/lymphocyte (P/L) ratio were significantly higher in all patients with MetS as compared to the healthy subjects. Serum leptin concentration and leptin-to-adiponectin ratio (LAR) were elevated significantly, while adiponectin level was significantly diminished in all MetS groups when compared to the control.

CONCLUSION

leukocytes and platelets indices were associated with hyperleptinemia and hypoadiponectinemia as well as MetS components. The study also suggested the necessary role of leukocytes, platelet indices, and LAR as markers in early diagnoses of individuals with MetS components.

Supplementation of whole grain flaxseeds (Linum usitatissimum) along with high cholesterol diet and its effect on hyperlipidemia and initiated atherosclerosis in Wistar albino male rats

Background and Aim

Flaxseeds are known to have varying antihypercholesterolemic and antiatherogenic activity due to its lignan secoisolariciresinol diglucoside, alpha-linolenic acid, and omega-3 fatty acids. The beneficial effect of whole grain dietary flaxseed was evaluated experimentally in high cholesterol diet (HCD)-fed Wistar albino rats.

Materials and Methods

Male Wistar albino rats (200 g) were divided into four groups of 12 rats each. Group I rats kept as control and given basal rat chew diet, Group II as positive control for induction of hypercholesterolemia and atherosclerosis by addition of 1% cholesterol and 15% saturated edible oil to the 1000 g of standard rat chew diet (HCD), Group III rats fed with whole grain flaxseed powder at 7.5 g/kg of rat/day in the standard rat chew diet and kept as flaxseed control, and Group IV rats supplemented with flaxseed at 7.5 g/kg of rat/day along with HCD and maintained for 90 days.

Results

Group II rats revealed significantly (p<0.05) higher total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and very LDL-C and significantly (p<0.05) reduced levels of high-density lipoprotein cholesterol (HDL-C), whereas tissue antioxidants such as catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S transferase (GST) were significantly (p<0.05) reduced, and lipid peroxidation products of thiobarbituric acid reactive substances (TBARS) level were nonsignificantly (p<0.05) increased in the heart and liver tissues. Flaxseeds supplementation along with HCD significantly ameliorated the serum levels of TC, TG, LDL-C, and HDL-C along with cellular antioxidant enzymes such as catalase, SOD, GPx, GR, GST, and non-significant amelioration of TBARS in the heart and liver tissues compared to Group II rats. Majority of the histopathologically initiated atherosclerotic changes in the aorta and fatty change in the liver of Group II were not observed in the flaxseed supplemented Group IV; however, interestingly proliferation of endothelial cells with new vascular channel formation in the liver and in between cardiac muscle fibers was observed in Group I and Group IV rats.

Conclusion

The present study established the hypercholesterolemia with initiated atherosclerotic lesion in the aorta but unable to establish the atheromatous plaque in the aorta. Flaxseed supplementation along with HCD showed significant antihypercholesterolemic effect and ameliorated the changes of initiated atherosclerosis in the aorta. It needs further studies to explore all the possible beneficial effects and angiogenic properties of flaxseeds in the laboratory animals and human trials.

Partners in crime: neutrophils and monocytes/macrophages in inflammation and disease

Neutrophils are becoming recognized as highly versatile and sophisticated cells that display de novo synthetic capacity and potentially prolonged lifespan. Emerging concepts such as neutrophil heterogeneity and plasticity have revealed that, under pathological conditions, neutrophils may differentiate into discrete subsets defined by distinct phenotypic and functional characteristics. Indeed, these newly described neutrophil subsets will undoubtedly add to the already complex interactions between neutrophils and other immune cell types for an effective immune response. The interactions between neutrophils and monocytes/macrophages enable the host to efficiently defend against and eliminate foreign pathogens. However, it is also becoming increasingly clear that these interactions can be detrimental to the host if not tightly regulated. In this review, we will explore the functional cooperation of neutrophil and monocytes/macrophages in homeostasis, during acute inflammation and in various disease settings. We will discuss this in the context of cardiovascular disease in the form of atherosclerosis, an autoimmune disease mainly occurring in the kidneys, as well as the unique intestinal immune response of the gut that does not conform to the norms of the typical immune system.

The Dietary Inflammatory Index is associated with elevated white blood cell counts in the National Health and Nutrition Examination Survey

White blood cells (WBCs) are considered a reliable biomarker of inflammation. Elevations in both WBCs and pro-inflammatory cytokines are associated with several chronic conditions. Diet is a strong moderator of inflammation and WBCs. The purpose of this study was to examine the association between the Dietary Inflammatory Index (DII®) and WBCs using data from the United States National Health and Nutrition Examination Survey (NHANES). NHANES is a cross-sectional study that occurs in two-year cycles. Respondents from five cycles (n = 26,046) with available data on diet (collected through a single 24-h dietary recall [24HR]) and WBCs (derived using the Coulter method) were included. The DII (theoretical range is about -8 to +8) was derived from the micro and macronutrients calculated from the 24HR. Linear regression models, using survey design procedures, were used to estimate adjusted mean WBC (i.e., total, lymphocytes, monocytes, and neutrophils) counts and percentages by DII quartiles. Among all participants no statistically significant difference in WBCs were observed when comparing DII quartile 4 (most pro-inflammatory) to quartile 1 (most anti-inflammatory). However, a one-unit increase in the DII was associated with a 0.028 (1000 per µL) increase in total WBCs (p = .01). Additionally, a 0.024 increase in neutrophils (p < .01) was observed for a one-unit increase in the DII. In the group of participants with normal body mass index (BMI, 18.5-24.9 kg/m²), those in DII quartile 4 had higher levels of total WBCs compared to subjects with normal BMI in DII quartile 1 (7.12 vs. 6.88, p = .01). Similar comparisons were observed for monocytes and neutrophils. However, these relationships were not observed for participants who were overweight or obese, which are pro-inflammatory conditions. Normal-weight individuals consuming more pro-inflammatory diets were more likely to have elevated WBCs. Because of its cross-sectional design, NHANES cannot inform directly on temporal relations, thus limiting causal inference. Future research is needed to examine the impact of anti-inflammatory diet adoption on lowering levels of WBCs, in addition to other inflammatory mediators.

High density lipoproteins and type 2 inflammatory biomarkers are negatively correlated in atopic asthmatics

Blood eosinophil counts and serum periostin levels are biomarkers of type 2 inflammation. Although serum levels of HDL and apoA-I have been associated with less severe airflow obstruction in asthma, it is not known whether serum lipids or lipoprotein particles are correlated with type 2 inflammation in asthmatics. Here, we assessed whether serum lipids and lipoproteins correlated with blood eosinophil counts or serum periostin levels in 165 atopic asthmatics and 163 nonasthmatic subjects with and without atopy. Serum lipids and lipoproteins were quantified using standard laboratory assays and NMR spectroscopy. Absolute blood eosinophils were quantified by complete blood counts. Periostin levels were measured using the Elecsys® periostin assay. In atopic asthmatics, blood eosinophils negatively correlated with serum HDL cholesterol and total HDL particles measured by NMR spectroscopy (HDL_NMR). Serum periostin levels negatively correlated with total HDL_NMR In contrast, blood eosinophil counts positively correlated with serum triglyceride levels. This study demonstrates for the first time that HDL particles were negatively correlated, whereas serum triglycerides were positively correlated, with blood eosinophils in atopic asthmatics. This supports the concept that serum levels of HDL and triglycerides may be linked to systemic type 2 inflammation in atopic asthma.

Eosinophil Count Is a Common Factor for Complex Metabolic and Pulmonary Traits and Diseases: The LifeLines Cohort Study

There is ongoing debate on the association between eosinophil count and diseases, as previous studies were inconsistent. We studied the relationship of eosinophil count with 22 complex metabolic, cardiac, and pulmonary traits and diseases. From the population-based LifeLines Cohort Study (N = 167,729), 13,301 individuals were included. We focused on relationship of eosinophil count with three classes of metabolic (7 traits, 2 diseases), cardiac (6 traits, 2 diseases), and pulmonary (2 traits, 2 diseases) outcomes. Regression analyses were applied in overall, women and men, while adjusted for age, sex, BMI and smoking. A p-value of <0.00076 was considered statistically significant. 58.2% of population were women (mean±SD 51.3±11.1 years old). In overall, one-SD higher of ln-eosinophil count was associated with a 0.04 (±SE ±0.002;p = 6.0×10⁻⁶) SD higher levels in ln-BMI, 0.06 (±0.007;p = 3.1×10⁻¹²) SD in ln-TG, 0.04 (±0.003;p = 7.0×10⁻⁶) SD in TC, 0.04 (±0.004;p = 6.3×10⁻⁷) SD in LDL, 0.04 (±0.006;p = 6.0×10⁻⁶) SD in HbA1c; and with a 0.05 (±0.004;p = 1.7×10⁻⁸) SD lower levels in HDL, 0.05 (±0.007;p = 3.4×10⁻²³) SD in FEV1, and 0.09 (±0.001;p = 6.6×10⁻²⁸) SD in FEV1/FVC. A higher ln-eosinophil count was associated with 1.18 (95%CI 1.09–1.28;p = 2.0×10⁻⁵) odds ratio of obesity, 1.29 (1.19–1.39;p = 1.1×10⁻¹⁰) of metabolic syndrome, 1.40 (1.25–1.56;p = 2.7×10⁻⁹) of COPD and 1.81 (1.61–2.03;p = 1.0×10⁻²³) of asthma. Similar results were found in women. We found no association between ln-eosinophil count either with blood pressure indices in overall, women and men; or with BMI, LDL, HbA1c and obesity in men. In a large population based cohort, we confirmed eosinophil count as a potential factor implicated in metabolic and pulmonary outcomes.

Postprandial Monocyte Activation in Individuals With Metabolic Syndrome

CONTEXT

Postprandial hyperlipidemia has been suggested to contribute to atherogenesis by inducing proinflammatory changes in monocytes. Individuals with metabolic syndrome (MS), shown to have higher blood triglyceride concentration and delayed triglyceride clearance, may thus have increased risk for development of atherosclerosis.

OBJECTIVE

Our objective was to examine fasting levels and effects of a high-fat meal on phenotypes of monocyte subsets in individuals with obesity and MS and in healthy controls. Design, Setting, Participants, Intervention: Individuals with obesity and MS and gender- and age-matched healthy controls were recruited. Blood was collected from participants after an overnight fast (baseline) and at 3 and 5 hours after ingestion of a high-fat meal. At each time point, monocyte phenotypes were examined by multiparameter flow cytometry.

MAIN OUTCOME MEASURES

Baseline levels of activation markers and postprandial inflammatory response in each of the three monocyte subsets were measured.

RESULTS

At baseline, individuals with obesity and MS had higher proportions of circulating lipid-laden foamy monocytes than controls, which were positively correlated with fasting triglyceride levels. Additionally, the MS group had increased counts of nonclassical monocytes, higher CD11c, CX3CR1, and human leukocyte antigen-DR levels on intermediate monocytes, and higher CCR5 and tumor necrosis factor-α levels on classical monocytes in the circulation. Postprandial triglyceride increases in both groups were paralleled by upregulation of lipid-laden foamy monocytes. MS, but not control, subjects had significant postprandial increases of CD11c and percentages of IL-1β+ and tumor necrosis factor-α+ cells in nonclassical monocytes.

CONCLUSIONS

Compared to controls, individuals with obesity and MS had increased fasting and postprandial monocyte lipid accumulation and activation.

Association of complete blood cell counts with metabolic syndrome in an elderly population

Background

Metabolic syndrome’s (MetS) role in predicting cardiovascular diseases and diabetes has been confirmed in many large cohort studies. Nontraditionally, hematogram components are significantly related to MetS in many different age groups. However, little is known about its role among the elderly.

Methods

We enrolled 18,907 subjects over the age of 65 years who underwent regular health examinations. They were divided into three groups according to age: young old (YO: ≥ 65 and < 74 years old), old old (OO: ≥ 75 and < 84 years old), and oldest old (ODO: ≥ 85 years old). The MetS components were determined, and correlations between MetS and hematogram components were evaluated using Pearson and multivariate linear regression analyses. The hematogram components were the independent variables evaluated separately against the dependent variable (MetS components).

Results

While SBP and HDL-C increased, most other MetS and hematogram parameters decreased in men with age. Fewer significant differences were noted among the women. In the YO and OO groups for both genders, the subjects with MetS had higher WBC and Hb. None of the hematogram components were different for subjects with or without MetS in the ODO group. Multiple regression results show that most of the relationships between hematogram and MetS components disappeared in the ODO groups. The WBC levels were mainly correlated with WC and TG. At the same time, Hb was associated with BP, FPG, and LDL-C. Compared to WBC and Hb, PLT was least related to MetS, except in the cases of LDL-C and TG. Among the MetS components, BMI, LDL-C, and TG were consistently related to all the hematogram components in YO and OO men. However, only TG had the same consistency among YO and OO women.

Conclusions

This study’s three major findings are as follows: WBC and Hb are associated with MetS, even among the YO and OO groups, regardless of gender; among the three hematogram components, Hb had the strongest and PLT had the weakest correlation with MetS; and TG is not the only component with relatively higher r values, and it is related to all hematogram components.

Curcumin protects against nicotine-induced stress during protein malnutrition in female rat through immunomodulation with cellular amelioration

Nicotine aggravates many chronic inflammatory disorders in females under the protein-malnourished conditions because women are more susceptible to nicotine-induced diseases due to their low innate immunity. Although curcumin have been found to obliterate the nicotine-induced disorders through its anti-nicotinic activity under the protein-malnourished condition, the exact mechanism of protective action of curcumin is still unclear. Female Wister rats maintained under the normal and protein-restricted diets in two separate groups were injected with the effective dose of nicotine-tartrate (2.5 mg/kg body weight/day, subcutaneously) and supplemented with the effective dose of curcumin (80 mg/kg body weight/day, orally) for 21 days. The morphology of red blood cells (RBCs), molecular docking, lipid profile and activities of antioxidant enzymes in tissues, cytokines profiling (T helper cell type 1; and T helper cell type 2), mRNA and protein expression of cytokines, transcription factors (activator protein 1), regulatory molecule (P(53)), growth factors (Granulocyte-macrophage colony-stimulating factor; Transforming growth factor beta) were determined to establish the mechanism of actions of curcumin against the nicotine-mediated stress in the protein-malnourished rats. This study revealed that curcumin bound to the Histidine 87 residues of haemoglobin with a greater binding affinity and significantly protected the RBCs against nicotine-induced damage. Furthermore, the nicotine-mediated disruption of Th1/Th2 balance through upregulation and downregulation of different factors was effectively restored by curcumin under the protein-malnourished conditions. The study demonstrated that curcumin was a potent protective compound against the nicotine-induced stress and offered a probable biochemical and immunomodulatory mechanism of protective action of curcumin.

Influence of sex, age, pubertal maturation and body mass index on circulating white blood cell counts in healthy European adolescents—the HELENA study

Percentiles 10th, 25th, 50th, 75th and 90th are presented for circulating white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils and basophils in healthy European adolescents (12.5-17.5 years, n = 405, 48.9% boys), considering age, sex, puberty and body mass index (BMI). CD3(+) (mature T cells), CD4(+) (T helper), CD8(+) (T cytotoxic), CD16(+)56(+) (natural killer), CD19(+) (B cells), CD3(+)CD45RA(+), CD4(+)CD45RA(+), CD8(+)CD45RA(+) (naïve), CD3(+)CD45RO(+), CD4(+)CD45RO(+) and CD8(+)CD45RO(+) (memory) lymphocytes were also analysed by immunophenotyping. Girls presented higher WBC, neutrophil, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) cell counts and CD3(+)/CD19(+) ratio, and lower CD3(+)CD45RA(+) and CD4(+)CD45RA(+) counts than boys. Age was associated with higher neutrophil counts and CD3(+)/CD19(+), and lower CD19(+) counts; in boys, with lower CD3(+)CD45RA(+), CD4(+)CD45RA(+) and CD8(+)CD45RA(+) counts as well; in girls, with higher WBC, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) counts. Pubertal maturation in boys was associated with lower WBC and lymphocyte counts; in girls, with higher basophil, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) values. BMI was associated with higher WBC counts; in boys, also with higher lymphocyte counts; in girls, with higher neutrophil, CD4(+), CD3(+)CD45RO(+) and CD4(+)CD45RO(+) counts.

CONCLUSION

Our study provides normative values for circulating immune cells in adolescents, highlighting the importance of considering sex, age, pubertal maturation and BMI when establishing reference ranges for WBC in paediatric populations.

Haemostatic and inflammatory alterations in familial hypercholesterolaemia, and the impact of angiotensin II infusion

INTRODUCTION

We examined potential prothrombotic and proinflammatory effects of angiotensin II in 16 otherwise healthy familial hypercholesterolaemia subjects and 16 matched controls.

METHODS

Markers of fibrinolysis, thrombin generation and inflammation were assessed in plasma before, during and 1h after a 3h intravenous infusion of angiotensin II. In addition, placebo experiments with saline infusion were carried out.

RESULTS

Baseline plasminogen activator inhibitor type-1 activity and plasmin-antiplasmin-complex concentrations were similar in FH and controls, as were interleukin-6, leukocyte counts and C-reactive protein. Fibrinogen levels were higher in FH, and we observed a greater thrombin generating potential in FH (calibrated automated thrombogram), but no signs of elevated thrombin generation in vivo (prothrombin fragment 1+2). During angiotensin infusion plasminogen activator inhibitor type-1 activity decreased and plasmin-antiplasmin-complex concentrations increased similarly in FH and controls. Total and maximal amount of thrombin generated was unchanged, as were prothrombin-fragment-1+2 levels. Interleukin-6 and leukocyte counts increased similarly in both groups during angiotensin infusion, while fibrinogen tended to increase in FH and increased in controls. During saline infusion plasminogen activator inhibitor type-1 activity and prothrombin fragment 1+2 concentrations fell, whereas other markers were unchanged.

CONCLUSIONS

FH exhibits an increased thrombin generation potential, an intact fibrinolysis, and has no convincing signs of inflammation. Angiotensin has proinflammatory effects, and might have minor profibrinolytic and procoagulatory effects.

Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?

Objective:

Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS.

Methods:

The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed.

Results:

Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively).

Conclusion:

NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS.

Obesity and nutrition in acute respiratory distress syndrome

This article discusses obesity, its contribution to clinical outcomes, and the current literature on nutrition. More than one third of Americans are obese. Literature suggests that, among critically ill patients, the relationship between obesity and outcomes is complex. Obese patients may be at greater risk of developing acute respiratory distress syndrome (ARDS) than normal weight patients. Although obesity may confer greater morbidity in intensive care, it seems to decrease mortality. ARDS is a catabolic state; patients demonstrate a profound inflammatory response, multiple organ dysfunction, and hypermetabolism, often with malnutrition. The concept of pharmaconutrition has emerged.

Elevated white blood cell count is associated with higher risk of glucose metabolism disorders in middle-aged and elderly Chinese people

White blood cell (WBC) count has been associated with diabetic risk, but whether the correlation is independent of other risk factors has hardly been studied. Moreover, very few such studies with large sample sizes have been conducted in Chinese. Therefore, we investigated the relationship between WBC count and glucose metabolism in China. We also examined the relevant variables of WBC count. A total of 9,697 subjects (mean age, 58.0 ± 9.1 years) were recruited. The subjects were classified into four groups, including subjects with normal glucose tolerance, isolated impaired fasting glucose, impaired glucose tolerance and type 2 diabetes mellitus (T2DM). We found that WBC count increased as glucose metabolism disorders exacerbated. WBC count was also positively correlated with waist hip ratio, body mass index, smoking, triglycerides, glycosylated haemoglobin A1c (HbA1c) and 2-h postprandial glucose. In addition, high density lipoprotein and the female gender were inversely correlated with WBC levels. In patients with previously diagnosed T2DM, the course of T2DM was not correlated with WBC count. Our findings indicate that elevated WBC count is independently associated with worsening of glucose metabolism in middle-aged and elderly Chinese. In addition, loss of weight, smoking cessation, lipid-modifying therapies, and control of postprandial plasma glucose and HbA1c may ameliorate the chronic low-grade inflammation.

Longitudinal associations between lymphocyte count and LDL cholesterol in a health screening population

Background

Longitudinal associations between leukocyte subtype counts and LDL cholesterol have not been reported.

Methods and Results

This is a retrospective observational study in a health screening population. Spearman's correlation coefficients were calculated between leukocyte subtype counts and LDL cholesterol levels at baseline and after four years. Using Cox regression models, hazard ratios (HRs) of hyper-LDL cholesterolemia for leukocyte subtype counts during four years of follow-up were calculated adjusted for age, sex, high-sensitivity C-reactive protein (hs-CRP) and other confounders. Spearman's correlation coefficients (p values) between changes in counts of neutrophil, lymphocyte, monocyte, basophil and eosinophil and changes in LDL cholesterol levels through 4 years were 0.02 (0.494), 0.12 (<0.001), 0.06 (0.016), 0.02 (0.524) and 0.03 (0.257), respectively among 1735 subjects who visited our medical check-up center, did not use anti-hyperlipidemic drugs and revisited after 4 years. Among 1992 followed subjects, 481 developed hyper-LDL cholesterolemia during four years (60.4 per 1000 person-years). The HRs (95% confidence intervals; p values) of hyper-LDL cholesterolemia for each one SD increase in counts of neutrophil, lymphocyte, monocyte, basophil and eosinophil were 1.08 (0.99-1.19; 0.085), 1.14 (1.04-1.25; 0.005), 1.05 (0.95-1.15; 0.339), 1.01 (0.92-1.11; 0.858) and 1.04 (0.95-1.14; 0.397), respectively.

Conclusions

Lymphocyte count and LDL cholesterol were longitudinally positively correlated and lymphocyte count was associated with incidence of hyper-LDL cholesterolemia independently of hs-CRP in a health screening population.

Peripheral blood leucocyte subclasses as potential biomarkers of adipose tissue inflammation and obesity subphenotypes in humans

While obesity is clearly accepted as a major risk factor for cardio-metabolic morbidity, it is also apparent that some obese patients largely escape this association, forming a unique obese subphenotype(s). Current approaches to define such subphenotypes include clinical biomarkers that largely reflect already manifested comorbidities, such as markers of dyslipidaemia, hyperglycaemia and impaired regulation of vascular tone, and anthropometric or imaging-based assessment of adipose tissue distribution. Low-grade inflammation, evident both systemically and within adipose tissue (particularly intra-abdominal fat depots), seems to characterize the more cardio-metabolically morbid forms of obesity. Indeed, several systemic inflammatory markers (C-reactive protein), adipokines (retinol-binding protein 4, adiponectin) and cytokines have been shown to correlate in humans with adipose tissue inflammation and with obesity-associated health risks. Circulating leucocytes constitute a diverse group of cells that form a major arm of the immune system. They are both major sources of cytokines and likely also of infiltrating adipose tissue immune cells in obesity. In the present review, we summarize currently available literature on 'classical' blood white cell classes and on more specific leucocyte subclasses present in the circulation in human obesity. We critically raise the possibility that leucocytes may constitute clinically available markers for the more morbidity-associated obesity subphenotype(s), and when available, for intra-abdominal adipose tissue inflammation.

Challenges of imaging for cancer in patients with diabetes and obesity

A growing body of evidence supports a connection among diabetes (predominantly type 2), obesity, and cancer. Multiple meta-analyses of epidemiological data show that people with diabetes are at increased risk of developing a variety of different cancers and suffer from an increased rate of perioperative complications and cancer mortality. Computed tomography (CT) has played an important role in diagnosis and staging of cancer. Positron emission tomography is complementary to CT in the diagnosis, staging, and evaluation of treatment response for many types of cancer. Because of generally poor clinical outcome of cancers when they are detected in late stages, more research is now focused on stratifying risk to allow personalized screening of at-risk patients and cancer detection at an earlier stage. In this review, we summarize basic noninvasive imaging techniques currently in use to detect cancer with emphasis on the challenges of imaging for early cancer detection in obese patients with diabetes.

Could mean platelet volume among complete blood count parameters be a surrogate marker of metabolic syndrome in pre-pubertal children?

Interest in childhood metabolic syndrome (MetS) has increased substantially due to the increasing prevalence of childhood obesity on a global scale. Early recognition of MetS is critical in order to delay the development of cardiovascular disease (CVD). In this study, we evaluated the relationship between complete blood count (CBC) parameters and MetS among pre-pubertal children which may provide evidence in support of using low cost, readily available clinical haematological parameters for the detection of MetS. A retrospective analysis was carried out on 330 (125 lean vs. 205 overweight) Turkish pre-pubertal children who attend to a paediatric outpatient clinic. Age, gender, puberty, body mass index, CBC parameters, cardiometabolic risk factors including lipid profiles, high sensitive serum reactive protein (hsCRP) and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated and compared among lean, overweight children and children with MetS. The mean age of the study population was 7.4 ± 1.9 years. In both gender, the mean values of mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were significantly lower and red blood cell (RBC), platelet (PLT) counts were significantly higher in overweight children. Overall, 8.4% (n = 28) of patients met the criteria of MetS. Children with MetS had higher levels of PLT and lower levels of mean platelet volume (MPV). Of all the haematological parameters analysed, PLT was positively, whereas MPV was negatively correlated with MetS in girls. In addition, MPV was inversely correlated with fasting blood glucose, HOMA-IR, low density lipoprotein-cholesterol (LDL-C) and low density lipoprotein-cholesterol/high density lipoprotein-cholesterol (LDL-C/HDL-C) ratio in girls after adjusting for confounding factors. The risk analyses of MetS in terms of MPV quartiles showed that the adjusted OR (95% CI) for the lowest vs. the highest quartile was 7.71 (1.45-40.89) in girls. These data might suggest that MPV could be another feature of MetS in pre-pubertal girls and might be used as a surrogate marker for MetS in clinical settings.

Seventeen year risk of all-cause and cause-specific mortality associated with C-reactive protein, fibrinogen and leukocyte count in men and women: the EPIC-Norfolk study

There is strong evidence from observational studies suggesting serum C-reactive protein (CRP) is associated with cardiovascular and all-cause mortality. However, less is known about whether there are differences in the association of CRP with all-cause or cause specific mortality by sex, smoking, body mass index (BMI), or physical activity. We aimed to investigate these interactions and also investigate and compare the association of CRP and other inflammation markers (i.e., fibrinogen and leukocyte count) with all-cause and cause-specific mortality. Men and women aged 40-79 were recruited in 1993-1997 in the EPIC-Norfolk cohort study. A total of 16,850 participants with high-sensitivity assayed CRP data who had no known cancer, myocardial infarction and stroke at baseline were entered in the analysis to test the association of CRP, fibrinogen and leukocyte count with risk of all-cause and cause specific mortality. A total of, 2,603 all-cause deaths (1,452 in men) including 823 cardiovascular and 1,035 cancer deaths, were observed after 231,000 person-years of follow-up (median 14.3 years). CRP was positively associated with risk of all-cause, cardiovascular, and non-cancer non-cardiovascular mortality independent of established risk factors. The hazard ratio of all-cause mortality (95 % CI) for participants with CRP in the range of 3-10 and >10 mg/l (vs. <0.5 mg/l) was 1.56 (1.26-1.93) and 1.87 (1.43-2.43) respectively in men and 1.34 (1.07-1.68) and 1.98 (1.50-2.63) in women. The association was less positively graded in women with the increased risk being significant only at higher levels of the CRP distribution. The association persisted in never smokers and did not vary by levels of BMI or physical activity. Although fibrinogen and leukocyte count were also positively associated with mortality risk, only CRP remained a significant predictor of mortality when the inflammation markers were adjusted for one another in multivariable models. Serum CRP levels were a long-term predictor of risk of cardiovascular and non-cardiovascular mortality independent of known risk factors, fibrinogen, and leukocyte count.

White blood cell counts as risk markers of developing metabolic syndrome and its components in the PREDIMED study

Background

The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS.

Methods

Participants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components.

Results

Of the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03–2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS.

Conclusions

Total WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS.

Trial registration

Controlled-Trials.comISRCTN35739639.

Systemic inflammation in 222.841 healthy employed smokers and nonsmokers: white blood cell count and relationship to spirometry

Background

Smoking has been linked to low-grade systemic inflammation, a known risk factor for disease. This state is reflected in elevated white blood cell (WBC) count.

Objective

We analyzed the relationship between WBC count and smoking in healthy men and women across several age ranges who underwent preventive medical check-ups in the workplace. We also analysed the relationship between smoking and lung function.

Methods

Cross-sectional descriptive study in 163 459 men and 59 382 women aged between 16 and 70 years. Data analysed were smoking status, WBC count, and spirometry readings.

Results

Total WBC showed higher counts in both male and female smokers, around 1000 to 1300 cell/ml (t test, P < 0.001). Forced expiratory volume in 1 second (FEV₁%) was higher in nonsmokers for both sexes between 25 to 54 years (t test, P < 0.001). Analysis of covariance showed a multiple variable effect of age, sex, smoking status, body mass index on WBC count. The relationship between WBC blood count and smoking status was confirmed after the sample was stratified for these variables. Smokers with airway obstruction measured by FEV₁% were found to have higher WBC counts, in comparison to smokers with a normal FEV₁% among similar age and BMI groups.

Conclusions

Smoking increases WBC count and affects lung function. The effects are evident across a wide age range, underlining the importance of initiating preventive measures as soon as an individual begins to smoke.

Lymphocyte count was significantly associated with hyper-LDL cholesterolemia independently of high-sensitivity C-reactive protein in apparently healthy Japanese

The aim of this study was to investigate the association between leukocyte subtype counts and hyper-LDL cholesterolemia, hypertriglyceridemia, and hypo-HDL cholesterolemia. Logistic regressions using hyper-LDL cholesterolemia, hypertriglyceridemia, and hypo-HDL cholesterolemia as a dependent variable and total leukocyte, basophil, eosinophil, neutrophil, lymphocyte, and monocyte counts as an independent variable were calculated adjusting for age, body mass index (BMI), high-sensitivity C-reactive protein (hs-CRP), smoking, drinking, and physical activity in apparently healthy Japanese men (1,803) and women (1,150). The odds ratio (OR) of hyper-LDL cholesterolemia for total leukocyte, eosinophil, and lymphocyte counts, the OR of hypertriglyceridemia for total leukocyte, eosinophil, neutrophil, and lymphocyte counts, and the OR of hypo-HDL cholesterolemia for total leukocyte, neutrophil, and lymphocyte counts were significant in men, and the OR of hyper-LDL cholesterolemia, for lymphocyte count, and the OR of hypo-HDL cholesterolemia for eosinophil count were significant in women. Lymphocyte count was significantly associated with hyper-LDL cholesterolemia independently of hs-CRP in apparently healthy Japanese.

Relationship between white blood cell count and components of metabolic syndrome among young adolescents

Components of metabolic syndrome (MetS) have been associated with several inflammatory factors, including white blood cell count (WBCC). In the present study, the relationships between WBCC and aspects of MetS in young adolescents were investigated. We enrolled 596 participants (328 males and 268 females) from 10 to 13 years of age and with normal WBCC in this study. They were divided into four quartiles according to WBCC (WBCC1-4, from lowest to highest WBCC). The mean values of MetS components for each group were compared in males and females separately. Multivariate linear regression analysis between the WBCC and the components of MetS after adjusted for age and body mass index (BMI) were also evaluated. In the male group, the BMI of WBCC1 and WBCC2 was significantly lower than WBCC4. The total cholesterol and low-density lipoprotein-cholesterol (LDL-C) of WBCC2 were significantly higher than WBCC1 and WBCC4. Triglyceride (TG) levels of WBCC1 were significantly lower than WBCC3 and WBCC4, and TG levels of WBCC2 were significantly lower than WBCC4. Alternatively, the BMI of WBCC1 and WBCC2 were significantly lower than WBCC3 in the female group. Finally, the TG and fasting plasma glucose (FPG) levels of WBCC1 were significantly lower than WBCC3 or WBCC4, respectively. After multivariate linear regression, WBCC was positively correlated to BMI and TG, but negatively correlated to FPG in males whereas in young adolescent females, WBCC was positively correlated to BMI and FPG. In conclusion BMI was positively correlated with WBCC in young adolescent females and males. Thus, BMI is the most important component of MetS in this age group. In addition, TG levels in males and FPG in females were significantly related to WBCC. These findings could be regarded an early indication for the future development of full-blown MetS or cardiovascular diseases.

Lifestyle Factors, Exposures, Genetic Susceptibility, and Renal Cell Cancer Risk: A Review

Malignant kidney tumors account for approximately 2% of all new primary cancer cases diagnosed in the United States, with an estimated 30,000 cases occurring annually. Although a variety of agents, chemical and biological, have been implicated as causal agents in the development of renal cell carcinoma (RCC), the etiology remains enigmatic. The strongest association has been developed between cigarette smoking and renal cancer however consistent, positive associations between RCC and obesity, diabetes, and hypertension have also been reported. In addition, more recent investigations of familial kidney cancer syndromes indicate that a strong genetic component contributes to RCC development. Several genes have been identified through investigation of familial kidney cancer syndromes. This review article describes recent trends in RCC incidence and the currently identifiable etiological causes that account for approximately half of the RCC cases diagnoses. The remainder of this review then focuses on additional risk factors that have thus far not been well examined but may be helpful in explaining the increasing incidence trends and the geographic or racial variation observed nationally and worldwide.

Association between white blood cell count and components of metabolic syndrome

BACKGROUND

Components of metabolic syndrome (MetS) were found to be associated with several inflammatory factors including white blood cell count (WBCC), which is an easily available test in clinical practice. In the present study, the relationships between WBCC and MetS components were investigated in children.

METHODS

A total of 288 Taiwanese children, under 10 years old, with normal WBCC, were enrolled in the study. They were divided into quartiles according to WBCC (lowest, WBCC1; highest, WBCC4). The mean values of each MetS component for every group were compared in boys and girls separately. Multivariate linear regression between the WBCC and the MetS components after adjusting for age and body mass index (BMI) were also evaluated.

RESULTS

In group comparison, only the high-density lipoprotein-cholesterol (HDL-C) was found to be significantly lower in WBCC4 in boys. Other components were not different. After multivariate linear regression, WBCC was negatively correlated to HDL-C and positively to BMI in boys. Although not significant, similar relationships were also observed in girls. Interestingly, borderline positive correlation was noted between triglyceride (TG) and WBCC in girls.

CONCLUSION

BMI was positively and HDL-C was negatively related to WBCC in boys. A similar trend could also be observed in girls but without significance. Borderline significant correlation between TG and WBCC was noted in girls. These findings suggest that cardiovascular risks might commence even in childhood. Early detection of children with these abnormalities may help to prevent cardiovascular disease and diabetes in adolescence or even adulthood.

Primed polymorphonuclear leukocytes constitute a possible link between inflammation and oxidative stress in hyperlipidemic patients

BACKGROUND

Oxidative stress (OS) and chronic inflammation are involved and contribute to the development of atherosclerosis. Primed polymorphonuclear leukocytes (PMNLs) are a possible source for superoxide radicals and inflammatory mediators, hence can promote OS and inflammation. The involvement of primed PMNLs in clinical states associated with high risk for developing cardiovascular disease and atherosclerosis, such as hypertension, renal failure and diabetes has been described, however, little is known about PMNLs characteristics in hyperlipidemic patients.

METHODS

Hyperlipidemic patients and healthy control (HC) subjects were enrolled in this cross-sectional study. PMNL priming was estimated by measuring the rate of superoxide release and by levels of membrane CD11b. PMNL priming and myeloperoxidase (MPO) levels served as OS indices. Inflammation was linked to peripheral white blood cells and PMNL counts and to apoptosis. Systemic inflammation was estimated by blood levels of fibrinogen, C-reactive protein (CRP), transferrin and albumin. PMNL priming and inflammation parameters were related to the severity of hyperlipidemia.

RESULTS

PMNLs from hyperlipidemic patients are primed compared to HC. A decrease in PMNL-MPO levels with increased levels of serum MPO were found in hyperlipidemic patients. Leukocyte counts tended to be higher in hyperlipidemic patients with increased PMNL apoptosis. PMNL priming and fibrinogen levels correlated positively with the severity of hyperlipidemia (r=0.32, P=0.02 for CD11b vs. cholesterol and r=0.38, P=0.009 for CD11b vs. LDL-c; r=0.35, P=0.01 for fibrinogen vs. cholesterol and r=0.3, P=0.03 for superoxide release vs. LDL-c).

CONCLUSION

PMNLs are primed in hyperlipidemic patients contributing to OS and inflammation in these patients. This study highlights primed PMNLs as an additional risk factor for promoting atherosclerosis in hyperlipidemic patients.

Leukocyte Activation by Triglyceride-Rich Lipoproteins

Objective— Postprandial lipemia has been linked to atherosclerosis and inflammation. Because leukocyte activation is obligatory for atherogenesis, leukocyte activation by triglyceride-rich lipoproteins (TRLs) was investigated.

Methods and Results— The expression of CD11b and CD66b after incubation with glucose and native and artificial TRLs (NTRL and ATRL) in vivo and in vitro was evaluated by flowcytometry. Oral fat loading tests showed an increased expression of CD11b on monocytes and neutrophils and CD66b on neutrophils. In 11 volunteers, postprandial leukocytes became enriched with meal-derived fatty acids ([1- 13 C]16:0) suggesting uptake of exogenous fat. ApoB binding on leukocytes measured by flowcytometry in 65 subjects was highest on neutrophils and monocytes suggesting adherence of apoB-containing lipoproteins. Physiological concentrations of TRLs showed 62% increased neutrophil CD11b and a dose-dependent increased monocyte CD11b up to 84% in vitro. Incubations with lipid emulsions in the hypertriglyceridemic range showed a 5-fold increased monocyte CD11b expression, which was higher than the positive control (fMLP), and a dose-dependent 2- to 3-fold increased neutrophil CD11b and CD66b. The oxidative scavenger DMTU decreased the neutrophil CD66b expression by 36%.

Conclusion— Acute hypertriglyceridemia is a leukocyte activator most likely by direct interaction between TRLs and leukocytes and uptake of fatty acids. TG-mediated leukocyte activation is an alternative proinflammatory and proatherogenic mechanism of hypertriglyceridemia in part associated to the generation of oxidative stress.

Revision in Reference Ranges of Peripheral Total Leukocyte Count and Differential Leukocyte Percentages Based on a Normal Serum C-Reactive Protein Level

BACKGROUND/PURPOSE

A higher total leukocyte count is a predictor of all-cause mortality and cardiovascular morbidity. The currently used reference range for peripheral total leukocyte count is wide (4.5-11.0 x 10(9)/L) and is associated with a low sensitivity in identifying non-infectious chronic diseases. We attempt to revise it based on a normal serum C-reactive protein (CRP) level.

METHODS

Study subjects were participants in a health check program at our hospital between 2000 and 2002. Those whose leukocyte analysis had been checked with the Sysmex Cell Counter NE-9000 were enrolled.

RESULTS

Significantly positive relationships between CRP level and total leukocyte count, neutrophil percentage, and monocyte percentage were found in all subjects (n = 14,114; p < 0.0001). In contrast, CRP level had a significantly inverse correlation with lymphocyte percentage (p < 0.0001). A proposed new reference range for total leukocyte count was estimated based on the data in the normal CRP level group (CRP < 0.1 mg/dL; n = 4839). To rest on the essence of statistics that the range of [mean +/- 2 standard deviations] contains approximately the middle 95% of observations in a sampled population, a new reference range for total leukocyte count was accordingly estimated to be 3.11-8.83 x 10(9)/L.

CONCLUSION

In view of the abundant evidence showing that a higher peripheral total leukocyte count is harmful to health, a down-correction of its upper reference range from the currently used 11.0 x 10(9)/L to the proposed 8.83 x 10(9)/L, based on a normal CRP level, should allow more abnormal health conditions to be identified and promote the usefulness of peripheral leukocyte analysis.

Critical roles for CCR2 and MCP-3 in monocyte mobilization from bone marrow and recruitment to inflammatory sites

Monocyte recruitment to sites of inflammation is regulated by members of the chemokine family of chemotactic cytokines. However, the mechanisms that govern the migration of monocytes from bone marrow to blood and from blood to inflamed tissues are not well understood. Here we report that CC chemokine receptor 2 (CCR2) is highly expressed on a subpopulation of blood monocytes whose numbers are markedly decreased in CCR2(-/-) mice. In bone marrow, however, CCR2(-/-) mice had an increased number of monocytes, suggesting that CCR2 is critical for monocyte egress. Intravenous infusion of ex vivo-labeled WT or CCR2(-/-) bone marrow into WT recipient mice demonstrated that CCR2 is necessary for efficient monocyte recruitment from the blood to inflamed tissue. Analysis of mice lacking monocyte chemoattractant protein-1 (MCP-1), MCP-3, MCP-5, or MCP-2 plus MCP-5 revealed that MCP-3 and MCP-1 are the CCR2 agonists most critical for the maintenance of normal blood monocyte counts. These findings provide evidence that CCR2 and MCP-3/MCP-1 are critical for monocyte mobilization and suggest new roles for monocyte chemoattractants in leukocyte homeostasis.

Lung inflammation in rats following subchronic exposure to cigarette mainstream smoke

Female Sprague-Dawley rats were exposed to mainstream smoke from standard reference cigarettes and a nontobacco cellulose cigarette for 35 days. Whole smoke and smoke fractions were investigated. Lung inflammation was evaluated by differentiation of bronchoalveolar lavage cells and lymphocytes in thoracic lymph nodes. Histopathological changes in the nose and larynx were assessed. Results showed that the particulate phase of cigarette mainstream smoke is mostly responsible for inflammation in the lung (neutrophil increase up to 240-fold) and hyperplastic and metaplastic epithelial changes in the larynx, whereas irritative volatile constituents in the gas phase are mostly responsible for changes in the nose.

Effects of rosuvastatin on postprandial leukocytes in mildly hyperlipidemic patients with premature coronary sclerosis

We investigated whether pro-inflammatory aspects of the postprandial phase can be modulated by rosuvastatin in premature coronary artery disease (CAD) patients. Herefore standardized 8 h oral fat loading tests were performed off-treatment and after rosuvastatin 40 mg/d in 20 male CAD patients (50 +/- 4 years). The expression of leukocyte activation markers CD11a, CD11b, CD62L and CD66b was studied using flowcytometry. Migration of isolated neutrophils towards chemoattractants was determined in a fluorescence-based assay. Rosuvastatin did not affect baseline leukocyte counts nor the postprandial neutrophil increment (maximum mean increase +10% pre- and +14% post-treatment, P < 0.01 for each). Rosuvastatin reduced baseline platelets (from 266 +/- 78 to 225 +/- 74 x 10(9) cells/L, P < 0.001) and blunted the postprandial platelet count change (maximum mean increase +6%, P = 0.01, and 0%, respectively). The baseline expression of CD11a, CD11b and CD62L increased on most types of leukocytes by rosuvastatin, whereas the postprandial responses were unaffected. Pretreatment, postprandial neutrophil migration increased dose-dependently, but there were no postprandial changes after rosuvastatin. The latter effect was unrelated to changes in lipoprotein concentrations. In conclusion, in CAD patients postprandial pro-inflammatory and pro-coagulant changes can be modified by rosuvastatin. These apparently lipid-lowering independent effects may render protection against atherosclerosis.

Evaluation of peripheral blood neutrophil leucocytes in lead-exposed workers

BACKGROUND

Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (<50 microg/dl) blood lead (Pb-B) levels. Occupational exposure to lead causes a primary impairment of the chemotactic and phagocytic activities of neutrophil leucocytes.

OBJECTIVE

To verify whether, after taking into account the main confounding factors, occupational lead exposure is shown to induce changes in the number of blood neutrophil leucocytes, and to assess a possible dose-response relationship between Pb-B and the circulating neutrophil count in exposed workers.

SUBJECTS AND METHODS

The study included 68 male lead-exposed (E) workers and 59 male workers in a food plant, recruited as controls (NE). A standardized questionnaire probing work, social, familial and personal medical history was administered to all the subjects. Blood and urine samples were collected to determine the dose and effect biological indices of lead and the total white blood cell and neutrophil counts.

RESULTS

Pb-B levels were significantly higher in E (geometric mean (GM): 20.5 microg/dl; 3.2-120 microg/dl) than in NE workers (GM: 3.5 microg/dl; 1-11 microg/dl). The mean absolute neutrophil count (ANC) was significantly higher in E workers with respect to NE workers. ANC correlated significantly with the biological lead dose and effect indices. Moreover, there was a dose-dependent increase of ANC with increasing Pb-B levels. The linear relationship between ANC and Pb-B was confirmed even after correction for age, body mass index and smoking habit. We also found an interaction between Pb-B level and smoking habit in increasing the number of blood neutrophils in lead-exposed workers.

CONCLUSION

Our study is the first to describe a dose-dependent effect of lead on ANC in exposed workers. Our results underline the importance of promoting a further reduction of occupational lead exposure levels, adopting adequate individual protection means, as well as conducting medical campaigns against smoking, at the workplace.

Activation of leukocytes by postprandial lipemia in healthy volunteers

Activation of leukocytes is obligatory for inflammation and atherogenesis by adhering to the endothelium via specific ligands. Although in vitro studies have shown that triglycerides (TG) can activate leukocytes, it is unknown whether this occurs in vivo. Using flowcytometry, we studied the expression of leukocyte activation markers CD11A, CD11B, CD62L (all involved in endothelium adhesion) and CD66B (a neutrophil degranulation marker) during a 6 h fat challenge (50 g/m2) and a water test in 10 healthy males (52 +/- 3 years). After fat, neutrophil counts were increased between t=1 and t =6 h, with a maximum at t=3 h (+32% versus t=0, P <0.05), while they remained unchanged after water. Both tests showed gradual lymphocyte count increments. The expression of activation markers on lymphocytes was low and showed comparable responses after both tests. After fat, a significant increase up to a maximum at t=6 h was seen for CD11B on monocytes and on neutrophils for CD11B, CD62L and CD66B. Postprandial activation of monocytes and neutrophils was higher after fat than after water. The maximal postprandial TG increment was significantly related to the increase of CD11B on monocytes (Pearson's R=0.64, P <0.05). In conclusion, postprandially there is a TG-specific increase of neutrophil counts and increased activation of monocytes and neutrophils. These results are suggestive of a pro-inflammatory situation that may correspond with increased adhesive capacity of these cells contributing to the inflammatory component of atherosclerosis.