White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children

Association of neck circumference and waist-hip ratio with total leukocyte count in healthy Indian adolescents

OBJECTIVES

One of the major risk factors for cardiovascular disease is obesity, particularly abdominal and visceral obesity. Another concern for it is inflammation. Both risk factors are interrelated as obesity is a state of subacute low-grade systemic inflammation. As neck circumference and waist-hip ratio are potential indicators of obesity, we wanted to compare the level of total leukocyte count in subjects with normal and high neck circumference and waist-hip ratio. We also wanted to observe whether there is any correlation between neck circumference and waist-hip ratio with total leukocyte count.

METHODS

We selected 62 subjects (30 males, and 32 females) for the study. Both males and females were categorized into groups of normal and high neck circumference and waist-hip ratios. The total leukocyte count was compared among the groups and we correlated neck circumference and waist-hip ratios with total leukocyte count. Statistical analysis was done with SPSS version 23.0.

RESULTS

We observed a statistically significant higher value of total leukocyte count in males with a high waist-hip ratio. But there was not a significant increase in TLC in males with high neck circumference. In females, the values were insignificant. On Pearson correlation, there was a negative correlation between neck circumference, waist-hip ratio, and total leukocyte count in both genders which is not significant.

CONCLUSIONS

These findings suggest that waist-hip ratio rather than neck circumference might be a proxy measure of a marker of inflammation in males.

How the metabolic phenotype in adulthood is affected by long-lasting immunological trajectories since adolescence

A close relationship between immune and metabolic systems has been perceived in the recent past. We aimed to assess whether the immunological trajectories of circulating white blood cells (WBC) started in adolescence, affects the metabolic phenotype in adulthood. We used data from 1183 participants of the population-based EPITeen cohort, evaluated at 13, 17, 21, 24 and 27 years of age. The Immunological trajectories from 13 to 27 years old were identified by mixed-effects models, being their association with metabolic features at 27 years old measured by logistic regression. The Higher Inflammatory Activation trajectory (HIA trajectory) had the highest percentage of individuals with metabolic syndrome, while Lowest Levels of WBC trajectory (LLWBC trajectory) showed the lowest percentage. Participants with HIA trajectory had significantly higher triglycerides, waist circumference, serum uric acid and BMI. After adjustment for sex and sports practice and hs-CRP, the odds of having one or more metabolic features in adulthood was significantly lower in LLWBC trajectory. Individuals with immunological trajectories of WBC linked with a pattern of higher immune activation showed a less favorable metabolic profile, while those with the lowest levels of WBC were less likely to have metabolic risk factors in adulthood.

Positive Associations between Body Mass Index and Hematological Parameters, Including RBCs, WBCs, and Platelet Counts, in Korean Children and Adolescents

We conducted this study to investigate the associations between hematological parameters and obesity in children and adolescents. The levels of hematological parameters (including white blood cells [WBCs], red blood cells [RBCs], hemoglobin [Hb], hematocrit [Hct], and platelets) of 7997 participants (4259 boys and 3738 girls) aged 10–18 years were recorded. The parameters were compared among participants with normal weight, overweight, and obesity. Significantly higher mean levels of WBCs (7.16 vs. 6.16 × 103/mm³, p < 0.001), RBCs (4.90 vs. 4.82 × 106/mm³, p < 0.001), Hb (14.07 vs. 13.99 g/dL, p < 0.05), Hct (42.31 vs. 41.91%, p < 0.001), and platelets (311.87 vs. 282.66 × 103/mm³, p < 0.001) were found in the obese than normal weight group, respectively, after adjusting for body mass index (BMI) and sex. BMI SDS had significant positive associations with the levels of WBCs (β = 0.275, p < 0.001), RBCs (β = 0.028, p < 0.001), Hb (β = 0.034, p < 0.001), Hct (β = 0.152, p < 0.001), and platelets (β = 8.372, p < 0.001) after adjusting for age, sex, and socioeconomic factors in a multiple linear regression analysis. A higher BMI was associated with elevated WBC, RBC, Hb, Hct, and platelet counts in children and adolescents. Because higher levels of hematological parameters are potential risk factors for obesity-related diseases, hematological parameters should be evaluated in obese children and adolescents.

Low-grade inflammation independently associates with cardiometabolic risk in children with overweight/obesity

BACKGROUND AND AIMS

Pediatric obesity associates with both low-grade inflammation and cardiometabolic risk on the population level. Yet on an individual patient level, overweight/obesity does not always equal increased cardiometabolic risk. In this study, we examine whether low-grade inflammation associates with cardiometabolic risk in Danish children, independent of degree of adiposity. We further assess the value of integrating multiple inflammation markers to identify children with very-high cardiometabolic risk profiles.

METHOD AND RESULTS

We studied 2192 children and adolescents aged 6-18 years from an obesity clinic cohort and a population-based cohort, in a cross-sectional study design. Anthropometry, blood pressure, pubertal stage and body composition by dual-energy X-ray absorptiometry were assessed, and biomarkers including fasting serum high sensitivity C-reactive protein (hsCRP), white blood cells (WBC), resistin, lipid profile and glucose metabolism were measured. Adjusted correlation analysis and odds ratios were calculated. We found that, independent of degree of adiposity, having high-normal inflammation marker concentrations associated with increased cardiometabolic risk: for girls, hsCRP >0.57-9.98 mg/L (mid/upper tertile) associated with ~2-fold higher odds of dyslipidemia and hepatic steatosis (vs. lower tertile). For both sexes, WBC >7.0-12.4 10⁹/L (upper tertile) associated with 2.5-fold higher odds of insulin resistance. Lastly, children with multiple inflammation markers in the high-normal range exhibited the most severe cardiometabolic risk profile.

CONCLUSION

Low-grade inflammation associates with cardiometabolic risk in children independent of degree of adiposity. The associations vary with sex and inflammation marker measured. Finally, integrating multiple low-grade inflammation markers identifies a very-high-risk subgroup of children with overweight/obesity and may have clinical value.

Changes in leukocyte profile and C-reactive protein concentration in overweight and obese adolescents after reduction of body weight

Aim of the study

To assess the changes in the leukocyte profile and C-reactive protein (CRP) concentration in adolescents with excess fat mass after 6-12 months of dietary intervention.

Material and methods

The retrospective study included 99 overweight and obese adolescents, aged from 10.0 to 17.5 years, 82 of whom were re-hospitalized 6 to 12 months after dietary counseling. The control group consisted of 42 normal weight peers. Anthropometric measurements and laboratory tests were performed, homeostasis model assessment – insulin resistance (HOMA-IR) and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio were calculated.

Results

Obese and overweight adolescents had higher white blood cells (WBC), neutrophil, monocyte counts and CRP concentration. In the backward stepwise regression analysis, body mass index standard deviation score (BMI SDS) and fasting insulin concentration were independent predictors of WBC and neutrophil counts at the baseline. At the follow-up visit in 45 (54.8%) children, who had lost weight, decreases in WBC, neutrophil and monocyte counts and CRP, fasting insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) concentrations were observed. Changes in WBC and neutrophil counts were dependent on changes in HOMA-IR and TG/HDL ratio. Changes in HOMA-IR had a significant impact on changes in the monocyte count.

Conclusions

Adipose tissue promotes systemic inflammation and its intensity depends on the degree of obesity and insulin resistance. This state is reversible. Changes in HOMA-IR were independent predictors of changes in WBC, neutrophil and monocyte counts after reduction of body weight.

Altered Thyroid Function and Structure in Children and Adolescents Who Are Overweight and Obese: Reversal After Weight Loss

CONTEXT

Obesity is associated with hypothyroidism and goiter.

OBJECTIVE

The aim of the study was to verify whether thyroid structure and function would improve after weight loss.

DESIGN AND PATIENTS

We evaluated 96 children who were overweight/obese who showed an altered parenchymal pattern at thyroid ultrasound without circulating antithyroid antibodies. At phase 1, body mass index (BMI), SD score (SDS), body composition, free T4 (fT4), TSH, high-sensitivity C reactive protein (CRPhs), white blood cells, metabolic profile, and a thyroid ultrasound were assessed. Thyroid volume was expressed as SDS on the basis of the references values for age. Alterations in echogenicity and homogeneity were graded from 0 to 5 (thyroid score). The same parameters were re-examined after a weight loss program (phase 2).

RESULTS

After a mean period of treatment of 0.8 ± 0.3 years, there was a significant decrease of BMI SDS, percentage fat mass, CRPhs, TSH, and thyroid volume SDS (all P < 0.0001), whereas fT4 remained unchanged. The thyroid score significantly improved (z = -9088; P < 0.0001) [i.e., it decreased in 82 individuals, was tied in 12, and worsened only in two subjects; the score completely normalized in 48 (50%) individuals]. BMI SDS reduction was a unique predictor of the decrease of TSH, thyroid volume, and structure, whereas CRPhs reduction was an independent predictor only for the TSH change. Moreover, CRPhs variations mediated the association between BMI SDS and TSH.

CONCLUSION

The alterations of thyroid function and structure in children with obesity are reversible after weight loss.

Relationship between serum alkaline phosphatase level, C-reactive protein and leukocyte counts in adults aged 60 years or older

Serum alkaline phosphatase (ALP), a useful marker of hepatobiliary or bone disorders, has been known to be associated with cardiovascular disease (CVD), which is increasingly being viewed as an inflammatory disease. C-reactive protein level and leukocyte count have also been highlighted as independent risk markers of CVD. Thus, the mechanism underlying the link between elevated ALP and CVD could be subclinical low-grade inflammation. This study aimed to examine associations of serum ALP level with inflammatory markers. This cross-sectional study included 2403 participants (1324 men and 1079 women) aged ≥60 years who participated in a health examination program. Serum ALP quartiles were categorized as follows: Q1: ≤51, Q2: 52-61, Q3: 62-74 and Q4: ≥75 U/L. The odds ratios (ORs) and 95% confidence intervals (CIs) for high CRP and leukocyte count (≥75th percentiles) were calculated after adjusting for confounding variables across serum ALP quartiles using multiple logistic regression analysis. Median CRP level and mean leukocyte count increased in accordance with serum ALP quartiles. Compared to the lowest quartile, the ORs (95% CI) of the highest quartile for high CRP and leukocyte count were 2.03 (1.50-2.76) and 1.54 (1.13-2.10) after adjusting for age, sex, body mass index, smoking status, alcohol intake, fasting plasma glucose, log-transformed triglyceride and HDL-cholesterol levels. Serum ALP level was positively and independently associated with inflammatory markers in adults aged 60 years or older.

Pediatric Obesity and the Immune System

Obesity has reached pandemic proportion and represents a major risk for several comorbidities. In addition to metabolic and cardiovascular obesity-related diseases, recent evidence suggested that obesity might affect immune system function. Adipose tissue is considered an endocrine organ that actively secretes cytokines also referred to as "adipokines." Adipokines play an important role in the control of human metabolism. The dysfunctional adipose tissue in obese individuals is characterized by an altered cytokine secretion pattern that promotes chronic low-grade inflammation. Epidemiological evidence highlights the association between obesity and allergic and immune-mediated diseases, such as asthma, allergic rhinitis, rheumatic arthritis, and psoriasis. Less is known about underlying pathogenic mechanisms. However, several recent in vivo and in vitro studies have reported that adipokines are involved in inflammatory and autoimmune disorders by influencing both innate and acquired immune responses. In addition, obesity has been associated with reduced immune surveillance and increased risk of cancer. This paper reviews the evidence regarding the role of adipokines in immune system regulation, with particular emphasis on autoimmune, allergic, and inflammatory disorders. Understanding how obesity affects immune system functions may enable researchers to find new potential therapeutic targets in the management of allergic and autoimmune diseases.

Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype

BACKGROUND AND AIMS

We aimed to evaluate whether the metabolically healthy obese (MHO) phenotype was associated with hepatic steatosis (HS) or left ventricular hypertrophy (LVH) in young people with overweight (OW), obesity (OB) and morbid obesity (MOB) and whether the prevalence of these comorbidities was affected by OB severity.

METHODS AND RESULTS

An abdominal ultrasound was performed in 1769 children and adolescents, mean age 10.6 years (range 5-18) with MHO phenotype, defined as the absence of traditional cardiometabolic risk factors, in order to identify HS. In a subsample of 177 youth the presence of LVH, defined by 95th percentile of LV mass/h^2.7 for age and gender, was also analyzed. The prevalence of HS increased from 23.0% in OW to 27.8% in OB and 45.1% in MOB (P < 0.0001). The proportion of LVH increased from 36.8% in OW to 57.9% in OB and 54.5% in MOB (P < 0.05). As compared with OW, the odds ratio (95% CI) for HS was 2.18 (1.56-3.05), P < 0.0001) in OB and 6.20 (4.26-9.03), P < 0.0001) in MOB, independently of confounding factors. The odds ratio for LVH was 2.46 (1.20-5.06), P < 0.025) in OB and 2.79 (1.18-6.61), P < 0.025) in MOB, as compared with OW.

CONCLUSION

In spite of the absence of traditional cardiometabolic risk factors, the prevalence of HS and LVH progressively increased across BMI categories. MHO phenotype does not represent a "benign" condition in youth.

Association between 14 bp insertion/deletion HLA-G functional polymorphism and insulin resistance in a cohort of Italian children with obesity

BACKGROUND

The non-classical HLA-class I molecule-g (HLA-G) gene shows a deletion/insertion (del/ins) polymorphism of a 14-base-pair sequence (14 bp) in the exon 8 at the 3' untranslated region. The presence of the 14 bp insertion allele has been associated to lower soluble HLA-G protein production, a protein with anti-inflammatory activities. So far, no studies have investigated the relationship between HLA-G 14 bp del/ins polymorphism and metabolic features of obese children and adolescents. We aimed to assess if the HLA-G ins/del polymorphism, and in particular the HLA-G ins/ins genotype determining lower sHLA-G production, is associated to insulin resistance (evaluated by homeostasis model assessment [HOMA]) in a population of obese children.

METHODS

We enrolled 574 obese children and adolescents. Anthropometric and laboratory data were collected. The white blood cell (WBC) count was evaluated as surrogate marker of inflammation. C-reactive protein (CRP) was available in 48 patients. HOMA was calculated. Patients were genotyped for the HLA-G del/ins polymorphism.

RESULTS

Subjects carrying the HLA-G ins/ins genotype, presented with higher HOMA, WBC and CRP values, compared to del/ins and del/del genotypes (P ≤ 0.0009, ≤0.02 and ≤0.0001, respectively). Comparison of the regression line slopes, performed for HOMA and WBC on the basis of HLA-G genotypes, showed that subjects carrying the HLA-G ins/ins genotype presented with a stronger correlation between HOMA and WBC, compared to the other genotypes (Model r2 3.13%, P ≤ 0.006).

CONCLUSIONS

We showed a strong association between HLA-G 14 bp ins/ins genotype and HOMA in obese children and adolescents. This association could be hypothetically modulated by subclinical inflammation.

Infections in children with simple obesity: The relation to phagocytic function and serum leptin

INTRODUCTION

There is a possible association between obesity and infections. We sought to investigate phagocytic functions in obese children and their relation to serum leptin levels.

METHODS

A cross sectional, controlled study was conducted, comprising 40 cases with simple visceral-type obesity. Subjects were evaluated for percentage of caloric intake, frequency and type of infections, body mass index (BMI) z score, in addition to complete blood counting, serum leptin assay (ELISA) and Dihydrorhodamine (DHR) flowcytometry.

RESULTS

Cases were 21 males (52.5%) and 19 females (47.5%) with mean age 7.14 years±2.73 SD with median duration of obesity 4.2 years (IQR: 2-6). Cases had higher frequency of infections compared with controls (p<0.001). Serum leptin was significantly higher among cases (t=-12.391, p<0.001), while DHR results were comparable in the studied groups (p=0.067). Among cases, absolute lymphocytic count (ALC) correlated negatively with percentage of total caloric intake (p=0.045). Leptin levels correlated positively with frequency of infections (p=0.019) but negatively with ALC (p=0.043). DHR results showed weak negative correlations with serum leptin (p=0.177) and with BMI Z score (p=0.109).

CONCLUSION

Obese children are posed at increased risk of infections and have higher serum leptin levels with possible negative effects of leptin on phagocytic functions.

Relationship between high white blood cell count and insulin resistance (HOMA-IR) in Korean children and adolescents: Korean National Health and Nutrition Examination Survey 2008-2010

BACKGROUND AND AIMS

Increasing evidence has indicated that insulin resistance is associated with inflammation. However, few studies have investigated the association between white blood cell (WBC) count and insulin resistance, as measured by a homeostasis model assessment of insulin resistance (HOMA-IR) in a general pediatric population. This study aimed to examine the association between WBC count and insulin resistance as measured by HOMA-IR in a nationally representative sample of children and adolescents.

METHODS AND RESULTS

In total, 2761 participants (1479 boys and 1282 girls) aged 10-18 years were selected from the 2008-2010 Korean National Health and Nutrition Examination Survey. Insulin resistance was defined as a HOMA-IR value greater than the 90th percentile. The odds ratios and 95% confidence intervals for insulin resistance were determined using multiple logistic regression analysis. The mean values of most cardiometabolic variables tended to increase proportionally with WBC count quartiles. The prevalence of insulin resistance significantly increased in accordance with WBC count quartiles in both boys and girls. Compared to individuals in the lowest WBC count quartile, the odds ratio for insulin resistance for individuals in the highest quartile was 2.84 in boys and 3.20 in girls, after adjusting for age, systolic blood pressure, body mass index, and waist circumference.

CONCLUSION

A higher WBC count was positively associated with an increased risk of insulin resistance in Korean children and adolescents. This study suggests that WBC count could facilitate the identification of children and adolescents with insulin resistance.

Association of blood glucose and lipid levels with complete blood count indices to establish a regression model

Hyperglycemia and hyperlipidemia, which are usually diagnosed by analysis of blood glucose (GLU) and lipid levels, are two of the most common diseases in modern society. The purpose of the current study was to investigate the potential association between blood GLU and lipid levels with complete blood count (CBC) indices in overweight and healthy individuals and establish a regression model. There were 456 healthy and 421 overweight participants in the study. Data were collected on triglyceride (TG), total cholesterol (CHO), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood GLU and CBC. The distribution characteristics and differences between healthy and overweight subjects were analyzed. Subsequently, the associations between TG, CHO, HDL, LDL and GLU with CBC were analyzed using correlation analysis and multiple linear regression (MLR). Significant differences were identified between the healthy and overweight individuals in TG, CHO, HDL, LDL, GLU and in the majority of the CBC indices. The correlation analysis indicated that there were strong correlations between TG, LDL, HDL, CHO and GLU with CBC indices in the healthy and overweight subjects. The MLR demonstrated that the regression models of TG, LDL, HDL and CHO, but no GLU, were statistically significant in the two groups (P<0.001). The HDL regression model exhibited the best regression parameters; the multiple correlation coefficients (R) were 0.351 and 0.308 in the healthy and overweight subjects, respectively. In the overweight and healthy subjects, there were strong correlations between TG, LDL, HDL and CHO with CBC indices, with HDL being the most relevant to the CBC indices. The CBC demonstrated statistical significance in the diagnosis of hyperlipidemia.