Volume 24, Issue 5 (Dec - Jan 2021)                   2021, 24(5): 444-453 | Back to browse issues page


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Hashemipour S, Ghorbani A, Jafari Aref N. Association of White Blood Cell Count With Metabolic Syndrome in Obese Men and Women. Journal of Inflammatory Diseases. 2021; 24 (5) :444-453
URL: http://journal.qums.ac.ir/article-1-3041-en.html
1- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran. , ghorbani_az@yahoo.com
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1. Introduction
Obesity has become an epidemic in the world especially in recent decades. About one third of worlds’ population are overweight or obese [1]. People with similar Body Mass Index (BMI) have a different risk of obesity complications [2]. In Wildman et al.’s study, about half of the overweight and one third of obese subjects were metabolically healthy [3]. This phenotype is called “metabolically healthy obesity” [4]. There are different definitions for this concept, but the most common definition is having two or more metabolic syndrome components [5]. There are various mechanisms for justifying different effects of obesity on metabolic risk factors. Difference in fat distribution and adiponectin level, oxidative stress, and free fatty acids are contributing factors in producing different metabolic complications in obese people [7]. Association of inflammatory markers such as White Blood Cells (WBC) count with metabolic complications of obesity has been reported in recent studies. In most cross-sectional and prospective studies, it has been reported that WBC count is associated with hypertriglyceridemia, impaired fasting glucose, hypertension, and metabolic syndrome; [8, 9] however, this association is different based on gender and ethnicity factors [10]. In most studies, association of inflammatory markers with metabolic complications has been reported to be stronger in high-risk groups including older people or diabetic patients [11, 12]. Gender differences of this association has also been reported in some studies [12]. Limited studies have compared inflammatory factors with metabolic disorders in healthy and unhealthy overweight or obese people. In most of these studies, small sample size or only female subjects have been used [13, 15]. Regarding the effect of gender difference in association of inflammatory markers with metabolic health, this study aims to compare the association of WBC count with metabolic health in obese men and women. 

2. Materials and Methods
This cross-sectional study is a part of Qazvin Metabolic Disease Study (QMDS) conducted on 622 subjects with BMI ≥25 kg/m2 recruited from those participated in the QMDS (1107 people aged ≥20 years living in Minoodar district of Qazvin province selected using a two-stage cluster sampling technique). For more details, see Reference No.16. This study has been approved by the Research Ethics Committee of Qazvin University of Medical Sciences. Two general practitioners examined subjects. After 12-14 hours of fasting, 10-cc serum level was collected for evaluating Fasting Blood Sugar (FBS), total cholesterol, High-Density Lipoprotein (HDL), triglyceride, and insulin levels. Measurement of insulin was performed using an ELISA kit (Monobind Inc., USA). Insulin resistance (HOMA-IR) was calculated using the Formula 1:

1. HOMA-IR=Insulin (mu/mL)×Glucose (mg/dL)/405

Insulin resistance in obese subjects was defined as HOMA-IR ≥3.4. Metabolic syndrome was defined according to Adult Treatment Panel III definition, i.e., the presence of three or more of the following criteria: systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥85 mmHg, HDL≥ 40 mg/dL in men and ≥50 mg/dL in women, triglyceride ≥150 mg/dL, FBS ≥100 mg/dL, waist circumference ≥102 cm in men and ≥ 88 cm in women. 
In statistical analysis, t-test and chi-squared test were used for comparing quantitative and qualitative variables, respectively, and logistic regression analysis was used for evaluating the association of WBC count quartiles with metabolic syndrome after adjusting based on age and BMI. A P≤ 0.05 was considered as a significance level.

3. Results 
The demographic characteristics of participants and the distribution of metabolic syndrome risk factors are shown in Table 1.

The prevalence of most metabolic disorders (Impaired fasting glucose, hypertension, hypertriglyceridemia) was higher in men than in women. In women, the frequency of metabolic syndrome, hypertriglyceridemia, and insulin resistance increased in the fourth quartile of WBC count compared to the first quartile. Among metabolic disorders, the prevalence of hypertriglyceridemia in the first quartile of WBC count in women was significantly lower than in the third (5.22% vs. 41.6%, P<0.01) and fourth quartiles (5.22% vs. 51.2%, P<0.001). According to the results of logistic regression analysis, there was a 2.8-fold higher risk of metabolic syndrome in women in the fourth quartile of WBC count compared to the first quartile (P<0.001).

4. Discussion and Conclusion 
In this study, in obese individuals, gender played a key role in the association of WBC count with metabolic syndrome such that even after controlling the effect of age and BMI, metabolic syndrome was about 2.5 times more prevalent in women with the highest WBC count than in women with the lowest WBC count. In men, the number of WBCs was not associated with metabolic syndrome. The association of inflammatory factors with metabolic problems has been reported in several studies.
In previous cross-sectional studies, higher WBC count was reported to be associated with higher visceral adiposity [20], higher risk of metabolic syndrome, higher insulin resistance, pancreatic beta-cell dysfunction [21], and higher risk of glucose metabolism disorders [11]. In our study, the frequency of hypertriglyceridemia in the third and fourth quartiles of WBC count in women was significantly higher than in the first quartile. The association of WBC count with metabolic syndrome and insulin resistance was observed only in obese women. Some studies have been conducted on the role of gender in metabolic disorders. In a study by Wannamethee et al. on older men and women, inflammatory factors and cardiovascular risk factors were lower in non-diabetic women than in non-diabetic men [27]. In some studies, insulin resistance in women has been associated with more abnormalities in inflammatory, coagulation, and endothelial factors [30]. It seems that, due to the fact that there are better resistances mechanisms against metabolic disorders in healthy women, more advanced stages of inflammatory disorders are needed to develop metabolic syndrome or diabetes [27].

Ethical Considerations
Compliance with ethical guidelines

This study obtained its ethical approval from the Research Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.RCE.1394.818).

Funding
This research was supported by the research projectFunded by Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin.

Authors' contributions
Conceptualization, supervision, methodology, editing & review, and data analysis: Sima Hashemipour; initial draft preparation, data analysis, editing & review: Azam Ghorbani; Data collection: Niloofar Jafari Aref.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the participants and the Metabolic Diseases Research Center staff at Qazvin University of Medical Sciences for their cooperation.

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Type of Study: Research | Subject: endocrinology

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