| Peer-Reviewed

Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease

Received: 10 November 2021     Accepted: 30 November 2021     Published: 24 December 2021
Views:       Downloads:
Abstract

Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and neutrophil to lymphocyte ratio (NLR), among T2DM Moroccan patients without chronic kidney disease and to find out the possible correlation between these parameters and glycated hemoglobin (HbA1c). Methods: 274 T2DM patients and 88 non-diabetic controls aged over 40 years old were analyzed. Fasting plasma glucose, lipid profile tests, liver and renal function tests, and HbA1c test were measured. The NLR and lipid ratios including total cholesterol / HDL-c, non- HDL-c and atherogenic index of plasma were calculated. Results: There was no significant difference in median level of all lipid profile parameters between the poor controlled T2DM group (HbA1c > 7%) compared to the well controlled group (HbA1c ≤ 7%) and control group (all P > 0.05). All lipid ratios were lower in the good controlled group compared to the poor controlled diabetes group, but the difference did not reach statistical significance (all P > 0.05). HbA1c was correlated with FPG, and neutrophils (r = 0.655, r = 0.263, P < 0.001 respectively). NLR was weekly correlated with HDL (r = -0.14, P = 0.01). By using multivariate logistic regression, FPG was the only factor significantly predictive of well diabetic control. Conclusion: This study did not show significant association between HbA1c, lipid ratios and NLR.

Published in American Journal of Laboratory Medicine (Volume 6, Issue 6)
DOI 10.11648/j.ajlm.20210606.15
Page(s) 107-113
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Diabetes Mellitus Type 2, Lipid Ratios, Neutrophil-to-lymphocyte ratio, Glycated Hemoglobin, Morocco

References
[1] Zimmet PZ. Diabetes and its drivers: the largest epidemic in human history? Clin Diabetes Endocrinol. 2017. 18; 3: 1.
[2] American Diabetes Association. Standards of medical in diabetes- 2021. Diabetes Care 2021 Jan; 44 (Supplement 1): S125-S150.
[3] 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41: 111-188.
[4] Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low- density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017; 38: 2459-2472.
[5] Turner RC, Millns H, Neil HAW, Stratton IM, Manley SE, Matthews DR et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). Br Med J. 1998; 316: 823–828.
[6] Dobiásová M, Frohlich J. The new atherogenic plasma index reflects the triglyceride and HDL-cholesterol ratio, lipoprotein particle size and the cholesterol esterification rate: changes during lipanor therapy. Vnitr Lek. 2000. Mar; 46 (3): 152-6.
[7] Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER (HDL)). Clin Biochem. 2001. Oct; 34 (7): 583-8.
[8] Dobiásová M, Urbanová Z, Samánek M. Relations between particle size of HDL and LDL lipoproteins and cholesterol esterification rate. Physiol Res. 2005; 54 (2): 159-65.
[9] Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clin Appl Thromb Hemost. 2016 Jul; 22 (5): 405-11.
[10] Bilgin S, Aktas G, Zahid Kocak M, Atak BM, Kurtkulagi O, Duman TT et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male. 2020 Dec; 23 (5): 923-927.
[11] American Diabetes A. Standards of medical care in diabetese 2010. Diabetes Care. 2010; 33 (Suppl. 1): S11e61.
[12] Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2019; 73 (24): e285-350.
[13] Chapman MJ, Ginsberg HN, Amarenco P, Andreotti F, Bore´n J, Catapano AL et al. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for managment. Eur Heart J. 2011; 32: 1345-1361.
[14] Dobiásová M, Frohlich J, Sedová M, Cheung MC, Brown BG. Cholesterol esterification and atherogenic index of plasma correlate with lipoprotein size and findings on coronary angiography. J Lipid Res. 2011. Mar; 52 (3): 566-71.
[15] Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014; 63: 2889–2934.
[16] Cao YY, Tang X, Sun KX, Liu ZK, Xiang X, Juan J, et al. [Relationship between glycemic control and visceral adiposity index among the patients with type 2 diabetes mellitus]. Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Jun 18; 49 (3): 446-450.
[17] de Pablos-Velasco P, Parhofer KG, Bradley C, Eschwège E, Gönder-Frederick L, Maheux P, el al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol (Oxf). 2014 Jan; 80 (1): 47-56.
[18] Jan SS, Rehman A, Ahmad R, Khan TM, Ahmad A, Abrar A. Evaluation of pattern of dyslipidemia in type 2 diabetics in swat. Gomal J Medic Sciences. 2011; 9 (2): 243–247.
[19] Moon J, Lee CJ, Lee S-H, Kang S-M, Choi D, Yoo T-H, et al. The Impact of Diabetes Mellitus on Vascular Biomarkers in Patients with End-Stage Renal Disease. Yonsei Med J. 2017; 58 (1): 75-81.
[20] Khan AH. Clinical significance of HBA1c as marker of circulating lipids in male and female type 2 diabetic patients. Acta Diabetol. 2007 Dec; 44 (4): 193-200.
[21] Gonna H, Ray KK. The importance of dyslipidaemia in the pathogenesis of cardiovascular disease in people with diabetes. Diabetes Obes Metab. 2019 Apr; 21 Suppl 1: 6-16.
[22] Avramoglu RK, Basciano H, Adeli K. Lipid and lipoprotein dysregulation in insulin resistant states. Clin Chim Acta. 2006 Jun; 368 (1-2): 1-19.
[23] Wang S, Ji X, Zhang Z, Xue F. Relationship between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China. Int J Environ Res Public Health. août 2020; 17 (15): 5317.
[24] Biadgo B, Abebe SM, Baynes HW, Yesuf M, Alemu A, Abebe M. Correlation between Serum Lipid Profile with Anthropometric and Clinical Variables in Patients with Type 2 Diabetes Mellitus. Ethiop J Health Sci. 2017; 27 (3): 215-26.
[25] Elnasri HA, Ahmed A M. Patterns of lipid changes among type 2 diabetes patients in Sudan. EMHJ - Eastern Mediterranean Health Journal. 2008; 14 (‎2) ‎: 314-324.
[26] Kumar A, Singh V. Atherogenic dyslipidemia and diabetes mellitus: what’s new in the management arena? Vasc Health Risk Manag. 2010; 6: 665–9.
[27] Zhu X-W, Deng F-Y, Lei S-F. Meta-analysis of Atherogenic Index of Plasma and other lipid parameters in relation to risk of type 2 diabetes mellitus. Prim Care Diabetes. 2015; 9 (1): 60-7.
[28] Mark L, Vallejo-Vaz AJ, Reiber I, Paragh G, Kondapally Seshasai SR, Ray KK. Non-HDL cholesterol goal attainment and its relationship with triglyceride concentrations among diabetic subjects with cardiovascular disease: a nationwide survey of 2674 individuals in Hungary. Atherosclerosis 2015; 241: 62-68.
[29] Ahn SS, Lee LE, Pyo JY, Song JJ, Park YB, Lee SW. Atherogenic index of plasma predicts cerebrovascular accident occurrence in antineutrophil cytoplasmic antibody-associated vasculitis. Lipids Health Dis. 2020 Aug 14; 19 (1): 184.
[30] Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with type 2 diabetes. Clin Chem. 2004; 50: 1184–8.
[31] Qin Z, Zhou K, Li Y, Cheng W, Wang Z, Wang J, et al. The atherogenic index of plasma plays an important role in predicting the prognosis of type 2 diabetic subjects undergoing percutaneous coronary intervention: results from an observational cohort study in China. Cardiovasc Diabetol. 2020; 19 (1): 23.
[32] Gimeno-Orna JA, Faure-Nogueras E, Sancho-Serrano MA. Usefulness of total cholesterol/HDL-cholesterol ratio in the management of diabetic dyslipidaemia. Diabet Med J Br Diabet Assoc. 2005; 22 (1): 26-31.
[33] Lu W, Resnick HE, Jablonski KA, Jones KL, Jain AK, Howard WJ et al. Non-HDL cholesterol as a predictor of cardiovascular disease in type 2 diabetes. The Strong Heart Study. Diabetes Care. 2003; 26: 16–23.
[34] Khaw K-T, Wareham N. Glycated hemoglobin as a marker of cardiovascular risk. Curr Opin Lipidol. 2006; 17 (6): 637-43.
[35] Mullugeta Y, Chawla R, Kebede T, Worku Y. Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation. Indian J. Clin. Biochem. 2012, 27, 363–369.
[36] Ozder A. Lipid profile abnormalities seen in T2DM patients in primary healthcare in Turkey: A cross-sectional study. Lipids Health Dis. 2014 Dec 6; 13: 183.
[37] Walton CM, Perry K, Hart RH, Berry SL, Bikman BT. Improvement in Glycemic and Lipid Profiles in Type 2 Diabetics with a 90-Day Ketogenic Diet. J Diabetes Res. 2019 Aug 14; 2019: 8681959.
[38] Blake GJ, Pradhan AD, Manson JE, Williams GR, Buring J, Ridker PM, et al. Hemoglobin A1c level and future cardiovascular events among women. Arch Intern Med. 2004 Apr 12; 164 (7): 757-61.
[39] Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002; 287 (19): 2570.
[40] Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil–lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008; 395 (1-2): 27-31.
[41] Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. Ann Epidemiol. 2005; 15 (4): 266-271.
[42] Luo W-J, Zhang W-F. The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review. Int J Ophthalmol. 2019; 12 (2): 312-23.
[43] Ulu SM, Dogan M, Ahsen A, Altug A, Demir K, Acartürk G, et al. Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther. 2013 Nov; 15 (11): 942-7.
[44] Yu Y, Lin Q, Ye D, Wang Y, He B, Li Y, et al. Neutrophil count as a reliable marker for diabetic kidney disease in autoimmune diabetes. BMC Endocr Disord. 2020; 20 (1): 158.
[45] Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010 Jan 15; 105 (2): 186-91.
[46] Eriksson EE, Xie X, Werr J, Thoren P, Lindbom L. Direct viewing of atherosclerosis in vivo: plaque invasion by leukocytes is initiated by the endothelial selectins. FASEB J. 2001; 15 (7): 1149-1157.
[47] Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008 Jan 12; 371 (9607): 117-25.
Cite This Article
  • APA Style

    Siham Aboulmakarim, Abderrahmane Boukhira, Sanae Sayagh, Saliha Chellak. (2021). Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease. American Journal of Laboratory Medicine, 6(6), 107-113. https://doi.org/10.11648/j.ajlm.20210606.15

    Copy | Download

    ACS Style

    Siham Aboulmakarim; Abderrahmane Boukhira; Sanae Sayagh; Saliha Chellak. Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease. Am. J. Lab. Med. 2021, 6(6), 107-113. doi: 10.11648/j.ajlm.20210606.15

    Copy | Download

    AMA Style

    Siham Aboulmakarim, Abderrahmane Boukhira, Sanae Sayagh, Saliha Chellak. Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease. Am J Lab Med. 2021;6(6):107-113. doi: 10.11648/j.ajlm.20210606.15

    Copy | Download

  • @article{10.11648/j.ajlm.20210606.15,
      author = {Siham Aboulmakarim and Abderrahmane Boukhira and Sanae Sayagh and Saliha Chellak},
      title = {Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease},
      journal = {American Journal of Laboratory Medicine},
      volume = {6},
      number = {6},
      pages = {107-113},
      doi = {10.11648/j.ajlm.20210606.15},
      url = {https://doi.org/10.11648/j.ajlm.20210606.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20210606.15},
      abstract = {Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and neutrophil to lymphocyte ratio (NLR), among T2DM Moroccan patients without chronic kidney disease and to find out the possible correlation between these parameters and glycated hemoglobin (HbA1c). Methods: 274 T2DM patients and 88 non-diabetic controls aged over 40 years old were analyzed. Fasting plasma glucose, lipid profile tests, liver and renal function tests, and HbA1c test were measured. The NLR and lipid ratios including total cholesterol / HDL-c, non- HDL-c and atherogenic index of plasma were calculated. Results: There was no significant difference in median level of all lipid profile parameters between the poor controlled T2DM group (HbA1c > 7%) compared to the well controlled group (HbA1c ≤ 7%) and control group (all P > 0.05). All lipid ratios were lower in the good controlled group compared to the poor controlled diabetes group, but the difference did not reach statistical significance (all P > 0.05). HbA1c was correlated with FPG, and neutrophils (r = 0.655, r = 0.263, P P = 0.01). By using multivariate logistic regression, FPG was the only factor significantly predictive of well diabetic control. Conclusion: This study did not show significant association between HbA1c, lipid ratios and NLR.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease
    AU  - Siham Aboulmakarim
    AU  - Abderrahmane Boukhira
    AU  - Sanae Sayagh
    AU  - Saliha Chellak
    Y1  - 2021/12/24
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajlm.20210606.15
    DO  - 10.11648/j.ajlm.20210606.15
    T2  - American Journal of Laboratory Medicine
    JF  - American Journal of Laboratory Medicine
    JO  - American Journal of Laboratory Medicine
    SP  - 107
    EP  - 113
    PB  - Science Publishing Group
    SN  - 2575-386X
    UR  - https://doi.org/10.11648/j.ajlm.20210606.15
    AB  - Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and neutrophil to lymphocyte ratio (NLR), among T2DM Moroccan patients without chronic kidney disease and to find out the possible correlation between these parameters and glycated hemoglobin (HbA1c). Methods: 274 T2DM patients and 88 non-diabetic controls aged over 40 years old were analyzed. Fasting plasma glucose, lipid profile tests, liver and renal function tests, and HbA1c test were measured. The NLR and lipid ratios including total cholesterol / HDL-c, non- HDL-c and atherogenic index of plasma were calculated. Results: There was no significant difference in median level of all lipid profile parameters between the poor controlled T2DM group (HbA1c > 7%) compared to the well controlled group (HbA1c ≤ 7%) and control group (all P > 0.05). All lipid ratios were lower in the good controlled group compared to the poor controlled diabetes group, but the difference did not reach statistical significance (all P > 0.05). HbA1c was correlated with FPG, and neutrophils (r = 0.655, r = 0.263, P P = 0.01). By using multivariate logistic regression, FPG was the only factor significantly predictive of well diabetic control. Conclusion: This study did not show significant association between HbA1c, lipid ratios and NLR.
    VL  - 6
    IS  - 6
    ER  - 

    Copy | Download

Author Information
  • Department of Biochemistry, Arrazi Hospital, Mohamed VI Medical Center, Marrakech, Morocco

  • Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco

  • Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco

  • Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco

  • Sections