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open access

Vol 72, No 4 (2021)
Original paper
Submitted: 2020-12-13
Accepted: 2021-03-05
Published online: 2021-04-08
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The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Małgorzata Morawiecka-Pietrzak12, Żaneta Malczyk1, Ewelina Dąbrowska3, Małgorzata Blaska3, Mikołaj Pietrzak4, Aleksandra Gliwińska5, Anna Góra1, Katarzyna Ziora1, Wojciech Pluskiewicz6, Zofia Ostrowska2
DOI: 10.5603/EP.a2021.0036
·
Pubmed: 34010435
·
Endokrynol Pol 2021;72(4):336-346.
Affiliations
  1. Department of Paediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
  2. 2Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  3. Pediatric Endocrinology Ward, Independent Public Clinical Hospital No. 1 in Zabrze, Medical University of Silesia in Katowice, Poland
  4. Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  5. Pediatric Nephrology Ward with Dialysis Division for Children, Independent Public Clinical Hospital No. 1 in Zabrze, Medical University of Silesia in Katowice, Poland
  6. Department and Clinic of Internal Diseases, Diabetology and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

open access

Vol 72, No 4 (2021)
Original Paper
Submitted: 2020-12-13
Accepted: 2021-03-05
Published online: 2021-04-08

Abstract

Introduction: Inflammation is supposed to be one of the factors contributing to decreased bone mineral density (BMD) in anorexia nervosa (AN). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and cost-effective inflammatory markers, well documented as indicators of postmenopausal osteoporosis. This study aimed to assess the relationships between these ratios and BMD in girls with AN.

Material and methods: The electronic records of 73 girls hospitalized for AN were analysed retrospectively. The age range of the study group was 12.56–17.67 years. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and expressed as Z-scores according to lumbar spine (s-BMD) and total body (TB-BMD) sites. NLR and PLR were calculated according to complete blood count results. Patients were divided into 2 subgroups with parallel analyses — according to the TB-BMD criterion and the s-BMD criterion: normal (Z-score > –2.0, n = 63) and low s-BMD subgroup (Z-score ≤ –2.0, n = 10), and normal (Z-score > –2.0, n = 45) and low TB-BMD subgroup (Z-score ≤ –2.0, n = 28).

Results: In the low s-BMD subgroup a tendency to an increase of mean NLR, PLR, and WBC values was observed. Respective BMD Z-score values correlated significantly and negatively with PLR in the low s-BMD (R = –0.892, p < 0.001) and normal TB-BMD (R = –0.451, p = 0.002) subgroups, while with NLR only in the normal TB-BMD subgroup (R = –0.685, p < 0.001). In the low s-BMD subgroup the PLR was shown to be a significant and independent predictor of s-BMD (β = –0.881, p < 0.001). The PLR contributed to 77.6% of the s-BMD Z-score variability (R2 = 0.776, p < 0.001). In the normal TB-BMD subgroup, the PLR and NLR levels were significant and independent predictors of TB-BMD (β = –0.352, p = 0.004; β = –0.450, p = 0.001; β = –0.339, p = 0.005, respectively) and explained 44.4% of TB-BMD Z-score variability (R2 = 0.444, p < 0.001).

Conclusions: These results indicate that there might be a relationship between bone mass loss and inflammation expressed as NLR and PLR in adolescent girls suffering from AN. These connections seem to be dependent on the examined skeletal area. NLR and PLR, which are common indicators of morbidity and mortality in many malignancies and inflammatory chronic diseases, can also be useful in the evaluation of bone condition in adolescent females with AN. However, there is a need for further investigation in this field.

 

Abstract

Introduction: Inflammation is supposed to be one of the factors contributing to decreased bone mineral density (BMD) in anorexia nervosa (AN). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and cost-effective inflammatory markers, well documented as indicators of postmenopausal osteoporosis. This study aimed to assess the relationships between these ratios and BMD in girls with AN.

Material and methods: The electronic records of 73 girls hospitalized for AN were analysed retrospectively. The age range of the study group was 12.56–17.67 years. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and expressed as Z-scores according to lumbar spine (s-BMD) and total body (TB-BMD) sites. NLR and PLR were calculated according to complete blood count results. Patients were divided into 2 subgroups with parallel analyses — according to the TB-BMD criterion and the s-BMD criterion: normal (Z-score > –2.0, n = 63) and low s-BMD subgroup (Z-score ≤ –2.0, n = 10), and normal (Z-score > –2.0, n = 45) and low TB-BMD subgroup (Z-score ≤ –2.0, n = 28).

Results: In the low s-BMD subgroup a tendency to an increase of mean NLR, PLR, and WBC values was observed. Respective BMD Z-score values correlated significantly and negatively with PLR in the low s-BMD (R = –0.892, p < 0.001) and normal TB-BMD (R = –0.451, p = 0.002) subgroups, while with NLR only in the normal TB-BMD subgroup (R = –0.685, p < 0.001). In the low s-BMD subgroup the PLR was shown to be a significant and independent predictor of s-BMD (β = –0.881, p < 0.001). The PLR contributed to 77.6% of the s-BMD Z-score variability (R2 = 0.776, p < 0.001). In the normal TB-BMD subgroup, the PLR and NLR levels were significant and independent predictors of TB-BMD (β = –0.352, p = 0.004; β = –0.450, p = 0.001; β = –0.339, p = 0.005, respectively) and explained 44.4% of TB-BMD Z-score variability (R2 = 0.444, p < 0.001).

Conclusions: These results indicate that there might be a relationship between bone mass loss and inflammation expressed as NLR and PLR in adolescent girls suffering from AN. These connections seem to be dependent on the examined skeletal area. NLR and PLR, which are common indicators of morbidity and mortality in many malignancies and inflammatory chronic diseases, can also be useful in the evaluation of bone condition in adolescent females with AN. However, there is a need for further investigation in this field.

 

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Keywords

anorexia nervosa; bone mineral density; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio

About this article
Title

The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Journal

Endokrynologia Polska

Issue

Vol 72, No 4 (2021)

Article type

Original paper

Pages

336-346

Published online

2021-04-08

Page views

1471

Article views/downloads

688

DOI

10.5603/EP.a2021.0036

Pubmed

34010435

Bibliographic record

Endokrynol Pol 2021;72(4):336-346.

Keywords

anorexia nervosa
bone mineral density
neutrophil-to-lymphocyte ratio
platelet-to-lymphocyte ratio

Authors

Małgorzata Morawiecka-Pietrzak
Żaneta Malczyk
Ewelina Dąbrowska
Małgorzata Blaska
Mikołaj Pietrzak
Aleksandra Gliwińska
Anna Góra
Katarzyna Ziora
Wojciech Pluskiewicz
Zofia Ostrowska

References (47)
  1. Malczyk Ż, Oświęcimska JM. Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa. Psychiatr Pol. 2017; 51(2): 219–229.
    CrossRefPubMed
  2. Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012; 14(4): 406–414.
    CrossRefPubMed
  3. Oświecimska J, Ziora K, Pluskiewicz W, et al. Skeletal status and laboratory investigations in adolescent girls with anorexia nervosa. Bone. 2007; 41(1): 103–110.
    CrossRefPubMed
  4. Shepherd S, Kyriakou A, Shaikh MG, et al. Longitudinal changes in bone parameters in young girls with anorexia nervosa. Bone. 2018; 116: 22–27.
    CrossRefPubMed
  5. Huang C, Li S. Association of blood neutrophil lymphocyte ratio in the patients with postmenopausal osteoporosis. Pak J Med Sci. 2016; 32(3): 762–765.
    CrossRefPubMed
  6. Koseoglu SB, Koseoglu SB. Bone loss & platelet-to-lymphocyte ratio. Biomark Med. 2017; 11(1): 5–10.
    CrossRefPubMed
  7. Zupan J, Jeras M, Marc J, et al. Osteoimmunology and the influence of pro-inflammatory cytokines on osteoclasts. Biochem Med (Zagreb). 2013; 23(1): 43–63.
    CrossRefPubMed
  8. Majewski PMa. Osteoimmunologia, czyli o wzajemnych oddziaływaniach komórek układów kostnego i odpornościowego. Kosmos. 2017; 66(317): 665–75.
  9. Ostrowska Z, Ziora K, Oświęcimska J, et al. Selected pro-inflammatory cytokines, bone metabolism, osteoprotegerin, and receptor activator of nuclear factor-kB ligand in girls with anorexia nervosa. Endokrynol Pol. 2015; 66(4): 313–321.
    CrossRefPubMed
  10. Yilmaz H, Uyfun M, Yilmaz TS, et al. Neutrophil-lymphocyte ratio may be superior to C-reactive protein for predicting the occurrence of postmenopausal osteoporosis. Endocr Regul. 2014; 48(1): 25–33.
    CrossRefPubMed
  11. Eroglu S, Karatas G, Eroglu S, et al. Platelet/lymphocyte ratio is an independent predictor for osteoporosis. Saudi Med J. 2019; 40(4): 360–366.
    CrossRefPubMed
  12. Öztürk ZA, Yesil Y, Kuyumcu ME, et al. Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people. Arch Gerontol Geriatr. 2013; 57(1): 81–85.
    CrossRefPubMed
  13. Czerwiec K, Myślińska D, Wądołowska A, et al. Charakterystyka mediatorów zapalenia – rola cytokin prozapalnych. Ann Acad Medicae Gedanensis. 2016; 46(1): 53–8.
  14. Moosazadeh M, Maleki I, Alizadeh-Navaei R, et al. Normal values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio among Iranian population: Results of Tabari cohort. Caspian J Intern Med. 2019; 10(3): 320–325.
    CrossRefPubMed
  15. Valiathan R, Ashman M, Asthana D, et al. Effects of Ageing on the Immune System: Infants to Elderly. Scand J Immunol. 2016; 83(4): 255–266.
    CrossRefPubMed
  16. Bachrach LK, Gordon CM, Bachrach LK, et al. Bone Densitometry in Children and Adolescents. Pediatrics. 2016; 138(4).
    CrossRefPubMed
  17. Crabtree NJ, Arabi A, Bachrach LK, et al. International Society for Clinical Densitometry, International Society for Clinical Densitometry. Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom. 2014; 17(2): 225–242.
    CrossRefPubMed
  18. Gordon CM, Leonard MB, Zemel BS, et al. International Society for Clinical Densitometry, International Society for Clinical Densitometry. 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom. 2014; 17(2): 219–224.
    CrossRefPubMed
  19. Morawiecka-Pietrzak M, Ziora K, Ostrowska Z. Interpretation of bone densitometry and definition of osteoporosis in children and adolescents. Pediatr Pol. 2019; 94(4): 241–247.
    CrossRef
  20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 2013. Diagnostic and Statistical Manual of Mental Disorders (DSM-5 .
  21. Palczewska I, Niedźwiedzka Z. Wskaźniki rozwoju somatycznego u dzieci i młodzieży warszawskiej. Med Wieku Rozw . 2001; 5 (Suppl. 1): 1–112.
  22. Misra M, Klibanski A. Anorexia nervosa and osteoporosis. Rev Endocr Metab Disord. 2006; 7(1-2): 91–99.
    CrossRefPubMed
  23. Mumford J, Kohn M, Briody J, et al. Long-term Outcomes of Adolescent Anorexia Nervosa on Bone. J Adolesc Health. 2019; 64(3): 305–310.
    CrossRefPubMed
  24. Misra M, Klibanski A. Anorexia nervosa and osteoporosis. Rev Endocrine Metab Dis. 2006; 7(1-2): 91–99.
    CrossRef
  25. Ilesanmi-Oyelere BL, Schollum L, Kuhn-Sherlock B, et al. Inflammatory markers and bone health in postmenopausal women: a cross-sectional overview. Immun Ageing. 2019; 16: 15.
    CrossRefPubMed
  26. Lee SH, Ryu SY, Park J, et al. The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Bone Mineral Density in Korean Postmenopausal Women. Chonnam Med J. 2019; 55(3): 150–155.
    CrossRefPubMed
  27. Lacativa PG, Farias ML. Osteoporosis and inflammation. Arq Bras Endocrinol Metabol. 2010; 54(2): 123–132.
    CrossRefPubMed
  28. Misra M, Miller KK, Tsai P, et al. Uncoupling of cardiovascular risk markers in adolescent girls with anorexia nervosa. J Pediatr. 2006; 149(6): 763–769.
    CrossRefPubMed
  29. Dalton B, Campbell IC, Chung R, et al. Inflammatory Markers in Anorexia Nervosa: An Exploratory Study. Nutrients. 2018; 10(11).
    CrossRefPubMed
  30. Dalton B, Bartholdy S, Robinson L, et al. A meta-analysis of cytokine concentrations in eating disorders. J Psychiatr Res. 2018; 103: 252–264.
    CrossRefPubMed
  31. Solmi M, Veronese N, Favaro A, et al. Inflammatory cytokines and anorexia nervosa: A meta-analysis of cross-sectional and longitudinal studies. Psychoneuroendocrinology. 2015; 51: 237–252.
    CrossRefPubMed
  32. Terashima A, Takayanagi H. Overview of Osteoimmunology. Calcif Tissue Int. 2018; 102(5): 503–511.
    CrossRefPubMed
  33. Poubelle PE, Chakravarti A, Fernandes MJ, et al. Differential expression of RANK, RANK-L, and osteoprotegerin by synovial fluid neutrophils from patients with rheumatoid arthritis and by healthy human blood neutrophils. Arthritis Res Ther. 2007; 9(2): R25.
    CrossRefPubMed
  34. Fang H, Zhang H, Wang Z, et al. Systemic immune-inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict the risk of osteoporotic fracture. J Clin Lab Anal. 2020; 34(1): e23016.
    CrossRefPubMed
  35. Phan T, Brailovsky Y, Fareed J, et al. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict All-Cause Mortality in Acute Pulmonary Embolism. Clin Appl Thromb Hemost. 2020; 26: 1076029619900549.
    CrossRefPubMed
  36. Awan MS, Daud MY, Khan M, et al. Usefulness Of Neutrophils To Lymphocytes Ratio For Predicting Troponin-I Elevation In Patients Presenting With Suspected Nste-Acute Coronary Syndrome. J Ayub Med Coll Abbottabad. 2019; 31(Suppl 1)(4): S674–S677.
    PubMed
  37. Gary T, Pichler M, Belaj K, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013; 8(7): e67688.
    CrossRefPubMed
  38. Tamhane UU, Aneja S, Montgomery D, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008; 102(6): 653–657.
    CrossRefPubMed
  39. Fisher A, Srikusalanukul W, Fisher L, et al. The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients. Int J Med Sci. 2016; 13(8): 588–602.
    CrossRefPubMed
  40. Yu Xy, Li Xs, Li Y, et al. Neutrophil-lymphocyte ratio is associated with arterial stiffness in postmenopausal women with osteoporosis. Arch Gerontol Geriatr. 2015; 61(1): 76–80.
    CrossRefPubMed
  41. Chakravarti A, Raquil MA, Tessier P, et al. Surface RANKL of Toll-like receptor 4-stimulated human neutrophils activates osteoclastic bone resorption. Blood. 2009; 114(8): 1633–1644.
    CrossRefPubMed
  42. Riegel A, Maurer T, Prior B, et al. Human polymorphonuclear neutrophils express RANK and are activated by its ligand, RANKL. Eur J Immunol. 2012; 42(4): 975–981.
    CrossRefPubMed
  43. Milos G, Spindler A, Rüegsegger P, et al. Cortical and trabecular bone density and structure in anorexia nervosa. Osteoporos Int. 2005; 16(7): 783–790.
    CrossRefPubMed
  44. Estrada A, Ramnitz MS, Gafni RI. Bone densitometry in children and adolescents. Curr Opin Obstet Gynecol. 2014; 26(5): 339–346.
    CrossRefPubMed
  45. Eroglu S, Karatas G, Aziz V, et al. Evaluation of bone mineral density and its associated factors in postpartum women. Taiwan J Obstet Gynecol. 2019; 58(6): 801–804.
    CrossRefPubMed
  46. Bachta A, Kulig M, Tłustochowicz W. Osteoporoza w przewlekłych zapaleniach stawów. Post Nauk Med. 2012; 3: 218–225.
  47. Spieler W, Schottstedt K, Keitel W, et al. Comparison of bone mineral density and fracture rates in rheumatoid arthritis and psoriatic arthritis. Osteopor Int. 1996; 6(S1): 289–289.
    CrossRef

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