title: Serum total bilirubin concentrations are inversely associated with total white blood cell counts in an adult population.
abstract: BACKGROUND
  Several studies have shown that serum bilirubin has a protective effect against cardiovascular disease and that inflammation plays an important role in its pathogenesis. This cross-sectional study investigated whether there was an association between blood total white blood cell count, a simple indicator of inflammation, and serum total bilirubin concentration in a cohort of an adult population in Taiwan.
  
  
  METHODS
  A total of 2458 apparently healthy adults (1246 men and 1212 women) who attended health examination at a medical centre in central Taiwan were enrolled. We collected anthropometric measurements, fasting blood test results, lifestyle habits and medical history.
  
  
  RESULTS
  Total white blood cell counts decreased progressively when the concentrations of total bilirubin increased as demonstrated in the total bilirubin quartiles. Both total bilirubin concentrations and total white blood cell counts showed significant correlations with the components of metabolic syndrome, including triglyceride and high-density lipoprotein cholesterol concentrations. Multivariate linear regression analysis revealed that, for both genders, total bilirubin showed an independent negative correlation with total white blood cell count after adjusting for conventional cardiovascular risk factors.
  
  
  CONCLUSIONS
  Higher serum total bilirubin concentrations within the reference range were associated with lower blood total white blood cell counts, regardless of other classical cardiovascular risk factors.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
authors.forename: Wan-Ni
authors.initials: WN
authors.lastname: Tsai
authors.affiliation: Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Ya-Yu
authors.initials: YY
authors.lastname: Wang
authors.affiliation: Division of Biochemistry, Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Jiin-Tsae
authors.initials: JT
authors.lastname: Liang
authors.affiliation: School of Medicine, National Yang Ming University, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: School of Medicine, National Yang Ming University, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wayne Huey-Herng
authors.initials: WH
authors.lastname: Sheu
authors.affiliation: Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan wdchang@vghtc.gov.tw.
authors.forename: Wen-Dau
authors.initials: WD
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes / Q000276:immunology*; D008297:Male; D008403:Mass Screening; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Bilirubin; cardiovascular disease; inflammation; white blood cell count