title: Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin Chronic Low-Grade Systemic Inflammation and Health cohort study.
abstract: OBJECTIVE
  It is widely known that inflammation is related to type 2 diabetes (T2D), but few studies have shown a direct relationship between the immune system and T2D using a reliable biomarker. Neutrophil:lymphocyte ratio (NLR) is an easy-to-analyze inflammation biomarker, but few studies have assessed the relationship between NLR and T2D. In order to evaluate how NLR is related to T2D, we designed a large-scale cross-sectional and prospective cohort study in an adult population.
  
  
  METHODS
  Participants were recruited from the Tianjin Medical University General Hospital-Health Management Centre. Both a baseline cross-sectional (n=87,686) and a prospective (n=38,074) assessment were performed. Participants without a history of T2D were followed up for ∼ 6 years (with a median follow-up of 2.7 years). Adjusted logistic and Cox proportional hazards regression models were used to assess relationships between the quintiles of NLR and T2D (covariates: age, sex, BMI, smoking status, drinking status, hypertension, hyperlipidemia, and family history of cardiovascular disease, hypertension, hyperlipidemia, or diabetes).
  
  
  RESULTS
  The prevalence and incidence of T2D were 4.9% and 6.8/1000 person-years respectively. The adjusted odds ratio and hazard ratio (95% CI) of the highest NLR quintile were 1.34 (1.21, 1.49) and 1.39 (1.09, 1.78) (both P for trend <0.01) respectively as compared to the lowest quintile of NLR. Leukocyte, neutrophil, and lymphocyte counts do not significantly predict the eventual development of T2D.
  
  
  CONCLUSIONS
  The present study demonstrates that NLR is related to the prevalence and incidence of T2D, and it suggests that NLR may be an efficient and accurate prognostic biomarker for T2D.
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Guo
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Wu
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Huanmin
authors.initials: H
authors.lastname: Du
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Shi
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Chongjin
authors.initials: C
authors.lastname: Wang
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Liu
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Chunlei
authors.initials: C
authors.lastname: Li
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Shaomei
authors.initials: S
authors.lastname: Sun
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Wang
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Guowei
authors.initials: G
authors.lastname: Huang
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Qiyu
authors.initials: Q
authors.lastname: Jia
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Honglin
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Song
authors.affiliation: Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China niukaijun@tmu.edu.cn nkj0809@gmail.com.
authors.forename: Kaijun
authors.initials: K
authors.lastname: Niu
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D009504:Neutrophils / Q000378:metabolism*; D011159:Population Surveillance; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology