# The Relationship Between Insulin Resistance Neutrophil to Lymphocyte Ratio

**Authors:** Alicia Shin  
**arXiv:** [2205.08308](https://arxiv.org/abs/2205.08308)  
**Date:** 2022-05-13  
**Summary page:** https://www.summarizepaper.com/en/paper/2205.08308v2/

## Key points

- Chronic inflammation is linked to various diseases
- High neutrophil-to-lymphocyte ratio (NLR) is a marker of chronic inflammation and associated with increased mortality and morbidity risk
- Insulin resistance (IR) has been suggested as a potential associate factor in preclinical studies
- Epidemiological studies investigating the association between NLR and IR are scarce and have only included diabetes mellitus patients rather than the general population
- This study aimed to determine if there is a direct correlation between NLR and IR in the US general population
- The sample for this study consisted of 3,307 individuals from the general population provided by the National Health and Nutrition Examination Survey (NHANES)
- Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) value was calculated to evaluate insulin resistance, and the relationship between NLR and HOMA-IR values was investigated through bivariate and multivariate linear regression analyses
- After exclusions based on fasting glucose levels exceeding 140 mg/dL, white blood cell counts over 10,000 WBCs in collected blood samples, or NLR over 9 which could be possible outliers due to abnormal figures, 3,375 samples remained.
- There is no visible relationship between IR and NLR in the general population; IR might not explain the variation of NLR value in healthy people.
- Further studies are needed to reveal associated factors for high NLR values.
- The NHANES data source provided a representative sample of the US population; exclusions based on abnormal figures ensured accurate analysis; however limitations include potential confounding variables not accounted for in this study as well as lack of longitudinal data to establish causality between NLR and IR.

## Summary

Chronic inflammation is increasingly recognized as a contributing factor to the pathogenesis of various diseases, and one of its markers, high neutrophil-to-lymphocyte ratio (NLR), has been associated with increased mortality and morbidity risk. Insulin resistance (IR) has been suggested as a potential associate factor in preclinical studies, but epidemiological studies investigating the association between NLR and IR are scarce and have only included diabetes mellitus patients rather than the general population. This study aimed to determine if there is a direct correlation between NLR and IR in the US general population. The sample for this study consisted of 3,307 individuals from the general population provided by the National Health and Nutrition Examination Survey (NHANES). Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) value was calculated to evaluate insulin resistance, and the relationship between NLR and HOMA-IR values was investigated through bivariate and multivariate linear regression analyses. As insulin use could result in inaccurate HOMA-IR estimation, subgroup analyses were conducted after excluding insulin users. After exclusions based on fasting glucose levels exceeding 140 mg/dL, white blood cell counts over 10,000 WBCs in collected blood samples, or NLR over 9 which could be possible outliers due to abnormal figures, 3,375 samples remained. During analysis an additional 68 insulin users were removed as they could be a confounding variable due to their unsteady insulin concentration in blood depending on when they receive treatment. The results showed that there was a relationship between NLR and IR when insulin users were included in the analysis with a beta coefficient value of 0.010 (95% confidence interval [CI] of 0.003-0.017). However, when insulin users were excluded from the analysis due to their potential confounding effect on HOMA-IR estimation, the beta value decreased to 0.004 (95% CI of -0.006-0.015). The statistical significance was not reached when age, sex, and body mass index were adjusted for in the multivariate analyses. In conclusion, there is no visible relationship between IR and NLR in the general population; IR might not explain the variation of NLR value in healthy people, and further studies are needed to reveal associated factors for high NLR values. The NHANES data source provided a representative sample of the US population; exclusions based on abnormal figures ensured accurate analysis; however limitations include potential confounding variables not accounted for in this study as well as lack of longitudinal data to establish causality between NLR and IR.