Relationship between high white blood cell count and insulin resistance (HOMA-IR) in Korean children and adolescents: Korean National Health and Nutrition Examination Survey 2008–2010
Introduction
Insulin resistance is a condition characterized by the inability of insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population [1]. Insulin resistance is linked to the development of numerous medical disorders, including type 2 diabetes mellitus, cardiovascular diseases, and certain cancers [2], [3], [4]. Although these diseases are all leading causes of mortality in adults, insulin resistance is also observed in early childhood and it can continue into adulthood [5], [6], [7]. The prevalence of childhood obesity has reached alarming levels and has become epidemic during the past few decades, leading to increased public health concerns regarding children and adolescents with insulin resistance [8], [9], [10]. Thus, early identification of insulin resistance in children and adolescents is significant from a public health perspective. However, there are few standard methods to quantify insulin resistance. Although the homeostasis model assessment of insulin resistance (HOMA-IR) is used for quantifying insulin resistance, it is not routinely measured in clinical practice. Therefore, a simple and more accessible marker for predicting insulin resistance could be useful for early identification of individuals with insulin resistance.
Increasing evidence indicates that insulin resistance is closely associated with chronic subclinical inflammation [11], [12], [13]. Inflammatory markers, such as white blood cell (WBC) count, C-reactive protein (CRP), and interleukin-6, are thought to be independent predictors of cardiovascular disease and type 2 diabetes mellitus in adults [14], [15], [16]. WBC count and CRP have also been associated with cardiometabolic risk factors in children [17], [18], [19]. However, there is limited research that has examined the association between WBC count and insulin resistance, as measured by HOMA-IR, in a general pediatric population. Although a recent study indicated that WBC count is associated with early derangements of glucose metabolism in overweight/obese children, the study focused on only overweight/obese children and did not include a non-obese pediatric population [19]. Therefore, we investigated the association between WBC count and insulin resistance as measured by HOMA-IR in a nationally representative sample of children and adolescents, after controlling for confounding factors including body mass index (BMI) and waist circumference, which has a strong effect on insulin resistance.
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Survey overview and study population
This cross-sectional study used data obtained from the 2008–2010 Korean National Health and Nutrition Examination Survey (KNHANES), which was conducted by the Korea Centers for Disease Control and Prevention [20]. The KNHANES is a nationwide, representative, population-based survey performed to evaluate the health and nutrition status of Koreans. The survey consists of a health interview survey, nutrition survey, and health examination survey. The target population of the survey was
Results
The characteristics of study participants according to sex are shown in Table 1. This study included 1479 boys and 1282 girls. The prevalence of overweight and obesity was 14.0% and 5.9% among boys and 10.8% and 5.6% among girls, respectively.
The characteristics of the study participants according to their sex-specific WBC count quartiles are presented in Table 2. The mean values of most cardiometabolic variables, such as BMI, BMI z-score, waist circumference, TG, insulin, and HOMA-IR, all
Discussion
In this nationally representative cross-sectional study, we found that a high WBC count was positively and independently related to HOMA-IR in Korean children and adolescents, after adjusting for potential confounding variables. These associations were maintained regardless of the effects of obesity, even after controlling for BMI z-score and waist circumference. Gilbert-Diamond et al. reported that WBC count was related to truncal adiposity in Colombian children [18]. In addition, Di Bonito
Conflict of interest statement
The authors have no conflict of interest to declare.
References (32)
- et al.
Insulin resistance is associated with increased risk of major cardiovascular events in patients with preexisting coronary artery disease
Am Heart J
(2007) - et al.
Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study
Metabolism
(1996) - et al.
Childhood obesity: public-health crisis, common sense cure
Lancet
(2002) - et al.
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
(2014) - et al.
Metabolic syndrome and its association with white blood cell count in children and adolescents in Korea: the 2005 Korean National Health and Nutrition Examination Survey
Nutr Metab Cardiovasc Dis
(2010) - et al.
Chronic inflammation is associated with overweight in Colombian school children
Nutr Metab Cardiovasc Dis
(2012) - et al.
White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children
Nutr Metab Cardiovasc Dis
(2016) - et al.
Obesity, inflammation, and insulin resistance
Gastroenterology
(2007) - et al.
Inflammation: the link between insulin resistance, obesity and diabetes
Trends Immunol
(2004) - et al.
IL-6: a regulator of the transition from neutrophil to monocyte recruitment during inflammation
Trends Immunol
(2003)
Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents
Nutr Metab Cardiovasc Dis
Insulin resistance: definition and consequences
Exp Clin Endocrinol Diabetes
Insulin resistance: the fundamental trigger of type 2 diabetes
Diabetes Obes Metab
Insulin resistance and cancer: the role of insulin and IGFs
Endocr Relat Cancer
Influence of insulin resistance and body mass index at age 13 on systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol at age 19
Hypertension
Obesity in adolescence and adulthood and the risk of adult mortality
Epidemiology
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