Neutrophil-to-lymphocyte ratio may predict renal function decline in diabetes

Researchers have found that Neutrophil-to-lymphocyte ratio is a predictor of renal dysfunction in diabetes patients.The study has been published in Diabetes Metabolic Syndrome: Clinical Research & Reviews. 

Inflammation play an important role in the pathogenesis of diabetic kidney disease.Neutrophil-to-lymphocyte ratio has been evaluated as a biomarker of inflammation and has been widely evaluated as a biomarker in various medical and surgical prognoses.However its usefulness in diabetic kidney disease is not yet known.

The researchers conducted a prospective observational study that included outpatients, comprising of 184 men aged 73 ± 11 (mean ± standard deviation) years and 174 women aged 76 ± 10 years at baseline, from a rural hospital. They examined the relationship between baseline NLR calculated by analyzing the differential leukocyte counts in the complete blood count and the 2-year estimated glomerular filtration rate (eGFR) decline rate (i.e. 2-year eGFR-baseline eGFR) ∗100/baseline eGFR. Rapid eGFR decline rate was defined as a value < -25%.

The researchers found that NLR (β = 0.138, p = 0.007) as well as presence of antidyslipidemic medication, hemoglobinA1c, and urinary albumin excretion stage were significantly and independently associated with a rapid eGFR decline rate.The multiple linear regression analysis using rapid eGFR decline rates as objective variables were adjusted for confounding factors as explanatory variables. 

The multivariate-adjusted odds ratios (95% confidence interval) of the 2nd and 3rd tertiles of baseline NLR for rapid eGFR decline rate were 3.62 (0.70-18.7) and 8.03 (1.54-41.9), respectively. 

Multivariate-adjusted mean eGFR (95% confidence interval) values after 2 years categorized by tertile of baseline NLR were: 1st, 63.9 (61.8-66.1); 2nd, 60.8 (58.7-62.9); and 3rd, 58.9 (56.8-61.0).
The researchers concluded that these results suggest that baseline Neutrophil-to-lymphocyte ratio might be a useful biomarker for renal function decline in outpatients with type 2 diabetes. This biomarker may help evaluate renal function in diabetics.

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Depression, anxiety may lead to heart disease, arthritis

According to a recent study, anxiety and depression may be the leading predictors of conditions including heart disease, high blood pressure, arthritis, headaches, back pain, stomach ache. Anxiety and depression may have similar effects as long-established risk factors like smoking and obesity, the new research suggests.

Typically, an annual physical check-up involves a weight check and questions about unhealthy habits like smoking, but this study  suggests health care providers may be overlooking a critical question- Are you depressed or anxious?

In the study, authors looked at the health data of more than 15,000 older adults over a four-year period.

The authors evaluated health data from a government study of 15,418 retirees, whose average age was 68. Depression and anxiety symptoms were assessed using data from participant interviews. Participants were questioned about their current smoking status, while weight was self-reported or measured during in-person visits. Medical diagnoses and somatic symptoms were reported by participants.

They found that 16 percent (2,225) suffered from high levels of anxiety and depression, 31 percent (4,737) were obese and 14 percent (2,125) were current smokers.

Participants with high levels of anxiety and depression were found to face 65 percent increased odds for a heart condition, 64 percent for stroke, 50 percent for high blood pressure and 87 percent for arthritis, compared to those without anxiety and depression.

"These increased odds are similar to those of participants who are smokers or are obese. However, for arthritis, high anxiety and depression seem to confer higher risks than smoking and obesity," said the author. Unlike the other conditions investigated, the authors found that high levels of depression and anxiety were not associated with cancer incidence.

"Our findings are in line with a lot of other studies showing that psychological distress is not a strong predictor of many types of cancer. On top of highlighting that mental health matters for a whole host of medical illnesses, it is important that we promote these null findings. We need to stop attributing cancer diagnoses to histories of stress, depression and anxiety," he added.

The authors discovered that symptoms such as a headache, stomach upset, back pain and shortness of breath increased exponentially in association with high stress and depression. Odds for a headache, for example, were 161 per cent higher in this group, compared with no increase among the participants who were obese and smokers.

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Social isolation increases death risk

Findings of a recent study have linked social isolation to a higher risk of death. The study, says addressing social isolation holds promise if studies show interventions are effective, as they could be relatively simple and could influence other risk factors, as social isolation is also associated with hypertension, inflammation, physical inactivity, smoking, and other health risks.

Social isolation has been linked to higher mortality in studies comprising mostly white adults, yet associations among black adults are unclear. The new prospective cohort study, evaluated whether associations of social isolation with all-cause, cardiovascular disease and cancer mortality differed by race and sex.

Investigators weighted several standard components of social isolation -marital status, the frequency of religious service attendance and club meetings/group activities, and a number of close friends/relatives--giving a score of 0 (least isolated) or 1 (most isolated) on each of the factors for a total on a 5-point isolation scale.
For instance, someone who was married, frequently attended religious services, attended club meetings and/or group activities, and had seven or more close friends were given an isolation score of 0. Someone with none of those would have an isolation score of 4.
They found overall, the race seemed to be a stronger predictor of social isolation than sex; white men and white women were more likely to be in the least isolated category than black men and women. In the full sample, a statistically significant, positive dose-response relationship was found between social isolation and all-cause mortality risk over the 30-year follow-up period. However, associations were significantly stronger in the first 15 years of follow up.

Social isolation score was positively associated with heart disease (CVD) mortality in all subgroups. Although there was a positive association between social isolation score and cancer mortality among white men and white women, there was no association between social isolation score and cancer mortality among black men or black women. Each social isolation component was associated with all-cause and CVD mortality, and all but one (having fewer close friends/relatives) was associated with cancer mortality.

"Current findings indicate that a composite measure of social isolation is a robust predictor of mortality risk among men, women, blacks, and whites," write the authors. "Compared with the least isolated, the most socially isolated black men and women had a more than the 2-fold higher risk of death from any cause, and white men and women had 60 per cent and 84 per cent greater risks of death, respectfully."

The authors say as the era of precision medicine develops, several influences on health, including social factors, are expected to become more important to clinical care. Addressing social isolation is aligned with this more holistic approach, they write, saying: "Lack of interpersonal connections seems particularly detrimental." 

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