Synergistic Effect of Low Neutrophil–Lymphocyte Ratio With Physical Activity on Quality of Life in Type 2 Diabetes Mellitus: A Community-Based Study

Abstract

Background: Physical inactivity and Type 2 diabetes mellitus (T2DM)–associated inflammatory biomarkers are correlated with poor quality of life (QoL). However, no study has investigated the synergistic effect of physical activity (PA) and lower neutrophil–lymphocyte ratio (NLR) on QoL. Objective: We examined the independent and synergistic effects of PA and inflammatory biomarkers on three domains of QoL in T2DM. Methods: This cross-sectional study included 294 patients with T2DM from community clinics in Indonesia. The 36-item Short Form Survey and a questionnaire about PA engagement were used to measure QoL and metabolic equivalent of task (MET)-hr/week, respectively. Inflammatory biomarkers were measured in fasting blood. Adjusted coefficients β and 95% confidence interval (CI) were estimated using multiple linear regression. The synergistic effect was analyzed using additive interaction for linear regression. Results: Patients with PA ≥ 7.5 MET-hr/week exhibited significantly higher total QoL (β = 8.41, 95% CI = [6.04, 10.78]) and physical component score (PCS; β = 13.90, 95% CI = [10.52, 17.29]) than those with PA < 7.5 MET-hr/week. Patients with NLR < 1.940 had significantly higher total QoL (β = 4.76, 95% CI = [3.41, 6.11]), mental component score (MCS; β = 2.62, 95% CI = [0.75, 4.49]), and PCS (β = 6.89, 95% CI = [4.97, 8.82]) than patients with NLR ≥ 1.940. PA ≥ 7.5 MET-hr/week and NLR < 1.940 exhibited a synergistic effect on total QoL, MCS, and PCS. Conclusions: High PA level and low NLR had a positive synergistic effect on QoL among patients with T2DM.

Synergistic Effects of Regular Walking and Alkaline Electrolyzed Water on Decreasing Inflammation and Oxidative Stress, and Increasing Quality of Life in Individuals with Type 2 Diabetes: A Community Based Randomized Controlled Trial

“…The 36-Item Short Form Survey (SF-36) is one of the most widely used instruments to measure self-reported QoL [ 35 ]. In addition, the SF-36 is widely used in diabetes research [ 5 , 35 ]. The Indonesian-translated version of the SF-36 questionnaire had a test–retest reliability of r = 0.626–1 and had good internal consistency, with a Cronbach’s alpha of 0.789 [ 36 ].…”

“…In particular, this threat is also present in Indonesia, where the prevalence of diabetes is expected to rise from 10.7 million to 16.6 million from 2019 and 2045 [ 4 ]. Consequently, these conditions may impair the quality of life (QoL) [ 5 ]. Therefore, identifying the formation of oxidative stress and inflammatory markers, and their roles in behavioral factors, is necessary for a better understanding of their effects on the QoL.…”

“…Further, a previous study showed that treatment with 2 L/day of AEW for patients receiving radiotherapy for liver tumors improved QoL within 6 weeks [ 28 ]. Moreover, lower levels of inflammation markers, such as NLR and WBCs, were positively associated with higher QoL [ 5 ]. Similarly, the amelioration of chronic inflammation is a potentially novel biobehavioral therapeutic strategy for improving QoL [ 10 ].…”

Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study

“…Physical activity level was ascertained by estimating MET-h/week for the most recent 12 months [ 19 ]. The metabolic equivalent of task (MET) is a unit used to measure caloric expenditure.…”

“…Moreover, physical activity of <7.5 MET-hr/week is a potentially vital factor for increasing high NLR and decreasing the quality of life in patients with T2DM. These conditions can trigger out of control hyperglycemia and contribute to deteriorating the process of T2DM [ 19 ]. We hypothesize that inactivity and/or a low volume of physical activity could be predominant risk factors for developing T2DM among Indonesians.…”