The Association between Neutrophil-to-Lymphocyte Ratio and Diabetic Depression in U.S. Adults with Diabetes: Findings from the 2009-2016 National Health and Nutrition Examination Survey (NHANES)

Abstract

Objective. To determine the association between neutrophil-to-lymphocyte ratio (NLR) and clinically relevant depressive symptoms in people with diabetes. Methods. This cross-sectional study was conducted among adults (age >18) with diabetes in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016. NLR was calculated from complete blood count. Nine-item Patient Health Questionnaire (PHQ-9) was used to measure depression, with scores ≥10 indicating the presence of clinically relevant symptoms. Multivariable logistic regression was used to calculate the odds ratio (OR) with 95% confidence interval (CI) of clinically relevant depressive symptoms in relation to the NLR. We performed the smooth curve fitting and established a weighted generalized additive model to identify the nonlinearity of NLR and depression in diabetes patients. To account for the nonlinear relationship between NLR and depression in diabetes patients, weighted two-piecewise linear model was applied. Results. We included 2,820 eligible participants, of which 371 (12.4%) had clinically relevant depressive symptoms. In the unadjusted model, the OR (95% CI) of clinically relevant depressive symptoms for the second (NLR 1.75-2.57) and third (NLR >2.57) were 1.24 (0.90, 1.70) and 1.68 (1.23, 2.30), respectively, compared to the reference group ( NLR < 1.75 ). After controlling for potential confounding factors, NLR was significantly associated with clinically relevant symptoms ( odds ratio = 1.57 , 95% confidence interval: 1.13–1.87; P for trend = .0078). Nonlinear relationships were observed, and a two-piecewise linear regression model was established. The inflection point of NLR was 2.87. To the left of the inflection point ( NLR ≤ 2.87 ), the OR (95% CIs) was 1.33 (1.07–1.66) ( P < .031 ). Conclusions. Elevated levels of NLR are independently associated with increased odds of clinically relevant depressive symptoms in people with diabetes. Prospective study is needed to further analyze the role of NLR in depression in diabetic patients.

The Platelet–Lymphocyte Ratio Associated with Depression in Diabetes Patients in the US National Health and Nutrition Examination Survey

“…In addition, the association between neutrophil to lymphocyte ratio (NLR) and depression in DM patients has been already discussed in previous studies. 38 We also found a nonlinear relationship between NLR and depression in DM. Even though using NLR and PLR independently can be helpful to predict depression, combination of both is plausible.…”

Association Between the Children's Dietary Inflammatory Index (C-DII) and Markers of Inflammation and Oxidative Stress Among Children and Adolescents: NHANES 2015-2018

“…Outcome variables consisted of markers of inflammation and oxidative stress, including ferritin (measured with the Roche Elecsys-17 immunoassay), lymphocyte count (evaluated using automated hematology analyzing devices) ( 25 ), absolute neutrophil count (determined using the Beckman Coulter MAXM upon receipt of samples of MECs, as described on the NHANES website) ( 26 ), hsCRP [SYNCHRON System(s) High Sensitivity C-Reactive Protein reagent was based on the highly sensitive Near-Infrared Particle Immunoassay rate methodology], and albumin (the DcX800 bichromatic digital endpoint method), serum iron (the DcX800 timed-endpoint method), ALP [a simple reaction wherein ALP acts upon a substrate (p-nitrophenol phosphate, or PNPP) in the presence of magnesium and zinc activators to form a colored product (p-nitrophenol), whose appearance was measured at 450 nm], and bilirubin (coupling with 3,5-chlorophenyl diazonium in the presence of a solubilizing agent in a strongly acidic medium to produce azobilirubin). The latter three variables are also markers of liver disease.…”

Association between Plasma Homocysteine Concentrations and the First Ischemic Stroke in Hypertensive Patients with Obstructive Sleep Apnea: A 7-Year Retrospective Cohort Study from China

“…Moreover, we calculated the cumulative IS incidence function of events over time using the Kaplan-Meier method. Further, we simulated the dose-response correlation between plasma Hcy concentration and IS risk using a generalized additive model, fitted the model with a recursive algorithm using maximum likelihood, and calculated the inflection points for the nonlinear correlation [ 31 ]. Considering that association between plasma Hcy concentrations and IS may differ in some populations, we performed exploratory stratified analysis by using a Cox proportional hazards model for some subgroups and used likelihood ratio tests to check for hierarchical differences to determine if there was an interaction.…”