The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Abstract

Introduction: Inflammation is supposed to be one of the factors contributing to decreased bone mineral density (BMD) in anorexia nervosa (AN). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and cost-effective inflammatory markers, well documented as indicators of postmenopausal osteoporosis. This study aimed to assess the relationships between these ratios and BMD in girls with AN. Material and methods:The electronic records of 73 girls hospitalized for AN were analysed retrospectively. The age range of the study group was 12.56-17.67 years. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and expressed as Z-scores according to lumbar spine (s-BMD) and total body (TB-BMD) sites. NLR and PLR were calculated according to complete blood count results. Patients were divided into 2 subgroups with parallel analysesaccording to the TB-BMD criterion and the s-BMD criterion: normal (Z-score > -2.0, n = 63) and low s-BMD subgroup (Z-score ≤ -2.0, n = 10), and normal (Z-score > -2.0, n = 45) and low TB-BMD subgroup (Z-score ≤ -2.0, n = 28).Results: In the low s-BMD subgroup a tendency to an increase of mean NLR, PLR, and WBC values was observed. Respective BMD Z-score values correlated significantly and negatively with PLR in the low s-BMD (R = -0.892, p < 0.001) and normal TB-BMD (R = -0.451, p = 0.002) subgroups, while with NLR only in the normal TB-BMD subgroup (R = -0.685, p < 0.001). In the low s-BMD subgroup the PLR was shown to be a significant and independent predictor of s-BMD (β = -0.881, p < 0.001). The PLR contributed to 77.6% of the s-BMD Z-score variability (R 2 = 0.776, p < 0.001). In the normal TB-BMD subgroup, the PLR and NLR levels were significant and independent predictors of TB-BMD (β = -0.352, p = 0.004; β = -0.450, p = 0.001; β = -0.339, p = 0.005, respectively) and explained 44.4% of TB-BMD Z-score variability (R 2 = 0.444, p < 0.001). Conclusions:These results indicate that there might be a relationship between bone mass loss and inflammation expressed as NLR and PLR in adolescent girls suffering from AN. These connections seem to be dependent on the examined skeletal area. NLR and PLR, which are common indicators of morbidity and mortality in many malignancies and inflammatory chronic diseases, can also be useful in the evaluation of bone condition in adolescent females with AN. However, there is a need for further investigation in this field.

The relationship between chemerin, bone metabolism, the RANKL/RANK/OPG system, and bone mineral density in girls with anorexia nervosa

“…Baseline low s-and TB-BMD Zscores were observed in 12/75 (16.0%) and 28/75 (37.3%) of the patients, respectively. Similar results were observed in our earlier research [34]. Moreover, nutritional indices, OC, and the OPG/sRANKL ratio were lower while the duration of the disease was longer in low sand TB-BMD.…”

“…Consequently, it may contribute to loss of bone mass. It should also be emphasized that the presented results confirm our earlier observation [34] that BMD differs depending on the examined skeletal area in adolescent girls with AN. Cortical bone is more severely affected than trabecular bone.…”

“…nuclear factor-kB ligand/receptor activator of the nuclear factor-kB/osteoprotegerin (RANKL/RANK/OPG) system might play an important role in the regulation of bone metabolism [18,19,[22][23][24][25][26][27]. Both cortical and trabecular bone sites become affected in girls with AN [28][29][30][31][32][33][34]. However, the results regarding each of these compartments are not always unequivocal.…”

The Impact of Clinical Factors, Vitamin B12 and Total Cholesterol on Severity of Anorexia Nervosa: A Multicentric Cross-Sectional Study

“…Among the various hematological and immunological abnormalities documented in AN [19][20][21][22], bone marrow degeneration has been linked to the severity of weight loss [23], while concentrations of the chemokine CCL11 seem to be inversely related to Body Mass Index (BMI) [24]. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) showed significant correlations with lower BMI [17] and alterations in bone mineral density [25]. Changes in bone mineral density have also been associated with leptin and adiponectin levels [26].…”

Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study

“…However, it is still unclear whether the witnessed disturbances in peripheral white blood cells is related to a primary immunological predisposition in patients with AN or to a non speci c end result due to malnutrition [28]. To date, the only study evaluating NLR in patients with AN has demonstrated that it is inversely correlated to bone mineral density due to in ammation's effect on bone mineralization in adolescent girls [29]. To our knowledge, there is no study that assesses the impact of CM on the immune system of patients with AN as re ected by the NLR.…”