Associations between CT-determined visceral fat burden, hepatic steatosis, circulating white blood cell counts and neutrophil-to-lymphocyte ratio

Abstract

Visceral adiposity is associated with cardiovascular disease, an association that may be mediated in part by inflammation. We hypothesized that regional measures of visceral adiposity would associate with commonly obtained clinical measures of immune status. We consecutively studied 3,291 subjects (mean age, 49.8±9.8 years) who underwent an annual cardiovascular risk survey. Peri-cardial (PCF) and thoracic peri-aortic adipose tissue (TAT) volumes were determined by dedicated computed tomography (CT) software (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). Hepatic steatosis was assessed by abdominal ultrasonography. We explored cross-sectional associations between visceral fat measures and high-sensitivity C-reactive protein (hs-CRP), leukocyte counts, and the neutrophil-to-lymphocyte ration (NLR). Among 3,291 study participants, we observed positive linear associations between PCF and TAT, higher degree of hepatic steatosis and hs-CRP, various leukocyte counts, either total and its differential counts, and NLR (all trend p<0.001). Multi-variate linear and logistic regression models showed independent associations between PCF/TAT (ß-Coef: 0.14/0.16, both p<0.05) and total WBC counts, with only TAT further demonstrated significant relations with neutrophil counts and NLR (both p<0.05) and independently identified abnormally high WBC and NLR (Odds ratio: 1.18 & 1.21, both p<0.05). C-statistics showed significant incremental model prediction for abnormally high WBC and NLR (both ΔAUROC<0.05) when TAT was superimposed on traditional cardiovascular risks and biochemical information. Greater visceral adiposity burden and hepatic steatosis may be associated with higher circulating leukocyte counts and markers for atherosclerosis, with more pronounced influences for peri-aortic adiposity. Our data suggested the differential biological impacts for region-specific visceral adiposity.

Pericardial fat, thoracic peri-aortic adipose tissue, and systemic inflammatory marker in nonalcoholic fatty liver and abdominal obesity phenotype

“…MDCT, which can be used to measure EAT and TAT, provides reliable and robust modality for assessing the visceral abdominal fat, accurately and non-invasively 4 , 9 , 25 . Prior work suggests that EAT and TAT contribute to systemic inflammation and play an independent role in the pathogenesis of atherosclerosis and left ventricular (LV) structure or functional deterioration, especially strongly correlated with EAT, coronary calcium deposit, and LV remodeling 5 , 6 , 10 , 12 , 26 – 30 . In past decades, CAC assessment performed using MDCT has been well accepted clinically in preventive medicine for risk stratification in asymptomatic subjects 31 , 32 .…”

“…Over-production of various systemic inflammatory mediators by excessive adipose tissue that leads to a variety of metabolic disorders 1 , 2 . Previous studies mentioned that two volume-based measures of region-specific visceral adipose tissue, epicardial fat (EAT) including adipose tissue inside pericardium and along myocardium as well as thoracic peri-aortic adipose tissue (TAT) including adipose tissue confined in the area along the margin of thoracic vertebral body, and surrounding thoracic descending aorta—have been shown to correlate with metabolic risk factors and atherosclerosis 3 , 4 , which are independently associated systemic inflammatory markers such as hs-CRP 5 , 6 .…”

Both epicardial and peri-aortic adipose tissue blunt heart rate recovery beyond body fat mass

“…Thoracic PAF was defined as the adipose tissue surrounding the thoracic aorta, which extended 67.5 mm from the level of the bifurcation of pulmonary arteries ( Figures 1C,D ) with cranial-caudal coverage of the thoracic aorta. Detailed methods conducted in our laboratory for similar measures have been published elsewhere ( 5 , 17 , 18 ).…”

The Association of Nonalcoholic Fatty Liver Disease With Neutrophil-to-Lymphocyte Ratio and Neutrophil-Percentage-to-Albumin Ratio

“…Even though cytokines are only rarely tested in routine practice, the total white blood cell count and its different subtypes might indicate the presence of an inflammatory condition [11]. The neutrophil-to-lymphocyte ratio (NLR) in particular has been suggested as an indicator of the risk for an inflammatory state in metabolic syndrome, cancer, and cardiovascular diseases [12][13][14][15]. Additionally, the neutrophil-percentage-to-albumin ratio (NPAR) is a useful biomarker that assesses systemic inflammation in a manner similar to the one described above by utilizing neutrophil percentage and albumin levels.…”

“…Recent studies have shown a significant association between the presence of NAFLD and higher levels of NLR and NPAR. These findings suggest that these biomarker levels have the potential to be useful in predicting the progression of this disease [ 12 , 16 , 17 ]. Hence, the aim of this study is to assess the association between the occurrence of NAFLD and NPAR as well as NLR.…”