Clinical and Peripheral Biomarkers in Female Patients Affected by Anorexia: Does the Neutrophil/Lymphocyte Ratio (NLR) Affect Severity?

Caldiroli, Alice; Tegola, Davide La; Affaticati, Letizia Maria; Manzo, Francesca; Cella, Francesca; Scalia, A.; Capuzzi, Enrico; Nicastro, Monica; Colmegna, Fabrizia; Buoli, Massimiliano; Clerici, Massimo; Dakanalis, Antonios

doi:10.3390/nu15051133

Cited by 7 publications

(7 citation statements)

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“…Therefore, also sexual dimorphism in lipid metabolism must be considered and could explain the link among adipose tissue, aging, and chronic inflammation. Alternatively, starvation, malnutrition, as well as single nutrient deficiencies, may modify the balance between adaptive and innate immunity, probably as a consequence of bone marrow failure [ 60 ]. Moreover, intermitting fasting and/or caloric restriction response is gender-specific [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study.

Pellegrino,

Paganelli,

Iorio

et al. 2023

Preprint

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Background Neutrophils and lymphocytes represent the larger percentage of all white bloodcells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of severalclinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years’ follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value=0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.

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Section: Discussionmentioning

confidence: 99%

Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study.

Pellegrino,

Paganelli,

Iorio

et al. 2023

Preprint

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“…Among micronutrients, only selenium, vitamin B12, and folic acid have been investigated as putative indicators of AN severity. Specifically, plasma levels of vitamin B12 and folate seem to increase proportionally with the degree of severity [11,17], while selenium deficiency might characterize subjects with more severe AN [10]. Interestingly, a recent study reported higher cholesterol levels in subjects with a more critical course of the disorder [18].…”

Section: Introductionmentioning

confidence: 97%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, white matter abnormalities seem to characterize the early stages of the disorder [28], while BMI was proposed as a clinical marker differentiating peak-onset versus late-onset AN [29]. In addition, substance use disorders appear to be more prevalent in patients with a lower BMI [17] and have been associated with severity of depressive symptoms [30] as well as higher mortality [31].…”

Section: Introductionmentioning

confidence: 99%

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

Affaticati,

Buoli,

Vaccaro

et al. 2023

Nutrients

Self Cite

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Severe forms of Anorexia Nervosa (AN) are characterized by medical complications, psychiatric comorbidity, and high mortality. This study investigated potential associations between clinical/biological factors and the severity of AN, measured by the Body Mass Index (BMI). Red and white blood cells, hemoglobin, platelets, iron, vitamins D and B12, folate, and total cholesterol were measured in a mixed sample of 78 inpatients and outpatients. Linear regressions and one-way analyses of variance (ANOVAs) were carried out to evaluate the relationship between BMI and clinical/biochemical variables. BMI was significantly lower in hospitalized patients (F = 4.662; p = 0.034) and in those under pharmacological treatment (F = 5.733; p = 0.019) or poly-therapy (F = 5.635; p = 0.021). Higher vitamin B12 (β = −0.556, p < 0.001), total cholesterol (β = −0.320, p = 0.027), and later age at onset (with a trend towards significance) (β = −0.376, p = 0.058) were associated with a lower BMI. Increased total cholesterol and vitamin B12, later age at onset, current pharmacological treatment, and poly-therapy might be distinctive in patients with a lower BMI. In clinical practice, these findings may contribute to the early identification of AN patients at higher risk of developing complicated or chronic forms of the disorder. Further studies on larger samples are needed to identify potential predictive factors of AN severity in the framework of precision medicine.

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“…Phagocytic function, complement system, cytokine production, mucous secretory antibody response, antibody affinity, and mediated cell immunity have been identified as potential significant alterations [ 12 ]. Therefore, it is intuitive that dysregulation of the immune system and the increased risk of infection are potentially associated with chronic AN [ 13 ]. Several blood alterations, including leukopenia, polycythemia, and thrombocytopenia, have also been found in young male patients with AN [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Association between Blood SIRT1 and Ghrelin, Leptin, and Antibody Anti-Hypothalamus: A Comparison in Normal Weight and Anorexia Nervosa

Amerio

Escelsior

Martino

et al. 2023

JPM

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Sirtuin 1 (SIRT1) is a sensor of cell energy availability, regulating metabolic homeostasis as well as leptin and ghrelin, and it could be considered as a potential plasmatic marker. The aim of this study was to assess whether circulating SIRT1 varies consistently with leptin, ghrelin, body mass index (BMI), and IgG reactive to hypothalamic antigens in anorexia nervosa (AN). Fifty-four subjects were evaluated: 32 with AN and 22 normal-weight control subjects. Serum levels of SIRT1, leptin, ghrelin, and IgG reactive to hypothalamic antigens were evaluated by ELISA. Results showed that serum SIRT1 is increased in patients with AN, and the amount is decreased in relation to the duration of the illness. SIRT1 concentration approaches the values obtained for the control group, although the difference is still statistically significant. A negative correlation between serum SIRT1 values and leptin or BMI values has been found. On the contrary, a positive correlation between SIRT1 and ghrelin or IgG specific for hypothalamic antigens is reported. These findings suggest that a peripheral evaluation of SIRT1 could be a possible clinical/biochemical parameter related to AN. In addition, we can assume that SIRT1 is related to autoantibody production and may correlate with the intensity/severity of AN. Thus, reducing the production of autoantibodies specific for hypothalamic cells could be a sign of improvement of the clinical condition.

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Clinical and Peripheral Biomarkers in Female Patients Affected by Anorexia: Does the Neutrophil/Lymphocyte Ratio (NLR) Affect Severity?

Cited by 7 publications

References 81 publications

Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study.

Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study.

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

The Association between Blood SIRT1 and Ghrelin, Leptin, and Antibody Anti-Hypothalamus: A Comparison in Normal Weight and Anorexia Nervosa

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