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

Abstract

Purpose: Anorexia nervosa (AN) is a serious mental illness that is frequently accompanied with a history of childhood maltreatment (CM) which may constitute a speci c ecophenotype of the eating disorder necessitating special assessment and management. Chronic stress in icted by CM in patients with AN may manifest through increased low grade in ammation re ected by an increase in ratios from white blood cells count such as neutrophils to lymphocytes ratio (NLR) platelets to lymphocytes ratio (PLR) and monocytes to lymphocytes ratio (MLR).Methods: N=206 participants were evaluated in an eating disorders daycare unit in Montpellier, France between March 2013 and January 2020. CM was assessed using childhood trauma questionnaire (CTQ). AN clinical severity was assessed using eating disorder examination (EDE-Q). The MINI was used to assess other clinical characteristics.Results: NLR has been found to be higher in patients with AN and a history of CM (p=0.029) as well as in patients with AN and a history of emotional abuse (p=0.021) when compared to patients with AN and without a history of CM. In the multivariate analysis, emotional abuse (β=0.17; p=0.027) contributed signi cantly to NLR's variability.Conclusion: NLR is a low grade in ammation marker that is in uenced by multiple sociodemographic, clinical and biological factors in patients with AN. It is more directly affected by certain subtypes of CM, especially emotional abuse than by the presence or absence of a history of CM. Future studies may focus on mediators between CM and increased in ammation such as interoceptive awareness, emotional dysregulation, food addiction and stress-sensitization.

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

“…In addition, both clinical [44] and pre-clinical [45] research observed increased levels of oxidative stress in patients suffering from this disorder, contributing to the persistence of an over-inflammatory state in these individuals [46]. Finally, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), two well-established markers of low-grade inflammation, have been recently correlated with certain features of AN, such as a history of childhood maltreatment [47] and altered bone mineral density [48].…”

Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study

“…As a reliable and readily available marker of immune response to various infectious and non-infectious stimuli, NLR is widely used across various medical disciplines, such as cancer, atherosclerosis, infection, inflammation, psychiatric disorders, and stress ( 25 , 33 – 37 ). Some studies have also investigated the association between NLR and acute postoperative pain ( 38 , 39 ), but few studies have addressed the role of NLR in CPSP.…”

“…Since the degree and duration of acute postoperative pain are independent risk factors for CPSP ( 4 ), the altered perioperative inflammatory status may influence CPSP by affecting acute postoperative pain. NRL is also associated with perioperative stress status ( 37 ), whereas perioperative stress is an independent risk factor for CPSP ( 44 ); therefore, NRL may interact with stress and affect CPSP. However, further studies are required to explore the underlying mechanisms involved.…”