Yonsei Med J.  2013 May;54(3):615-620. 10.3349/ymj.2013.54.3.615.

The Risk of Metabolic Syndrome According to the White Blood Cell Count in Apparently Healthy Korean Adults

• Jung CH
• Lee WY
• Kim BY
• Park SE
• Rhee EJ
• Park CY
• Oh KW
• Mok JO
• Kim CH
• Park SW
• Kim SW
• Kang SK

• KMID: 1727873
• DOI: http://doi.org/10.3349/ymj.2013.54.3.615

Abstract

PURPOSE
Considerable amount of interest has been focused on the positive relationship between inflammation and the metabolic syndrome (MS). However, few studies have been performed to evaluate the relationship between baseline white blood cell (WBC) count and future risk for developing MS. Therefore, we investigated whether the baseline plasma levels of WBC count could be associated with future risk for MS in apparently healthy Korean.
MATERIALS AND METHODS
A total of 1135 subjects (781 men and 354 women with a mean age of 49 years), who underwent health examinations at Kangbuk Samsung Hospital in both 2002 and 2005 were enrolled. The presence of MS was defined using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III using BMI instead of waist circumference.
RESULTS
The baseline levels of WBC count were significantly higher among incident MS cases than among subjects without MS. The relative risks of incident MS were 1.4, 3.2 and 2.7 for WBC quartiles 2, 3, and 4, respectively, when compared with the first quartile (p-value for trend <0.001). These positive associations persisted after adjustment for baseline body mass index, blood pressure, fasting glucose, high density lipoprotein-cholesterol, triglyceride and homeostatic model assessment-insulin resistance; adjusted relative risk of incident MS for the 2nd, 3rd and 4th quartile groups vs. the lowest quartile were 1.2, 2.4 and 1.7, respectively (p-value for trend =0.011).
CONCLUSION
This retrospective cohort study suggests that an elevated WBC count could be associated with incident MS, suggesting that baseline inflammation mirrored by WBC level can impact future MS development.

Keyword

White blood cell count; metabolic syndrome; inflammation

MeSH Terms

Adult
Body Mass Index
Female
Humans
Leukocyte Count
Male
Metabolic Syndrome X/*blood
Middle Aged
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors

Reference

1. Alexander RW. Inflammation and coronary artery disease. N Engl J Med. 1994. 331:468–469.

2. Koenig W. Predicting risk and treatment benefit in atherosclerosis: the role of C-reactive protein. Int J Cardiol. 2005. 98:199–206.

3. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003. 107:499–511.

4. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998. 279:1477–1482.

5. Wang YY, Lin SY, Liu PH, Cheung BM, Lai WA. Association between hematological parameters and metabolic syndrome components in a Chinese population. J Diabetes Complications. 2004. 18:322–327.

6. Yen ML, Yang CY, Yen BL, Ho YL, Cheng WC, Bai CH. Increased high sensitivity C-reactive protein and neutrophil count are related to increased standard cardiovascular risk factors in healthy Chinese men. Int J Cardiol. 2006. 110:191–198.

7. Festa A, D'Agostino R Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000. 102:42–47.

8. Aguilar-Salinas CA, Rojas R, Gómez-Pérez FJ, Mehta R, Franco A, Olaiz G, et al. The metabolic syndrome: a concept hard to define. Arch Med Res. 2005. 36:223–231.

9. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003. 107:391–397.

10. Han TS, Sattar N, Williams K, Gonzalez-Villalpando C, Lean ME, Haffner SM. Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico City Diabetes Study. Diabetes Care. 2002. 25:2016–2021.

11. Kannel WB, Anderson K, Wilson PW. White blood cell count and cardiovascular disease. Insights from the Framingham Study. JAMA. 1992. 267:1253–1256.

12. Nagasawa N, Tamakoshi K, Yatsuya H, Hori Y, Ishikawa M, Murata C, et al. Association of white blood cell count and clustered components of metabolic syndrome in Japanese men. Circ J. 2004. 68:892–897.

13. Lohsoonthorn V, Dhanamun B, Williams MA. Prevalence of metabolic syndrome and its relationship to white blood cell count in a population of Thai men and women receiving routine health examinations. Am J Hypertens. 2006. 19:339–345.

14. Oda E, Kawai R. The prevalence of metabolic syndrome and diabetes increases through the quartiles of white blood cell count in Japanese men and women. Intern Med. 2009. 48:1127–1134.

15. Odagiri K, Uehara A, Mizuta I, Yamamoto M, Kurata C. Longitudinal study on white blood cell count and the incidence of metabolic syndrome. Intern Med. 2011. 50:2491–2498.

16. Chen W, Srinivasan SR, Xu J, Berenson GS. Black-white divergence in the relation of white blood cell count to metabolic syndrome in preadolescents, adolescents, and young adults: the Bogalusa Heart Study. Diabetes Care. 2010. 33:2474–2476.

17. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005. 112:2735–2752.

18. Grau AJ, Buggle F, Becher H, Werle E, Hacke W. The association of leukocyte count, fibrinogen and C-reactive protein with vascular risk factors and ischemic vascular diseases. Thromb Res. 1996. 82:245–255.

19. Lao XQ, Neil Thomas G, Jiang C, Zhang W, Adab P, Lam TH, et al. White blood cell count and the metabolic syndrome in older Chinese: the Guangzhou Biobank Cohort Study. Atherosclerosis. 2008. 201:418–424.

20. Kim DJ, Noh JH, Lee BW, Choi YH, Chung JH, Min YK, et al. The associations of total and differential white blood cell counts with obesity, hypertension, dyslipidemia and glucose intolerance in a Korean population. J Korean Med Sci. 2008. 23:193–198.

21. Fernández-Real JM, Ricart W. Insulin resistance and inflammation in an evolutionary perspective: the contribution of cytokine genotype/phenotype to thriftiness. Diabetologia. 1999. 42:1367–1374.

22. Mohamed-Ali V, Goodrick S, Rawesh A, Katz DR, Miles JM, Yudkin JS, et al. Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab. 1997. 82:4196–4200.

23. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993. 259:87–91.

24. Fernandez-Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J, et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. J Clin Endocrinol Metab. 2001. 86:1154–1159.

25. Sims E. Humoral factors. 1993. Oxford: IRL Press;1–373.

26. Targher G, Seidell JC, Tonoli M, Muggeo M, De Sandre G, Cigolini M. The white blood cell count: its relationship to plasma insulin and other cardiovascular risk factors in healthy male individuals. J Intern Med. 1996. 239:435–441.

27. Kawada T. Smoking-induced leukocytosis can persist after cessation of smoking. Arch Med Res. 2004. 35:246–250.

28. Corre F, Lellouch J, Schwartz D. Smoking and leucocyte-counts. Results of an epidemiological survey. Lancet. 1971. 2:632–634.

29. Ford ES. Leukocyte count, erythrocyte sedimentation rate, and diabetes incidence in a national sample of US adults. Am J Epidemiol. 2002. 155:57–64.

30. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.

31. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009. 120:1640–1645.

32. Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004. 110:1245–1250.

33. Wong ND, Sciammarella MG, Polk D, Gallagher A, Miranda-Peats L, Whitcomb B, et al. The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol. 2003. 41:1547–1553.

34. Shiwaku K, Nogi A, Kitajima K, Anuurad E, Enkhmaa B, Yamasaki M, et al. Prevalence of the metabolic syndrome using the modified ATP III definitions for workers in Japan, Korea and Mongolia. J Occup Health. 2005. 47:126–135.