Reflection of Gender Differences on the Associations Among Body Mass Index, Body Fat Percentages, Body Circumference Values and Cardiometabolic Parameters

Authors: Mustafa M. Donma

Abstract:

The associations among anthropometric measurements, body fat, and cardiometabolic parameters have attracted attention for years due to the importance and topicality of the subject. Gender is also an important factor to be considered during the evaluation of the study findings. Gender is particularly important in the field of pediatrics and during the interpretation of complete blood cell count parameters. These parameters are important because their ratios are being used as valuable and informative markers demonstrating cardiometabolic risk. The aim of this study was to introduce potential differences between male and female children in terms of the associations between these ratios and parameters closely related with obesity development. The study population was composed of 627 children, 58% were females and 42% were males. The body mass index (BMI) distribution of the groups was almost the same. The study was evaluated by the Institutional Ethics Committee and approved. Parents have given informed consent forms in behalf of their children to participate in the study. Anthropometric measurements were taken. Complete blood cell count, biochemical, and body fat percentage analysis were performed. BMI, neutrophil-to-lymphocyte (N/L) ratio, and aspartate aminotransferase-to-platelet count ratio were calculated. Statistical evaluations were performed by a statistical package program. BMI, circumferences of waist, hip, head, and neck values were higher, and body fat percentages of trunk and extremities were lower in males than females (p > 0.05). Increased eosinophil percent and alanine aminotransferase-to-aspartate aminotransferase ratio, decreased N/L ratio values in males were observed. Positive correlations between total body fat percent and N/L ratio in female children, and platelet count in male children were noteworthy. In conclusion, associations of total body fat percent with N/L and platelet count in female children and male children, respectively, point out the importance of N/L and platelet count in different genders for the future development of cardiovascular diseases.

Keywords: Body fat percentages, children, gender, neutrophil-to-lymphocyte ratio, platelet count.

References:

[1] A. C. Skinner, E. M. Perrin, L. A. Moss, and J. A. Skelton, “Cardiometabolic risks and severity of obesity in children and young adults,” N. Engl. J. Med., vol. 373, pp.1307-1317, Oct. 2015.
[2] G. A. Robinson, I. Pineda-Torra, C. Ciurtin, and E. C. Jurya, “Predicting long-term cardiometabolic risk: Do childhood metabolomic signatures hold the key?,” The Lancet (eBioMedicine), vol. 74, pp. 103702, Dec. 2021.
[3] D. Drozdz, J. Alvarez-Pitti, M. Wójcik, C. Borghi, R. Gabbianelli R, et al., “Obesity and cardiometabolic risk factors: from childhood to adulthood,” Nutrients, vol. 13, no 11, pp. 4176, Nov. 2021.
[4] S. T. Chung, A. U. Onuzuruike, and S. N. Magge, “Cardiometabolic risk in obese children, Ann. N. Y. Acad. Sci., vol. 1411, no. 1, pp. 166-183, Jan. 2018.
[5] A. Nakhleh, R. Sakhnini, E. Furman, and N. Shehadeh, “Cardiometabolic risk factors among children and adolescents with overweight and Class 1 obesity: A cross-sectional study. Insights from stratification of Class 1 obesity,” Front. Endocrinol., vol. 14, pp. 1108618, Jan. 2023.
[6] J. A. G. Casimir, S. Mulier, L. Hanssens, K. Zylberberg, and J. Duchateau, “Gender differences in inflammatory markers in children”, Shock, vol. 33, no. 3, pp. 258-262, Mar. 2010.
[7] M. Vacas, Y. Saez, J. D. Sagastagoitia, J. P. Saez de Lafuente, M. Santos, et al. “Gender differences in thrombogenic profile associated to coronary obstruction angiographically evaluated”, Open Atheros. Thrombos. J., vol 4, pp. 11-15, Jul. 2011.
[8] M. M. Donma, O. Donma, M. Aydın, M. Demirkol, B. Nalbantoğlu, et al, “Gender differences in morbid obese children: Clinical significance of two diagnostic obesity notation model assessment indices,” Int. J. Med. Health Sci., vol:10, no:5, pp. 310-316, May 2016.
[9] M. Donma, and O. Donma, “Neutrophil-to-lymphocyte ratio: A predictor of cardiometabolic complications in morbid obese girls,” Int. J. Med. Health Sci., vol. 11, no. 5, pp. 261-264, May 2017.
[10] O. Donma, and M. Donma, “Eosinophils and platelets: Players of the game in morbid obese boys with metabolic syndrome,” Int. J. Med. Health Sci., vol. 11, no. 5, pp. 257-260, May 2017.
[11] World Health Organization (WHO). The WHO Child Growth Standards. Available at: http://www.who.int/childgrowth/en/ Accessed on June 10, 2016.
[12] C. De Matteis, M. Cariello, G. Graziano, S. Battaglia, P. Suppressa, et al., “AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects,” Sci. Rep., vol.11, no.1, pp.14834, Jul. 2021.
[13] M. Donma, and O. Donma, “Interpretation of two indices for the prediction of cardiovascular risk in pediatric obesity,” Int. J. Med. Health Sci., vol. 17, no. 9, pp. 195-198, Sep. 2023.
[14] R. Y. Sung, C. C. Yu, K. C. Choi, A. McManus, A. M. Li, et al., “Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors,” Int. J. Obes. (Lond)., vol. 31, no. 3, pp. 550-558, Mar. 2007.
[15] S. Suwała, and R. Junik, “Body mass index and waist circumference as predictors of above-average increased cardiovascular risk assessed by the SCORE2 and SCORE2-OP calculators and the proposition of new optimal cut-off values: Cross-Sectional Single-Center Study,” J. Clin. Med., vol. 13, no. 7, pp. 1931, Mar. 2024.
[16] K. M. Flegal, J. A. Shepherd, A. C. Looker, B. I. Graubard, L. G. Borrud et al., “Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults.” Am. J. Clin. Nutr., vol. 89, no. 2, pp. 500-508, Feb. 2009.
[17] J. Simon, S. Guptha, K. V. Rajalakshmi, A. Perumal Kumaresan, and S. Bose, “Evaluating cardiovascular risks: the platelet lymphocyte ratio and the neutrophil lymphocyte ratio as high-risk heart score predictors in non-ST elevation myocardial infarction (NSTEMI) and unstable angina patients,” Cureus, vol. 16, no. 5, pp. e61279, May 2024.
[18] S. Hong, H. He, P. Fang, S. Liu, and C. Chen, “Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular and all-cause mortality in hypertension patients,” Heliyon, vol. 10, no.6, pp. e27517, Mar. 2024.
[19] P. J. Connelly, Z. Azizi, P. Alipour, C. Delles, L. Pilote, et al., “The importance of gender to understand sex differences in cardiovascular disease, Can. J. Cardiol., vol. 37, no. 5, pp. 699-710, May 2021.
[20] V. Rovella, L. Anemona, M. Cardellini, M. Scimeca, A. Saggini, et al., “The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors,” Cardiovasc. Diabetol., vol. 17, no. 1, pp. 46, Mar. 2018.
[21] M. Vakhshoori, S. Nemati, S. Sabouhi, B. Yavari, M. Shakarami, et al. “Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis,” BMC Cardiovasc. Disord., vol. 23, no. 1, pp. 555, Nov. 2023.
[22] Q-C. Wang, and Z-Y. Wang, “Comparative analysis of neutrophil-to-lymphocyte ratio and remnant cholesterol in predicting cardiovascular events and mortality in general adult population,” Sci. Rep., vol. 13, pp. 22362, Dec. 2023.
[23] Y. Wang, Y. Zhuang, C. Lin, H. Hong, F. Chen, et al., “The neutrophil-to-lymphocyte ratio is associated with coronary heart disease risk in adults: A population-based study,” PLoS ONE, vol. 19, no. 2, e0296838, Feb. 2024.
[24] L. Gu, Z. Xia, B. Qing, H. Chen, W. Wang, et al., “The core role of neutrophil-lymphocyte ratio to predict all-cause and cardiovascular mortality: A research of the 2005-2014 National Health and Nutrition Examination Survey,” Front. Cardiovasc. Med., vol. 9, pp. 847998, May 2022.
[25] S. Tangjitgamol, W. Udayachalerm, C. Wanishsawad, W. Kaewwanna, and N. Ativanichayapong, “Association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and coronary artery disease among the physicians,” J. Inflamm. Res., vol. 17, pp. 59-66, Jan. 2024.
[26] M. Pruc, J. Kubica, M. Banach, D. Swieczkowski, Z. Rafique, et al., “Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients,” Kardiol. Pol., vol. 82, no. 3, pp. 276-284, Mar. 2024.
[27] T. Pongdee, S. M. Manemann, P. A. Decker, N. B. Larson, S. Moon, et al., “Rethinking blood eosinophil counts: Epidemiology, associated chronic diseases, and increased risks of cardiovascular disease,” J. Allergy Clin. Immunol. Glob., vol. 1, no. 4, pp. 233-240, Nov. 2022.
[28] N. Hosadurg, C. Flora, T. Patel, C. McNamara, and T. Villines, “Blood eosinophils predict more severe coronary artery disease as determined by the coronary computed tomography angiography Leiden score ın a prospective cohort,” J. Cardiovasc. Comput. Tomogr., vol. 18, no. 4, pp. S89, Jul.- Aug. 2024.
[29] P. J. Vinholt, A. M. Hvas, H. Frederiksen, L. Bathum, M. K. Jørgensen, et al., “Platelet count is associated with cardiovascular disease, cancer and mortality: A population-based cohort study,” Thromb. Res., vol. 148, pp. 136-142, Dec. 2016.