Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.

<h4>Objective</h4>Biological evidence suggests that inflammation might induce type 2 diabetes (T2D), and epidemiological studies have shown an association between higher white blood cell count (WBC) and T2D. However, the association has not been systematically investigated.<h4>Rese...

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Main Authors: Effrossyni Gkrania-Klotsas, Zheng Ye, Andrew J Cooper, Stephen J Sharp, Robert Luben, Mary L Biggs, Liang-Kung Chen, Kuppan Gokulakrishnan, Markolf Hanefeld, Erik Ingelsson, Wen-An Lai, Shih-Yi Lin, Lars Lind, Vitool Lohsoonthorn, Viswanathan Mohan, Antonio Muscari, Goran Nilsson, John Ohrvik, Jiang Chao Qiang, Nancy Swords Jenny, Koji Tamakoshi, Theodora Temelkova-Kurktschiev, Ya-Yu Wang, Chittaranjan Sakerlal Yajnik, Marco Zoli, Kay-Tee Khaw, Nita G Forouhi, Nicholas J Wareham, Claudia Langenberg
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2010-10-01
Series:PLoS ONE
Online Access:https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0013405&type=printable
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author Effrossyni Gkrania-Klotsas
Zheng Ye
Andrew J Cooper
Stephen J Sharp
Robert Luben
Mary L Biggs
Liang-Kung Chen
Kuppan Gokulakrishnan
Markolf Hanefeld
Erik Ingelsson
Wen-An Lai
Shih-Yi Lin
Lars Lind
Vitool Lohsoonthorn
Viswanathan Mohan
Antonio Muscari
Goran Nilsson
John Ohrvik
Jiang Chao Qiang
Nancy Swords Jenny
Koji Tamakoshi
Theodora Temelkova-Kurktschiev
Ya-Yu Wang
Chittaranjan Sakerlal Yajnik
Marco Zoli
Kay-Tee Khaw
Nita G Forouhi
Nicholas J Wareham
Claudia Langenberg
author_facet Effrossyni Gkrania-Klotsas
Zheng Ye
Andrew J Cooper
Stephen J Sharp
Robert Luben
Mary L Biggs
Liang-Kung Chen
Kuppan Gokulakrishnan
Markolf Hanefeld
Erik Ingelsson
Wen-An Lai
Shih-Yi Lin
Lars Lind
Vitool Lohsoonthorn
Viswanathan Mohan
Antonio Muscari
Goran Nilsson
John Ohrvik
Jiang Chao Qiang
Nancy Swords Jenny
Koji Tamakoshi
Theodora Temelkova-Kurktschiev
Ya-Yu Wang
Chittaranjan Sakerlal Yajnik
Marco Zoli
Kay-Tee Khaw
Nita G Forouhi
Nicholas J Wareham
Claudia Langenberg
author_sort Effrossyni Gkrania-Klotsas
collection DOAJ
description <h4>Objective</h4>Biological evidence suggests that inflammation might induce type 2 diabetes (T2D), and epidemiological studies have shown an association between higher white blood cell count (WBC) and T2D. However, the association has not been systematically investigated.<h4>Research design and methods</h4>Studies were identified through computer-based and manual searches. Previously unreported studies were sought through correspondence. 20 studies were identified (8,647 T2D cases and 85,040 non-cases). Estimates of the association of WBC with T2D were combined using random effects meta-analysis; sources of heterogeneity as well as presence of publication bias were explored.<h4>Results</h4>The combined relative risk (RR) comparing the top to bottom tertile of the WBC count was 1.61 (95% CI: 1.45; 1.79, p = 1.5*10(-18)). Substantial heterogeneity was present (I(2) = 83%). For granulocytes the RR was 1.38 (95% CI: 1.17; 1.64, p = 1.5*10(-4)), for lymphocytes 1.26 (95% CI: 1.02; 1.56, p = 0.029), and for monocytes 0.93 (95% CI: 0.68; 1.28, p = 0.67) comparing top to bottom tertile. In cross-sectional studies, RR was 1.74 (95% CI: 1.49; 2.02, p = 7.7*10(-13)), while in cohort studies it was 1.48 (95% CI: 1.22; 1.79, p = 7.7*10(-5)). We assessed the impact of confounding in EPIC-Norfolk study and found that the age and sex adjusted HR of 2.19 (95% CI: 1.74; 2.75) was attenuated to 1.82 (95% CI: 1.45; 2.29) after further accounting for smoking, T2D family history, physical activity, education, BMI and waist circumference.<h4>Conclusions</h4>A raised WBC is associated with higher risk of T2D. The presence of publication bias and failure to control for all potential confounders in all studies means the observed association is likely an overestimate.
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spelling doaj-art-3d87df69aa524c5fa75e8b6dfaf7ecb72025-08-20T03:26:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032010-10-01510e1340510.1371/journal.pone.0013405Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.Effrossyni Gkrania-KlotsasZheng YeAndrew J CooperStephen J SharpRobert LubenMary L BiggsLiang-Kung ChenKuppan GokulakrishnanMarkolf HanefeldErik IngelssonWen-An LaiShih-Yi LinLars LindVitool LohsoonthornViswanathan MohanAntonio MuscariGoran NilssonJohn OhrvikJiang Chao QiangNancy Swords JennyKoji TamakoshiTheodora Temelkova-KurktschievYa-Yu WangChittaranjan Sakerlal YajnikMarco ZoliKay-Tee KhawNita G ForouhiNicholas J WarehamClaudia Langenberg<h4>Objective</h4>Biological evidence suggests that inflammation might induce type 2 diabetes (T2D), and epidemiological studies have shown an association between higher white blood cell count (WBC) and T2D. However, the association has not been systematically investigated.<h4>Research design and methods</h4>Studies were identified through computer-based and manual searches. Previously unreported studies were sought through correspondence. 20 studies were identified (8,647 T2D cases and 85,040 non-cases). Estimates of the association of WBC with T2D were combined using random effects meta-analysis; sources of heterogeneity as well as presence of publication bias were explored.<h4>Results</h4>The combined relative risk (RR) comparing the top to bottom tertile of the WBC count was 1.61 (95% CI: 1.45; 1.79, p = 1.5*10(-18)). Substantial heterogeneity was present (I(2) = 83%). For granulocytes the RR was 1.38 (95% CI: 1.17; 1.64, p = 1.5*10(-4)), for lymphocytes 1.26 (95% CI: 1.02; 1.56, p = 0.029), and for monocytes 0.93 (95% CI: 0.68; 1.28, p = 0.67) comparing top to bottom tertile. In cross-sectional studies, RR was 1.74 (95% CI: 1.49; 2.02, p = 7.7*10(-13)), while in cohort studies it was 1.48 (95% CI: 1.22; 1.79, p = 7.7*10(-5)). We assessed the impact of confounding in EPIC-Norfolk study and found that the age and sex adjusted HR of 2.19 (95% CI: 1.74; 2.75) was attenuated to 1.82 (95% CI: 1.45; 2.29) after further accounting for smoking, T2D family history, physical activity, education, BMI and waist circumference.<h4>Conclusions</h4>A raised WBC is associated with higher risk of T2D. The presence of publication bias and failure to control for all potential confounders in all studies means the observed association is likely an overestimate.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0013405&type=printable
spellingShingle Effrossyni Gkrania-Klotsas
Zheng Ye
Andrew J Cooper
Stephen J Sharp
Robert Luben
Mary L Biggs
Liang-Kung Chen
Kuppan Gokulakrishnan
Markolf Hanefeld
Erik Ingelsson
Wen-An Lai
Shih-Yi Lin
Lars Lind
Vitool Lohsoonthorn
Viswanathan Mohan
Antonio Muscari
Goran Nilsson
John Ohrvik
Jiang Chao Qiang
Nancy Swords Jenny
Koji Tamakoshi
Theodora Temelkova-Kurktschiev
Ya-Yu Wang
Chittaranjan Sakerlal Yajnik
Marco Zoli
Kay-Tee Khaw
Nita G Forouhi
Nicholas J Wareham
Claudia Langenberg
Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
PLoS ONE
title Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
title_full Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
title_fullStr Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
title_full_unstemmed Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
title_short Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies.
title_sort differential white blood cell count and type 2 diabetes systematic review and meta analysis of cross sectional and prospective studies
url https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0013405&type=printable
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