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Open AccessArticle

Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study

1
School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
2
Faculty of Health and Medicine, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri 64114, Indonesia
3
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, NSW, Australia
4
Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
5
Department of Nursing, Shin Kong Wu Ho Su Memorial Hospital, Taipei 11031, Taiwan
6
Department of Epidemiology and Biostatistics, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
7
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei 11031, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(16), 5696; https://doi.org/10.3390/ijerph17165696
Received: 16 July 2020 / Revised: 1 August 2020 / Accepted: 3 August 2020 / Published: 6 August 2020
(This article belongs to the Special Issue Diabetes: Screening, Prevention, Diagnosis and Therapy)
Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM. View Full-Text
Keywords: neutrophil–lymphocyte ratio; physical inactivity; secondhand smoke; type 2 diabetes mellitus; white blood cells neutrophil–lymphocyte ratio; physical inactivity; secondhand smoke; type 2 diabetes mellitus; white blood cells
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    Doi: 10.5281/zenodo.3943719
    Link: https://zenodo.org/record/3943719#.Xw1hNmozZQI
    Description: Figure S1. Correlation between smoking status (nonsmokers, those exposed to secondhand smoke, or active smokers) and (a) neutrophil-lymphocyte ratio (NLR); (b) white blood cell count (WBC), an inflammatory-biomarkers (N = 588); Figure S2. Correlation between average daily exposure to secondhand smoke (number of cigarettes) and (a) neutrophil-lymphocyte ratio; (b) white blood cell count (WBC), an inflammatory-biomarkers (N = 538); Figure S3. Correlation between physical activity (metabolic equivalent of task [MET]-h/week in previous month) and (a) neutrophil-lymphocyte ratio; (b) white blood cell count (WBC), an inflammatory-biomarkers (N = 538).
MDPI and ACS Style

Rias, Y.A.; Gordon, C.J.; Niu, S.F.; Wiratama, B.S.; Chang, C.W.; Tsai, H.T. Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study. Int. J. Environ. Res. Public Health 2020, 17, 5696. https://doi.org/10.3390/ijerph17165696

AMA Style

Rias YA, Gordon CJ, Niu SF, Wiratama BS, Chang CW, Tsai HT. Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study. International Journal of Environmental Research and Public Health. 2020; 17(16):5696. https://doi.org/10.3390/ijerph17165696

Chicago/Turabian Style

Rias, Yohanes A.; Gordon, Christopher J.; Niu, Shu F.; Wiratama, Bayu S.; Chang, Ching W.; Tsai, Hsiu T. 2020. "Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study" Int. J. Environ. Res. Public Health 17, no. 16: 5696. https://doi.org/10.3390/ijerph17165696

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