Association of reticulocyte-related indices with metabolic syndrome and its components: Evidence from the China National Health Survey

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-09-23 DOI:10.1016/j.diabres.2025.112917

Lunhui Huang , Binbin Lin , Guoqing Zhu , Yueyi Mu , Yansong Ren , Qiang Li , Yong Li , Yueshen Ma , Yulong Fan , Xuehang Li , Miao Yu , Yuqing Wang , Chunyan Ping , Huijing He , Yaoda Hu , Zhen Song , Yonghui Xia

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Abstract

Background

Reticulocyte-related indices have emerged as promising biomarkers for various hematologic and metabolic disorders. However, their associations with metabolic syndrome (MetS) and the underlying mechanisms remain poorly understood. This study aimed to examine the relationship between reticulocyte-related indices and MetS, evaluate their predictive utility, and explore the potential mediating role of inflammation.

Methods

This cross-sectional study included 6,098 Chinese adults aged 18 years and older. Reticulocyte-related indices, such as reticulocyte count (RET#), reticulocyte percentage (RET%), low/medium/high fluorescence reticulocytes (LFR, MFR, HFR), reticulocyte hemoglobin equivalent (RET-HE), immature reticulocyte fraction (IRF), and reticulocyte production indices (RPI), were analyzed for their associations with MetS. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Stratified analyses assessed potential interactions, while restricted cubic spline (RCS) regression evaluated nonlinear dose–response relationships. Mediation analysis explored the role of inflammatory markers in linking reticulocyte-related indices to MetS.

Results

After multivariable adjustment, participants in the highest quartile of reticulocyte-related indices, excluding LFR and RET-HE, exhibited at least a two-fold increased risk of MetS. The ORs (95% CIs) for the highest vs. lowest quartile were as follows: RET# 5.45 (4.56, 6.51), RET% 4.09 (3.44, 4.85), IRF 2.97 (2.51, 3.52), MFR 2.23 (1.89, 2.63), HFR 3.54 (2.99, 4.21), and RPI 4.19 (3.53, 4.98). Conversely, LFR showed a protective association (highest vs. lowest quartile OR: 0.33, 95% CI: 0.28, 0.40). RET-HE was significantly associated with low high-density lipoprotein cholesterol and high waist circumference. Subgroup analyses revealed stronger associations among younger individuals, males, and those without obesity. RCS regression indicated nonlinear relationships between various reticulocyte-related indices and MetS. Inflammation was found to partially mediate the associations between reticulocyte-related indices and MetS.

Conclusion

This study identifies reticulocyte indices, particularly RET#, RET%, and IRF, as strongly associated with MetS, highlighting their potential utility in early screening and personalized risk stratification. These findings provide new insights into the role of erythropoiesis in metabolic health. Further longitudinal research is needed to elucidate the underlying mechanisms and validate the clinical applications of reticulocyte indices in managing MetS.

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网织细胞相关指数与代谢综合征及其组成部分的关联：来自中国国民健康调查的证据

背景：网状细胞相关指标已成为各种血液学和代谢疾病的有前途的生物标志物。然而，它们与代谢综合征（MetS）的关系及其潜在机制仍然知之甚少。本研究旨在研究网织细胞相关指数与MetS之间的关系，评估其预测效用，并探讨炎症的潜在介导作用。方法：本横断面研究纳入6098名年龄在18岁 及以上的中国成年人。网织红细胞相关指标，如网织红细胞计数（RET#）、网织红细胞百分比（RET%）、低/中/高荧光网织红细胞（LFR、MFR、HFR）、网织红细胞血红蛋白当量（RET- he）、未成熟网织红细胞分数（IRF）和网织红细胞生成指数（RPI），分析了它们与MetS的关系。采用多变量logistic回归计算校正优势比（ORs）和95% %置信区间（CIs）。分层分析评估潜在的相互作用，而限制三次样条（RCS）回归评估非线性剂量-反应关系。中介分析探讨了炎症标志物在将网状细胞相关指数与MetS联系起来中的作用。结果：在多变量调整后，网状细胞相关指数（不包括LFR和RET-HE）最高四分位数的参与者表现出至少两倍的MetS风险增加。最高和最低四分位数的or （95% ci）如下：RET# 5.45 (4.56, 6.51), RET% 4.09 (3.44, 4.85), IRF 2.97 (2.51, 3.52), MFR 2.23 (1.89, 2.63), HFR 3.54 (2.99, 4.21), RPI 4.19（3.53, 4.98）。相反，LFR显示保护性关联（最高与最低四分位数OR: 0.33, 95% CI: 0.28, 0.40）。RET-HE与低高密度脂蛋白胆固醇和高腰围显著相关。亚组分析显示，年轻人、男性和非肥胖者之间的关联更强。RCS回归表明，网状细胞相关指标与MetS之间存在非线性关系。炎症被发现部分介导网织细胞相关指数和MetS之间的关联。结论：本研究确定网织红细胞指数，特别是RET#、RET%和IRF与MetS密切相关，强调了它们在早期筛查和个性化风险分层中的潜在效用。这些发现为红细胞生成在代谢健康中的作用提供了新的见解。需要进一步的纵向研究来阐明潜在的机制，并验证网织红细胞指数在管理MetS中的临床应用。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.