medical files of the patients who were referred to the outpatient clinics of children s health and diseases of namik kemal university research , and application hospital were analyzed , and height , bodyweight , waist , and hip circumferences of the patients were recorded . among these cases ,
patients who had undergone complete word counts because of medical requirement or routine control were included in the study , and their neutrophil , and lymphocyte parameters were evaluated . medical files or the patients were screened , and those with viral - bacterial infection , insulin - dependent diabetes , congenital metabolic disease or hormonal disorder were excluded from the study group . a total of 130 obese ( aged 615 years ) and 57 ( aged 715 years ) healthy control subjects were included in the study .
age , and measured body parametres of the healthy control , and obese individuals participating in the study body mass indices ( bmis ) of the children were estimated based on bmi percentiles established by the centers for disease control 2000 ( cdc ) for children , and adolescents .
participants with bmis between 8595 percentiles were defined as overweight , and those over 95 percentile as obese .
blood samples to be analyzed for neutrophils , lymphocytes , and other hemogram parametres were placed in tubes containing k2 edta . following 15 minutes of agitation , the samples were analyzed in pentra dx nexus ( uk ) device under room temperature . for biochemical measurements
all biochemical tests were performed in cobas c 501 roche ( japan ) biochemical analyzer using commercial kits . in all analyses spss 17.0 ( chicago , il . )
normality of continuous variables was checked with kruskal - wallis test . for comparison of data with non - normal distribution mann- whitney
medical files of the patients who were referred to the outpatient clinics of children s health and diseases of namik kemal university research , and application hospital were analyzed , and height , bodyweight , waist , and hip circumferences of the patients were recorded . among these cases ,
patients who had undergone complete word counts because of medical requirement or routine control were included in the study , and their neutrophil , and lymphocyte parameters were evaluated . medical files or the patients were screened , and those with viral - bacterial infection , insulin - dependent diabetes , congenital metabolic disease or hormonal disorder were excluded from the study group . a total of 130 obese ( aged 615 years ) and 57 ( aged 715 years ) healthy control subjects were included in the study .
age , and measured body parametres of the healthy control , and obese individuals participating in the study body mass indices ( bmis ) of the children were estimated based on bmi percentiles established by the centers for disease control 2000 ( cdc ) for children , and adolescents .
participants with bmis between 8595 percentiles were defined as overweight , and those over 95 percentile as obese .
blood samples to be analyzed for neutrophils , lymphocytes , and other hemogram parametres were placed in tubes containing k2 edta . following 15 minutes of agitation , the samples were analyzed in pentra dx nexus ( uk ) device under room temperature . for biochemical measurements
all biochemical tests were performed in cobas c 501 roche ( japan ) biochemical analyzer using commercial kits .
normality of continuous variables was checked with kruskal - wallis test . for comparison of data with non - normal distribution mann- whitney
measured parametres of a total of 187 healthy , and obese children are given as median , minimum , and maximum values in table 2 .
obese , and healthy control groups were compared , and lymphocyte , and neutrophil ratios were found to be significantly higher in the obese group ( p=0.03 , and 0.045 , respectively ) .
similarly , neutrophil / lymphocyte ratio , and crp levels were found to be significantly higher in the obese group ( p=0.03 , p=0.02 , and p=0.00 ) .
besides , mean platelet volume ( mpv ) was significantly higher in the obese group ( p=0.005 ) . both groups did not differ significantly as for platelet / lymphocyte ratio ( p=0.156 ) biochemical , and hematological parametres measured in healthy controls , and obese individuals p<0.05 statistically significant ; hgb : hemoglobin ; hct : hematocrit ; mcv : mean corpuscular volume ; mch : mean corpuscular hemoglobin ; mchc : mean corpuscular hemoglobin concentration ; rdw : red blood cell distribution width ; wbc : white blood cell ; mpv : mean platelet volume ; pdw : platelet distribution width ; crp : c - reactive protein .
in recent years because of diets rich in fats , and sedentary life style , prevalence of obesity has rapidly increased .
obesity plays a central role in insulin resistance which include hyperinsulinemia , hypertension , hyperlipidemia , and type-2 diabetes , and increases the risk of cardiovascular disease .
although , obesity has been demonstrated to be an independent risk factor for atherosclerotic cardiovascular diseases , the mechanism of increased cardiovascular risk in obese individuals has not been clarified yet . in studies performed , the pathogenesis of pathological processes of atherosclerotic cardiovascular disease , and related risk factors have been dated back to the pediatric age .
obesity is a chronic inflamatory disease characterized by altered adipokine production , and increase in the levels of inflammatory cytokines .
kim et al . analyzed levels of leptin , and inflammatory cytokines including hs - crp , tumor - necrosis factor ( tnt- ) , interleukin-6 ( il-6 ) in young obese girls , and they were found to be significantly higher in obese women relative to non - obese women . in recent studies increased levels of crp were detected in obese individuals [ 14 , 15 ] .
high - sensitive c - reactive protein ( hs - crp ) which can be used as a marker of metabolic syndrome is a useful marker of childhood obesity .
prevention of obesity , and inflammation which start in childhood will contribute to the prevention of metabolic syndrome in the future .
similarly , crp level in the obese group was found to be significantly higher in our study when compared with the healthy controls .
arslan and makay have demonstrated that mpv levels were higher in obese adolescents with non - alcoholic fatty liver when compared with healthy controls , and other obese patient groups . however , kilciler et al .
reported that any significant difference was not found between the patients with non - alcoholic fatty liver disease as for mpv levels .
also in our study , we detected higher mpv levels in the obese patient group when compared with the healthy controls .
nlr which is a strong indicator of inflammation has been investigated in various inflammatory , and neoplasic diseases including metabolic syndrome , behcet s disease , coronary artery disease [ 21 , 22 ] , heart failure [ 23 , 24 ] , colorectal cancer , chest , and lung diseases , and hepatocellular carcinoma .
the main fundamental etiological factor of this wide spectrum is that nlr contains two separate inflammation markers .
neutrophils have been reported to migrate into ischemic myocardial tissue before other inflammatory cells , and cause destructive changes by stimulating release of proteolytic enzymes , reactive oxygen radicals , and neutrophils . as a known fact ,
in the pathophysiology of atherosclerotic cardiovascular diseases , increased inflammation , and endothelial dysfunction play fundamental roles .
outcomes of this study suggest that nlr may be one of the markers of endothelial dysfunction , and inflammation in obese patients .
related studies performed in adults have suggested that various comorbidities as diabetes , insulin resistance , hyperlipidemia , and coronary artery disease prevent disclosure of cause - effect relationship between obesity , and inflammation .
therefore this study provides a clarification on this issue which also aids in the evaluation of this correlation between obesity , and inflammation . in conclusion , in chidhood obesity ,
therefore keeping obesity under control using dietary modifications , and other treatment methods carries importance in decreasing mortality , and morbidity rates in adulthood .
 objective : obesity is a growing health problem in most of the developed countries . it is associated with many chronic diseases , affecting particularly endocrine and cardiovascular systems . inflammation plays a key role in pathophysiology of obesity . in this study , we aimed to investigate the inflammation status in obese children using neutrophil / lymphocyte ratio.methods:in this study 130 obese and 57 healthy children were assessed retrospectively . according to centers for disease control 2000 ( cdc ) bmi percentiles for childhood and adulthood , 
 8595 percentile was considered as overweight and > 95 percentile as obese.results:lymphocyte/neutrophil ratios in the obese group were significantly higher compared to those in healthy controls ( p=0.03 and p=0.045 , respectively ) 
 . neutrophil / lymphocyte ratio and crp level in the obese group were significantly higher compared to those in healthy controls ( p=0.02 and p=0.00 , respectively ) . 
 thrombocyte / lymphocyte ratios were not significantly different between two groups ( p=0.156).conclusion : it is possible that childhood obesity which has been increasingly prevalent recently triggers the pathogenesis of atherosclerosis during the early years of life . increased neutrophil / lymphocyte ratio might be associated with the severity of inflammation which plays a role in the early stages of atherosclerosis . therefore , 
 taking childhood obesity under control using diet and other treatment methods will prevent mortality and morbidity in the elderly . 