|Year : 2021 | Volume
| Issue : 2 | Page : 109-114
A study on association of age, gender, and body mass index with hematological parameters
Priyanka Singh1, Sanjay Kumar Singh2, Vamshi Krishna Reddy3, Supriya Sharma1, Shaleen Chandra1, Pradakhshana Vijay1
1 Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Sarjug Dental College, Darbhanga, Bihar, India
3 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||19-Jun-2020|
|Date of Decision||13-Apr-2021|
|Date of Acceptance||07-Jun-2021|
|Date of Web Publication||2-Aug-2021|
Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Hematologists have always had a keen interest in researching the pathophysiology and clinical relevance of hematological parameters in various populations. Factors that may affect hematological and serum biochemical parameters might include gender, age, body mass index (BMI), season, and nutrition. Aim: The aim of this study was to determine the association of hemoglobin, red blood cell (RBC) count, white blood cell (WBC) count, and platelets with the age, gender, and BMI of patients who came to the hematology section of the department in the regular outpatient department (OPD) services. Materials and Methods: We had selected 300 patients randomly who came to the hematology section of the department in the regular OPD services. We had calculated height and weight of the patient after their consent and calculated their BMI. The selected patients were categorized into five age groups from Group A to Group E (20–30 years, 31–40 years, 41–50 years, 51–60 years, and 61–70 years), into males and females (Group A and Group B), also according to BMI into four groups (Group A – BMI <18.5 kg/m2, Group B – BMI <18.5–25 kg/m2, Group C – BMI >25 kg/m2, and Group D – BMI >30 kg/m2). Blood sample was collected from each patient in an ethylenediaminetetraacetic acid anticoagulant and was analyzed using a hematological autoanalyzer. Results and Discussion: A decline in hemoglobin (HB) levels and RBC count was observed above 30 years, and it decreased more in females. The mean age of obese subgroup was found to be significantly more among males. Whereas, underweight and overweight were found to be significantly more among females. HB, RBC, and platelet count did not show any significant difference among the subgroups of BMI category, but WBC count was found to be adequate in majority of the subjects with normal weight. Conclusion: In our study, we found an age-dependent decline in HB levels in the age group above 30 years. RBC and platelet count did not show any significant difference among the subgroups of BMI category, but WBC count was found to be adequate in subjects with normal weight.
Keywords: Autoanalyzer, body mass index, hematological parameters, pathophysiology
|How to cite this article:|
Singh P, Singh SK, Reddy VK, Sharma S, Chandra S, Vijay P. A study on association of age, gender, and body mass index with hematological parameters. J Indian Assoc Public Health Dent 2021;19:109-14
|How to cite this URL:|
Singh P, Singh SK, Reddy VK, Sharma S, Chandra S, Vijay P. A study on association of age, gender, and body mass index with hematological parameters. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2022 May 24];19:109-14. Available from: https://www.jiaphd.org/text.asp?2021/19/2/109/322852
| Introduction|| |
Body mass index (BMI) is the most widely used parameter in epidemiological studies, usually in detection of population at risk of obesity/malnourishment.
The main advantages of BMI are its easy way to measure, cost-effectiveness, its association with body mass, and its association to morbidity and mortality and general performance.
The increasing prevalence of obesity/malnutrition is a major health problem globally. In 2005, an estimated 400 million adults worldwide were malnourished and 16%–31% of children are affected by obesity nowadays. Obesity increases various health problems such as the risk of type 2 diabetes, hypertension, heart disease, stroke, dyslipidemia, osteoarthritis, gynecological problems, sleep apnea, and respiratory problems. Furthermore, studies have reported that obesity has an adverse effect on iron concentration that can lead to derangements in blood parameters including hemoglobin (HB) and red blood cell (RBC) count.
The prevalence of obesity has increased in recent years. In general, it can be claimed that 16%–31% of children are affected by obesity nowadays. Rapid changes in lifestyles and dietary patterns from traditional hard diet to newer softer diets including large amounts of fat, sugar, and oil can be considered as the major causes of obesity.
In 2006, the WHO estimated that anemia affects approximately 30%–55% of young adults all over the world. This can result in reduction of physical resistance and tolerance to efforts, as well as damages to growth and intellectual capacity, hence difficulty to concentrate and memorize that exerts negative results in the learning development and performance.
Anemia is a common disorder in almost all the population, and it has been associated with substantial morbidity and mortality. It varies with age, gender, and BMI. It is, therefore, important to determine whether a patient is actually anemic, or whether his/her low HB level is a phenomenon of the expression of old age.
The association between anemia and BMI signifies the nutrition and health status of adults. Therefore, studying the hemoglobin level and RBC count and its relationship to BMI can be very useful in assessing the actual health of the person.
Many factors including diseases, nutrition, and parasitic infestation can cause changes in the blood cell concentrations including HB, RBCs, white blood cells (WBCs), and platelets.
Recently, the evaluation of changes of WBC count such as neutrophils, lymphocytes, monocytes, or ratio of neutrophil to lymphocyte counts (N/L) in peripheral blood has been identified as an easy, simple, inexpensive, and reliable prognostic index to determine host immunity. As immune cells, WBC values undergo changes in their proportion in peripheral blood by inhibition of apoptosis of neutrophils and apoptosis of lymphocytes in certain psychological and pathological conditions.
The role of WBC count in pathogenesis of infections, diabetes, cardiovascular disease, and obesity-related disorders has been reported earlier. Variations in WBC and hematologic profiles in obese individuals are still controversial.
Hematological and biochemical analyses are fundamental components of individual person health assessment. Typically, the normal level of each component of the blood should be determined to compare them against population level reference intervals (Stockham and Scott, 2008). Further, sensitivity for the detection of physiologic abnormalities is improved when reference intervals have been developed which control for normal variation due to environmental, for example, season, temperature, or physiological, example, sex, age, and reproductive state, e-ects.
Another component of blood is platelets that are responsible for hemostasis. These help in clotting of blood by both intrinsic and extrinsic systems. A study was conducted by Balduini and Noris, 2014, in which association between platelet count and age was found by a larger study that evaluated 12,142 adult inhabitants of the United States and found statistically significant differences between young and old individuals.
Evidence have also suggested that gender differences play a role in platelet reactivity and this observation has been confirmed in more recent studies and this observation has been confirmed in more recent studies. Differences in vessel wall biology between men and women, as well as the direct influence of sex hormones (estrogens, progesterone, or androgens) on platelets or their indirect effect on the blood vessel wall, might be underlying conditions from a biological point of view.
Therefore, the aim and objectives of the present study were to correlate the age, gender, and BMI with hematological parameters. The objectives were as follows:
- To determine the association of hemoglobin, RBC count, WBC count, and platelet count with the age of the patients who came to the hematology section of the department in the regular outpatient department (OPD) services
- To determine the association of hemoglobin, RBC count, WBC count, and platelet count with the gender of the patients who came to the hematology section of the department in the regular OPD services
- To determine the association of hemoglobin, RBC count, WBC count, and platelet count with the BMI of the patients who came to the hematology section of the department in the regular OPD services.
| Materials and Methods|| |
It was a hospital-based study, in which a minimum of total 300 patients who came to the hematology section of the department of oral microbiology and microbiology in the regular OPD services were selected after taking 95% confidence interval with 5% error.
After taking ethical approval by the institutional review board (Ref No– 269/Ethics/2020) for the protocol, subjects visiting the regular hematology OPD were included in the study.
After taking written consent, we calculated height (meters) with stadiometer and body weight (kg) of the patient wearing light-weighted clothes and without shoes, with digital weighing machine. After calculating body height and weight, we had calculated their BMI as the ratio of weight (kg) to the square of height (m2). The selected patients were categorized into five age groups from Group A to Group E (20–30 years, 31–40 years, 41–50 years, 51–60 years, and 61–70 years), into males and females (Group A and Group B), also according to BMI into four groups (Group A – BMI <18.5 kg/m2, Group B – BMI <18.5–25 kg/m2, Group C – BMI >25 kg/m2, and Group D – BMI >30 Kg/m2). Blood sample was collected from each patient in an ethylenediaminetetraacetic acid anticoagulant and was analyzed using a hematological autoanalyzer.
Association of age, gender, and BMI of the patient with HB, RBC count, WBC count, and platelet count had been analyzed by means of Chi-square test, Student's t-test (simple or in multiple comparison), and by ANOVA.
- Male and female subjects visiting the regular hematology OPD of the Department of Oral Pathology and Microbiology, KG Medical University, will be included in the study.
- Age = 20–70 years
- Willingness to participate in the study, with an ability to understand and sign written informed consent document
- Participants from the same geographical area to avoid physiologic variance.
- The participant with clinical evidence of hemorrhage
- The participant with clinical evidence of any infection
- The participant with clinical evidence of Fe, folate, Vitamin B12 deficiency
- The participant who has donated blood within 6 months from date
- The participant with clinical evidence of diabetes mellitus
- The participant with clinical evidence of any blood disorder.
| Results|| |
One-way ANOVA test was done for association of hematological parameters age wise; a statistically significant (P < 0.0001) age-dependent decline in HB levels was observed in the age group above 30 years [Graph 1].
On association of hematological parameters gender wise, independent t-test was applied in which mean HB concentration and RBC count was found to be significantly more among males as compared to females, whereas difference in the WBC count and platelet count was found to be statistically nonsignificant [Table 1].
Furthermore, one way ANOVA test for association of BMI age wise, the mean age of subjects was found to increase significantly from subjects with normal weight gr to overweight gr. The mean age of obese subgroup was found to be significantly more than that among overweight subgroup [Graph 2].
Chi-square test was done for association of BMI gender wise. Normal and obese were found to be significantly more among males as compared to females, while underweight and overweight were found to be significantly more among females [Table 2].
In our study, HB concentration did not show any significant difference among the subgroups of BMI category [Graph 3]. Furthermore, when one-way ANOVA test was applied to see any association of BMI with RBC count and platelet count, no significant difference in mean RBC count and platelet count was observed among different subgroups of BMI category [[Table 3] and [Table 4], respectively].
However, the present study showed that the mean WBC count was found to be significantly adequate among normal-weight persons as compared to obese persons when one-way ANOVA test was applied for association of BMI with WBC count [Graph 4].
| Discussion|| |
The hematological parameters of patients who came to the hematology section of the department in the regular OPD services have been studied with the aim of establishing their association with the age, gender, and BMI of the patients. In our study, a statistically significant (P < 0.0001) age-dependent decline in HB levels was observed in the age group above 30 years. Hemoglobin is a unique protein, which is responsible for oxygen and carbon dioxide transportation throughout the body. It is supposed that the hemoglobin amount could change depending on the person's demographics. Partial but similar results were concluded in a study conducted by Payne et al., 2018, in which they suggested that HB concentrations were inversely correlated with age.,
Our results were contrary to a study conducted by Mahlknecht and Kaiser, 2010, in which they concluded that the age-dependent increase in mean corpuscular HB levels was only statistically significant in males (P > 0.0001) and not in females (P = 0.359) and by Al-Mawali et al., 2018, in which they found that very minor differences with no statistical significance in the HB concentration were seen among the different age groups.
Other hematological parameters such as RBC count, WBC count, and platelet count also decreased with age, but the results were statistically nonsignificant. However, Castro et al., 1987, and Kubota et al., 1991, concluded in their study that the hemoglobin concentration, RBC count, and hematocrit value began to decrease in men in their sixth decade and in women in their seventh decade and the change was more prominent with advancing age, especially in men. The WBC count and platelet count tended to decrease with advancing age.
Gender-wise distribution of blood parameters showed that mean HB concentration and RBC count was found to be significantly more among males as compared to females. Our results were similar to a study performed by Omuse et al., 2018, and Rushton et al., 2001, in which they concluded that HB levels were lower while platelet counts were higher in females., Menstruation is the principal cause of iron loss in women. Furthermore, a large number of Indian females of childbearing age do not achieve the recommended daily intake of elemental iron (14.8 mg) from their diet. According to the WHO, women worldwide are at risk of being in a negative iron balance.
In relation to WBC and platelet count gender wise, our results were different from a study conducted by Bain, 1996, in which they concluded that women had higher WBC count and platelet counts than men in all ethnic groups and seem to be a genuine biological difference.
In our study, when BMI was correlated age wise, the mean age of subjects was found to increase significantly from normal people gr to overweight gr. Our results were in accordance with a study conducted by Reas et al., 2007, who concluded that average BMI increased significantly from 23.7 (standard deviation [SD] =3.4) to 25.4 (SD = 3.8), with equivalent increases for both genders. Contrary results were found in a study by Mungreiphy et al., 2011, and Kapoor and Tyagi, 2002, in which they suggested that body weight increased with age till the age of 49 years and slightly decreased after 50 years. The decline in body weight in more advanced age may be attributed to the decrease in muscle mass in response to reduced amount of protein intake as well as decline in number and size of muscle fibers due to degenerative diseases associated with the advancing age. It may partly be due to bones becoming lighter because of gradual mineral mass loss.,
On association of BMI with gender prevalence, normal and obese were found to be significantly more among males as compared to females, while underweight and overweight were found to be significantly more among females. Our results were found to be very similar to Atikovic et al., 2014, who suggested that in comparison to female students, male students had a 2.35 kg/m2 higher BMI, and they are more active in physical activities for 4.06 h in comparison to women. However, Kuan et al., 2011, stated as a conclusion of their study that overall 52.8% of students had normal BMI, with approximately an equal number of both sexes. More males than females were overweight (33.7%), while more females were underweight (25.3%). Furthermore, females were generally more concerned about body weight, body shape, and eating than males. They diet more frequently, had self-induced vomiting, and used laxatives and exercise as their weight-loss strategies.
When BMI was seen in association with HB, RBC, and platelet counts, their concentration did not show any significant difference among various BMI subgroups. Our results were supported by Ghadiri-Anari et al., 2014, according to whom no difference in hemoglobin concentrations was found between all BMI groups,,,, who suggested that BMI had no association with HB, RBC, and platelet count. Whereas, Kannan and Achuthan, 2017, Khakurel et al., 2017, Aishwarya and Saranya, 2017, suggested through their study that association of HB to grades of BMI showed a positive association of hemoglobin with BMI.,, Furthermore, Ausk and Ioannou, 2008, Chen et al., 2009., Jamshidi and Asghar, 2017 and Furuncuoğlu et al., 2016, showed a significant positive association. Further studies with larger sample size should be conducted in order to get the more accurate results.,,,
In the present study, WBC count was found to be significantly more among normal-weight group as compared to underweight and obese groups and the count decreased with altered BMI. WBC and platelet counts are hematologic parameters that can provide useful information regarding the risk for various health conditions. WBCs are necessary for protection against invading organisms and protection of the immune system and so are markers of inflammation. Our results were partly similar to that of Charles et al., 2007, and Bandaru et al., 2013, who found significant WBC count in people with normal weight. In our study, WBC count was found to be more in normal weight subjects, and as WBCs, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders, immunity could be assumed to be max in subjects with normal weight.,
Some have suggested that decreased total lymphocytes in peripheral blood populations had decreased CD8+ T-cell population along with decreased CD4+ T-cells. Obese/underweight subjects also showed reduced lymphocyte proliferative response to mitogen stimulation and dysregulated cytokine expression. Furthermore, another study from Poland even reported BMI to be related to susceptibility to respiratory infections.,
However, contrary to our results, the mean WBC count increased with the increase in BMI in a study performed by Alrubaie et al., 2019. They suggested obesity as the low-grade systemic inflammation which predisposes to WBC elevation. Furthermore, Jamshidi and Asghar, 2017, found a statistically significant positive linear association with WBC count. The results of a study conducted by Furuncuoğlu et al., 2016, showed a relationship between central and general adiposity and WBC count as an inflammation factor.,
| Conclusion|| |
In our study, we found an age-dependent decline in HB levels in the age group above 30 years. The mean age of subjects was found to increase significantly from normal people gr to overweight gr. Normal and obese were found to be significantly more among males. WBC count as related to host immunity was found to be significantly adequate among normal-weight group as compared to underweight and obese groups and the count decreased with altered BMI. However, further studies with larger sample size are required to accurately predict the role of age, gender, and BMI in hematological parameters.
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Conflicts of interest
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| References|| |
Felix CE, Ogodo ND, Ngizi AA. Evaluation of body mass index, hematocrit, erythrocyte sedimentation rate and total protein in voluntary and commercial blood donors in Nigeria: Advocating for simultaneous screening for nutritional status. Int J Blood Transfus Immunohematol 2017;7:26-32.
Ajayi O, Akinbo D. Correlation between body mass index and hematological indices in young adult Nigerians with different hemoglobin genotypes. Am J Biomed Sci 2017;9:38-46.
Ghadiri-Anari A, Nazemian N, Vahedian-Ardakani HA. Association of body mass index with hemoglobin concentration and iron parameters in Iranian population. ISRN Hematol 2014;2014:525312.
Mahlknecht U, Kaiser S. Age-related changes in peripheral blood counts in humans. Exp Ther Med 2010;1:1019-25.
Murphy WG. The Sex Difference in Hemoglobin Levels in Adults - Mechanisms, Causes and Consequences. Blood Rev 2014;12:1-7.
Al-Mawali A, Pinto AD, Al-Busaidi R, Al-Lawati RH, Morsi M. Comprehensive haematological indices reference intervals for a healthy Omani population: First comprehensive study in Gulf Cooperation Council (GCC) and Middle Eastern countries based on age, gender and ABO blood group comparison. PLoS One 2018;13:e0194497.
Grau M, Cremer JM, Schmeichel S, Kunkel M, Bloch W. Comparisons of blood parameters, red blood cell deformability and circulating nitric oxide between males and females considering hormonal contraception: A longitudinal gender study. Front Physiol 2018;9:1835.
Ahmed AE, Ali YZ, Al-Suliman AM, Albagshi JM, Al Salamah M, Elsayid M, et al
. The prevalence of abnormal leukocyte count, and its predisposing factors, in patients with sickle cell disease in Saudi Arabia. J Hematol 2017;8:185-91.
Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA. White blood cell count in women: Relation to inflammatory biomarkers, haematological profiles, visceral adiposity, and other cardiovascular risk factors. J Health Popul Nutr 2013;31:58-64.
Straface E, Gambardella L, Mattatelli A, Canali E, Boccalini F, Agati L, et al.
The red blood cell as a gender-associated biomarker in metabolic syndrome: A pilot study. Int J Cell Biol 2011;2011:204157.
Balduini CL, Noris P. Platelet count and aging. Haematologica 2014;99:953-5.
Breet NJ, Sluman MA, van Berkel MA, van Werkum JW, Bouman HJ, Harmsze AM, et al.
Effect of gender difference on platelet reactivity. Neth Heart J 2011;19:451-7.
Dogan S, Mermer E. Comparison of the hemoglobin amount between old and young persons in Bosnia and Herzegovina. J Biometr Biostat 2017;08:15-24.
Payne CF, Davies JI, Gomez-Olive FX, Hands KJ, Kahn K, Kobayashi LC, et al.
Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population. J Epidemiol Community Health 2018;72:796-802.
Castro OL, Haddy TB, Rana SR. Age- and sex-related blood cell values in healthy black Americans. Public Health Rep 1987;102:232-7.
Kubota K, Shirakura T, Orui T, Muratani M, Maki T, Tamura J, et al.
Changes in the blood cell counts with aging. Nihon Ronen Igakkai Zasshi 1991;28:509-14.
Omuse G, Maina D, Mwangi J, Wambua C, Radia K, Kanyua A, et al.
Complete blood count reference intervals from a healthy adult urban population in Kenya. PLoS One 2018;13:e0198444.
Rushton DH, Dover R, Sainsbury AW, Norris MJ, Gilkes JJ, Ramsay ID. Why should women have lower reference limits for haemoglobin and ferritin concentrations than men? BMJ 2001;322:1355-7.
Bain BJ. Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 1996;49:664-6.
Reas DL, Nygård JF, Svensson E, Sørensen T, Sandanger I. Changes in body mass index by age, gender, and socio-economic status among a cohort of Norwegian men and women (1990-2001). BMC Public Health 2007;7:269.
Mungreiphy NK, Kapoor S, Sinha R. Association between BMI, blood pressure, and age: Study among Tangkhul Naga Tribal males of North East India. J Anthropol 2011;4:1-6.
Kapoor S, Tyagi S. Fatness, fat patterns and changing body dimenions with age in adult males of a high altitude population. In: Bhasin MK, Malik SL, editors. Science of Man in the Service of Man. Vol. 8. 2002. p. 129.
Atikovic A, Hodzic S, Bilalic J, Mahinovik J. Gender differences in body mass index and physical activity of students of the University of Tuzla. J Phys Med 2014;6:183-92.
Kuan PX, Ho HL, Shuhaili MS, Siti AA, Gudum HR. Gender differences in body mass index, body weight perception and weight loss strategies among undergraduates in Universiti Malaysia Sarawak. Malays J Nutr 2011;17:67-75.
Akram G, Narjes N, Hassan-Ali V. Association of body mass index with haemoglobin concentration and iron parameters in Iranian population. Hematology 2014;52:312-3.
Manal IH, Ayat RA, Amal Z. Study of haemoglobin level and body mass index among preparatory year female students at Taibah University, Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2013;8:160-6.
Alrubaie A, Majid S, Alrubaie S, Kadhim FA. Effects of body mass index (BMI) on complete blood count parameters. Pren Med Argent Junio 2019;105:164-71.
Kannan U, Achuthan A. Correlation of Hemoglobin concentration with Body Mass Index among medical students. Indian J Clin Anat Physiol 2017;4:227-30.
Khakurel G, Chalise S, Pandey N. Correlation of hemoglobin level with body mass index in undergraduate medical students. Indian J Basic Appl Med Res 2017;6:318-23.
Aishwarya D, Saranya S. Body mass index based anemic status among children who are attending the pediatrics ward of southern part of Chennai - A prospective study. Int Arch Integr Med 2017;4:202-6.
Ausk KJ, Ioannou GN. Is obesity associated with anaemia of chronic disease? A population-based study. Obesity 2008;16:2356-61.
Chen SB, Lee YC, Ser KH. Serum C-reactive protein and white blood cell count in morbidly obese surgical patients. Obesity Surg 2009;19:461-6.
Jamshidi L, Asghar S. Association between obesity, white blood cell and platelet count. Eur Rev Med Pharmacol Sci 2016;20:1300-6.
Furuncuoğlu Y, Tulgar S, Dogan AN, Cakar S, Tulgar YK, Cakiroglu B. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: A retrospective study. Eur Rev Med Pharmacol Sci 2016;20:1300-6.
Charles LE, Fekedulegn D, McCall T, Burchfiel CM, Andrew ME, Violanti JM. Obesity, white blood cell counts, and platelet counts among police officers. Obesity (Silver Spring) 2007;15:2846-54.
Bandaru P, Rajkumar H, Nappanveetti G. The impact of obesity on immune response to infection and vaccine: An insight into plausible mechanisms. Endocrinol Metab Synd 2013;2:2-9.
Ylöstalo P, Suominen-Taipale L, Reunanen A, Knuuttila M. Association between body weight and periodontal infection. J Clin Periodontol 2008;35:297-304.
Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Rana SR. Impact of obesity in the critically ill trauma patient: A prospective study. J Am Coll Surg 2006;203:533-8.
[Table 1], [Table 2], [Table 3], [Table 4]