Baseline neutrophil-to-lymphocyte ratio is associated with long-term T2D remission after metabolic surgery

  • Aldo BonaventuraEmail author
  • Luca Liberale
  • Federico Carbone
  • Alessandra Vecchié
  • Alice Bonomi
  • Nicola Scopinaro
  • Giovanni Bruno Camerini
  • Francesco Saverio Papadia
  • Davide Maggi
  • Renzo Cordera
  • Franco Dallegri
  • Giovanni Adami
  • Fabrizio Montecucco
Original Article



Metabolic surgery is considered as a therapeutic option for obese patients with type 2 diabetes (T2D). In order to identify novel laboratory variables that could improve the selection of patients who might greatly benefit from a surgical approach, we focused on the neutrophil-to-lymphocyte ratio (NLR) as a predictor of long-term T2D remission following metabolic surgery.


Thirty-one obese patients with T2D included in this pilot study underwent Roux-en-Y gastric bypass or biliopancreatic diversion (BPD) at the Surgical Department of Genoa University, IRCCS Ospedale Policlinico San Martino in Genoa (Italy). Before surgery, serum samples were collected to evaluate blood count, glycemic profile, and circulating neutrophil degranulation products.


The median age was 56 years, median body mass index (BMI) was 32.37 kg/m2, and median glycated hemoglobin was 8.4%. White blood cell count was in a range of normality, with a median NLR of 1.97. By a receiver operating characteristic curve analysis, NLR has been found to be significantly associated with T2D remission at 1, 3, and 5 years and the best cutoff of ≤ 1.97 has been identified by Youden index. When comparing study groups according to NLR cutoff, those with NLR ≤ 1.97 were older and underwent more often BPD. By a logistic regression analysis, NLR ≤ 1.97 has been found to predict T2D remission across 5 years, irrespective of baseline BMI.


A baseline low NLR is associated with long-term T2D remission in obese patients undergoing metabolic surgery, suggesting that circulating inflammatory cells (i.e., neutrophils) might negatively impact on T2D remission.


Type 2 diabetes Metabolic surgery Neutrophil-to-lymphocyte ratio Diabetes remission Inflammation 



This study was supported by a Grant from the Rete Cardiologica from the Italian Ministry of Health to Fabrizio Montecucco.

Authors’ contributions

NS, GBC, and FSP recruited patients and made the surgical intervention. ABona, LL, FC, AV, and FM analyzed samples by ELISA. ABono gave help for the statistical analysis. ABona wrote the manuscript. RC, FD, GA, DM, and FM read critically the manuscript and gave suggestions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in the study were conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all patients included in the present study.

Supplementary material

592_2019_1345_MOESM1_ESM.pdf (12 kb)
Type 2 diabetes remitters and non-remitters across the whole follow-up period (PDF 11 kb)
592_2019_1345_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 17 kb)


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Aldo Bonaventura
    • 1
    • 2
    Email author
  • Luca Liberale
    • 1
    • 3
  • Federico Carbone
    • 1
  • Alessandra Vecchié
    • 1
    • 2
  • Alice Bonomi
    • 4
  • Nicola Scopinaro
    • 5
    • 6
  • Giovanni Bruno Camerini
    • 6
  • Francesco Saverio Papadia
    • 6
  • Davide Maggi
    • 7
  • Renzo Cordera
    • 7
  • Franco Dallegri
    • 1
    • 8
  • Giovanni Adami
    • 5
    • 6
  • Fabrizio Montecucco
    • 8
    • 9
  1. 1.First Clinic of Internal Medicine, Department of Internal MedicineUniversity of GenoaGenoaItaly
  2. 2.Division of Cardiology, Department of Internal Medicine, Pauley Heart CenterVirginia Commonwealth UniversityRichmondUSA
  3. 3.Center for Molecular CardiologyUniversity of ZürichSchlierenSwitzerland
  4. 4.Centro Cardiologico MonzinoIRCCSMilanItaly
  5. 5.International Federation of Surgery for ObesityGenoaItaly
  6. 6.Department of Surgery, University of GenoaIRCCS Ospedale Policlinico San MartinoGenoaItaly
  7. 7.Diabetology Unit, Department of Internal MedicineUniversity of GenoaGenoaItaly
  8. 8.IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular NetworkGenoaItaly
  9. 9.First Clinic of Internal Medicine, Deparment of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR)University of GenoaGenoaItaly

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