White Blood Cell Count and the Risk of Hyperglycemia according to Smoking Status

BACKGRUOND: Recently, inflammation has been associated with insulin resistance and the development of type 2 diabetes mellitus. We investigated the relationship between white blood cell (WBC) count and the incidence of hyperglycemia and the interactive effects of smoking and elevated WBC count on hyperglycemia. METHODS: We prospectively examined 6,734 Korean males without IFG (fasting plasma glucose concentration of > or = 110 mg/dL) or type 2 diabetes mellitus from 1994 to 2002. We divided WBC counts into 4 groups: 2.9~5.9 (reference quartile), 6.0~6.9, 7.0~8.1, 8.2~16.5 (x10(3) cells/microliter), respectively. The odds ratios were calculated by multiple logistic regression according to WBC quartiles after adjusting for predictive risk factors of type 2 diabetes mellitus. Also the odds ratios were calculated after stratification according to smoking status. RESULTS: Compaired to reference quartile, the odds ratio for hyperglycemia was 1.09 (95% CI, 0.91~1.30), 1.17 (95% CI, 0.99~1.40), 1.34 (95% CI, 1.12~1.60) (P value for trend=0.0009), respectively. And the odds ratio for IFG or type 2 diabetes mellitus was 1.08 (95% CI, 0.83~1.42), 1.16 (95% CI, 0.89~1.50), 1.28 (95% CI, 1.00~1.65) (P value for trend=0.0395) among the current smoking group, respectively. CONSLUSION: Our findings demonstrate that an elevated WBC count is associated with an increased risk of hyperglycemia, particularly in current and former smokers. These results support our hypothesis that inflammation increases the risk of hyperglycemia.

White Blood Cell Count and the Risk of Colon Cancer

Inflammation may be linked to the pathogenesis of colorectal cancer. However, two conflicting observational results were recently reported on the relationship between the inflammatory marker C-reactive protein (CRP) and the risk of colorectal cancer. Few epidemiologic studies have examined the association between inflammatory markers and the risk of colorectal cancer. We prospectively examined the mortality and incidence risk for colon and rectal cancers among 424,419 Koreans (108,907 men and 315,512 women). The subjects were 40 to 95 years of age and from the Korean Cancer Prevention Study (KCPS) cohort. All subjects received medical examination from the National Health Insurance Corporation in 1993 and 1995. The maximum follow-up period was 10 years, and the follow-up periods began in January 1, 1994 and ended in December 31, 2003. An elevated white blood cell count (WBC) was associated with a higher mortality risk of colon cancer (highest versus lowest quartile: men, 1.55, 95% CI 1.10-2.18, p for trend = 0.0014; women, 1.51, 95% CI 1.12- 2.03, p for trend = 0.0049). Similarly, an elevated WBC was associated with a higher incidence risk of colon cancer (highest versus lowest quartile: men, 1.38, 1.09-1.76, p for trend = 0.0017; women, 1.46, 95% CI 1.20-1.78, p for trend= 0.0003). A positive linear trend was also observed in non- smokers. There was no significant association between WBC and the risk of rectal cancer. Our findings demonstrate that an elevated WBC is associated with an increase in both the mortality and incidence rates of colon cancer. These results support our hypothesis that inflammation increases the risk of colon cancer.

Norovirus Outbreak after a School Trip among Girls' High School Students

Norovirus is one of the common causative agents of viral gastroenteritis in developed countries. A large outbreak of gastroenteritis occurred among girls' high school students in Cheongju city, Chungbuk province, who had attended a school trip to Cheju island from 19 to 21 May 2003. One hundred and ninety six students were consistent with case definition and attack rate was 54.9%. The epidemic curve was characteristic of a point-source outbreak. The frequency of diarrhea was 1 to 6 times (76.8%) and the duration of diarrhea was within two days (85.1%) in most cases. The most common symptom with diarrhea was abdominal pain followed by headache, tenesmus, febrile sense, chill and vomiting. The following bacterial organisms, Salmonella spp, Shigella spp, Vibrio spp, Staphylococcus aureus, and E coli O157 were examined in 196 stool specimens, but no suspicious organism was detected. In virological examinations, Norovirus was dectected in 3 out of 25 stool specimens from the sick students. Among the 22 stool specimens of the food handlers during the school trip, both bacterial and virological examinations were all negative. Among the 13 environmental specimens, the groundwater of the hotel, where the students had stayed during their school trip, was contaminated with general bacteria and E. Coli. However, we could not detect Norovirus in the groundwater of the hotel. We concluded that Norovirus might be a possible cause of this outbreak, and the water supply of the hotel might be a probable source of this outbreak.