{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:58:19Z","timestamp":1790931499307,"version":"4.1.0"},"reference-count":32,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insulin resistance (IR) is a key mechanism underlying type 2 diabetes mellitus and cardiometabolic disease. Although obesity-related inflammation is a major contributor to IR, increasing evidence indicates that IR may also develop in non-obese individuals. However, readily available inflammatory markers applicable to this population remain limited. We evaluated the association between inflammatory markers and insulin resistance in non-obese adults and assessed their predictive performance across body mass index (BMI) strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cross-sectional study included 149 non-obese adults (BMI &lt; 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) evaluated in an internal medicine outpatient clinic between January and December 2025. Insulin resistance was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) \u2265 2.5. Inflammatory markers and composite indices, including the C-reactive protein to high-density lipoprotein cholesterol (CRP\/HDL) ratio, were calculated. Multivariable logistic regression, BMI-stratified analyses, and receiver operating characteristic (ROC) curve analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Insulin resistance was identified in 54 participants (36.2%). Individuals with IR had higher white blood cell (WBC) counts, CRP levels, and CRP\/HDL ratios (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). In multivariable analysis, WBC count was independently associated with IR (OR = 1.407, 95% CI [1.090\u20131.815];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009). BMI-stratified analyses showed that WBC count independently predicted IR in normal-weight individuals (OR = 1.789, 95% CI [1.218\u20132.627];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), whereas in overweight participants (BMI 25\u201330 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), the CRP\/HDL ratio was independently associated with IR (OR = 7.793, 95% CI [1.056\u201357.499];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.044). ROC analyses demonstrated higher discriminative performance of WBC count in normal-weight individuals (AUC = 0.720) and greater predictive ability of the CRP\/HDL ratio in overweight individuals (AUC = 0.695).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low-grade systemic inflammation is independently associated with insulin resistance in non-obese adults, with distinct inflammatory predictors across BMI categories. WBC count may reflect early immune activation in normal-weight individuals, whereas the CRP\/HDL ratio appears more informative among overweight subjects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21769","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:50:23Z","timestamp":1790931023000},"page":"e21769","source":"Crossref","is-referenced-by-count":0,"title":["Body mass index\u2013stratified inflammatory predictors of insulin resistance in non-obese adults: a retrospective study"],"prefix":"10.7717","volume":"14","author":[{"given":"Aycan","family":"Acet","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Departmant of Internal Medicine, K\u00fctahya Health Sciences University, K\u00fctahya,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turkan","family":"Pasali Kilit","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Departmant of Internal Medicine, K\u00fctahya Health Sciences University, K\u00fctahya,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sertas","family":"Erarslan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Departmant of Internal Medicine, K\u00fctahya Health Sciences University, K\u00fctahya,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cumali","family":"Yal\u00e7\u0131n","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Departmant of Internal Medicine, Division of Hematology, K\u00fctahya Health Sciences University, K\u00fctahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"\u00d6zl\u00fc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Departmant of Internal Medicine, Division of Hematology, K\u00fctahya Health Sciences University, K\u00fctahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c7a\u011fla","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Departmant of Family Medicine, K\u00fctahya Health Sciences University, K\u00fctahya,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"10.7717\/peerj.21769\/ref-1","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1016\/j.dsx.2019.01.041","article-title":"How the association between obesity and inflammation may lead to insulin resistance and cancer","volume":"13","author":"Amin","year":"2019","journal-title":"Diabetes Metabolic syndrome"},{"key":"10.7717\/peerj.21769\/ref-2","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1177\/1076029612475023","article-title":"Higher neutrophil to lymhocyte ratio in patients with metabolic syndrome","volume":"19","author":"Balta","year":"2013","journal-title":"Clinical and Applied Thrombosis\/Hemostasis"},{"key":"10.7717\/peerj.21769\/ref-3","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.2337\/dc10-0619","article-title":"Black-white divergence in the relation of white blood cell count to metabolic syndrome in preadolescents, adolescents, and young adults: the Bogalusa heart study","volume":"33","author":"Chen","year":"2010","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.21769\/ref-4","doi-asserted-by":"publisher","first-page":"773","DOI":"10.2337\/db09-9028","article-title":"Banting lecture. 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