Analysis of the Relationship between Neutrophil-Lymphocyte Ratio (NLR) Values and Body Mass Index in Tuberculosis Patients
DOI:
https://doi.org/10.26630/jk.v17i1.5529Keywords:
Immune regulation, Inflammatory biomarker, Nutritional statusAbstract
Tuberculosis (TB) is a communicable infectious disease that remains a major public health problem, particularly in Indonesia. Low nutritional status can impair immune function and worsen the clinical course of TB. Body Mass Index (BMI) is commonly used to measure nutritional status. In contrast, the neutrophil–lymphocyte ratio (NLR) is a simple inflammatory biomarker reflecting the balance between innate and adaptive immune responses. This study aimed to analyze the relationship between NLR and BMI among TB patients undergoing treatment. This cross-sectional study involved 32 tuberculosis patients receiving treatment at Puskesmas Sukabumi, Bandar Lampung. NLR values were obtained from blood tests using a hematology analyzer and calculated as the neutrophil count divided by the lymphocyte count. BMI was determined from body weight and height measurements. Statistical analysis included Spearman's correlation test to examine the relationship between NLR and BMI, and a One-Way ANOVA to assess differences in NLR across BMI classifications. The results showed that the mean BMI was 20.4±3.0 kg/m², and the median NLR was 2.7. A significant negative correlation was found between BMI and NLR (r = -0.379; p = 0.03), indicating that lower BMI was associated with higher NLR. Significant differences in NLR were also observed among BMI categories (p = 0.003), with underweight subjects demonstrating the highest NLR values. These findings suggest a relationship between nutritional status and systemic inflammatory responses in TB patients. BMI and NLR may serve as simple indicators for assessing inflammatory status and monitoring treatment progress in tuberculosis patients.
References
Bintanah, S., Nugraha, S. E., Ulvie, Y. N. S., & Purwaningsih, S. (2024). The Relationship Between Nutritional Status With Neutrophil Levels and Neutrophil Lymphocyte Ratio of Pulmonary Tuberculosis in Ario Wirawan Pulmonary Hospital Salatiga. 2nd Lawang Sewu International Symposium on Health Sciences: Nutrition (LSISHSN 2023) (pp. 175-186). Atlantis Press. https://doi.org/10.2991/978-94-6463-550-8_19
Cho, S. H., Lee, H., Kwon, H., Shin, D. W., Joh, H. K., Han, K., Park, J. H., & Cho, B. (2022). Association of underweight status with the risk of tuberculosis: a nationwide population-based cohort study. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-20550-8
Dragomir, R., Dragomir, A., Negru, A., Săftescu, S., Popovici, D., Schenker, M., Lupușoru, R., & Negru, Șerban. (2021). Role of combining neutrophil to lymphocyte ratio and pretreatment body mass index in predicting progression free survival in patients with non small cell lung cancer treated with nivolumab. Experimental and Therapeutic Medicine, 21(5). https://doi.org/10.3892/etm.2021.9958
Feldman, C., Theron, A. J., Cholo, M. C., & Anderson, R. (2024). Cigarette Smoking as a Risk Factor for Tuberculosis in Adults: Epidemiology and Aspects of Disease Pathogenesis. Pathogens, 13(2). https://doi.org/10.3390/pathogens13020151
Lampung Provincial Government Health Service. (2025). Health Profile of Lampung Province 2024. Lampung.
Lagunas-Rangel, F. A. (2025). Neutrophil-to-lymphocyte ratio in aging: Trends and clinical implications. Experimental Gerontology (Vol. 211). https://doi.org/10.1016/j.exger.2025.112908
Li, Y., Cheng, J., Bai, X., Zheng, J., Mao, P., & Zhou, X. (2025). Impact of body mass index on mortality rates in tuberculosis: A systematic review and meta-analysis. Pakistan Journal of Medical Sciences, 41(6), 1836–1844. https://doi.org/10.12669/pjms.41.6.11722
Liu, Q. X., Tang, D. Y., Xiang, X., & He, J. Q. (2022). Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis. Frontiers in Cellular and Infection Microbiology, 12. https://doi.org/10.3389/fcimb.2022.1013751
Mansyur, S. I., Ramdani, A. H., & Santoso, K. (2018). Hubungan bakteri mycobacterium tuberculosis dengan nilai laju endap darah (led) dan nilai rasio neutrofil limfosit (rnl) pada penderita tuberkulosis baru di Puskesmas Se-Kota Kediri. Prosiding SINTESIS (Seminar Nasional Sains, Teknologi dan Analisis). https://www.prosidingonline.iik.ac.id/index.php/sintesis/article/view/49
Ministry of Health Republic Indonesia. (2021). Strategi Nasional Penanggulangan Tuberkulosis di Indonesia 2020-2024. Jakarta.
Ministry of Health Republic Indonesia. (2023). Laporan Program Penanggulangan Tuberkulosis Tahun 2023. Jakarta.
Regina, P. M., Silaen, J. C., & Sembiring, S. (2024). Neutrophil-Lymphocyte Ratio and Nutritional Status as Parameters of Sputum Conversion in MDR-TB Before & After 3 Months of Anti-TB Treatment. Jurnal Respirasi, 10(2), 137–142. https://doi.org/10.20473/jr.v10-i.2.2024.137-142
Rinawati, S. A. W. (2021). Indeks Massa Tubuh (IMT) Pasien Tuberkulosis Resisten Obat dan Kecenderungannya Terhadap Efek Samping Pengobatan. Jurnal Teknologi Kesehatan (Journal of Health Technology), 17(1), 1–5. https://e-journal.poltekkesjogja.ac.id/index.php/JTK/article/view/988
Song, M., Graubard, B. I., Rabkin, C. S., & Engels, E. A. (2021). Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-020-79431-7
Uzun, H., Fenercioglu, A. K., Senyigit, A., & Can, G. (2025). Relationship Between Nutritional Status and Systemic Immune–Inflammation Indices Across BMI Categories. Nutrients, 17(23). https://doi.org/10.3390/nu17233799
VanValkenburg, A., Kaipilyawar, V., Sarkar, S., Lakshminarayanan, S., Cintron, C., Prakash Babu, S., Knudsen, S., Joseph, N. M., Horsburgh, C. R., Ellner, J. J., Narasimhan, P. B., Johnson, W. E., Hochberg, N. S., & Salgame, P. (2022). Malnutrition leads to increased inflammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.1011166
World Health Organization. (2025). Global Tuberculosis Report 2025. Geneva.
Zahorec, R. (2021). Neutrophil-to-lymphocyte ratio, past, present, and future perspectives. Bratislava Medical Journal, 122(7), 474–488. https://doi.org/10.4149/BLL_2021_078
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Wahyu Nurfiyana, A. Zakaria Amien
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish in this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as this can lead to productive exchanges and earlier and greater citations of published work.
