Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.

中文翻译：

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二手烟与中性粒细胞-淋巴细胞比率升高有关，并且与体育锻炼无关，对增加2型糖尿病的易感性具有协同作用：基于社区的病例对照研究。

二手烟（SHS）和缺乏体育活动被认为与2型糖尿病（T2DM）有关，但是尚未评估SHS与缺乏体育活动的协同作用以及它们与T2DM相关的炎症生物标志物的关系。我们调查了SHS暴露和缺乏运动的作用及其对T2DM风险的协同作用，以及它们与T2DM相关的炎症生物标志物，中性白细胞-淋巴细胞比（NLR）和白细胞（WBC）的关系。印度尼西亚五个社区诊所的588名参与者（294例T2DM和294名健康对照）参加了病例对照研究。参与者完成了关于人口统计信息，吸烟状况，体育锻炼习惯和食物消费的标准化问卷。使用自动血液分析仪确定白细胞和NLR水平。使用多元逻辑回归模型分析调整后的优势比（AOR）和95％置信区间（CI）。使用加性相互作用进行逻辑回归分析协同效应。与未接触SHS且身体活动的人相比，接触SHS的身体不活动的人表现出的T2DM协同风险增加了7.78倍。SHS与高NLR，白细胞显着相关，并且与身体不活动对增加对T2DM的易感性具有协同作用。与没有接触过SHS和身体活动的人相比，身体不活跃的人接触SHS的人患T2DM的风险增加了7.78倍。SHS与高NLR，白细胞显着相关，并且与身体不活动对增加对T2DM的易感性具有协同作用。与没有接触过SHS和身体活动的人相比，身体不活跃的人接触SHS的T2DM风险增加了7.78倍。SHS与高NLR，白细胞显着相关，并且与身体不活动对增加对T2DM的易感性具有协同作用。