The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of depression among US adults: A cross-sectional NHANES study

Association of uric acid/high-density lipoprotein cholesterol ratio (UHR) with depression risk in US adults: A cross-sectional study

BACKGROUND

The uric acid/high-density lipoprotein cholesterol ratio (UHR) is a new indicator of inflammation and metabolism that has been found to be strongly associated with several chronic diseases. However, the relationship between the UHR and depression has not been studied to date.

METHODS

The study included a total of 16,920 participants aged 20 years and older from NHANES 2005-2018. Logistic regression models with weights were used to evaluate the association between quintile levels of UHR and depression risk.

RESULTS

Elevated UHR levels were significantly associated with a 52 % increased risk of depression after multivariable adjustment (Q5 OR: 1.52, 95 % CI: 1.26, 1.83, P-trend <0.001). We found a significant interaction between UHR level and sex (P = 0.018), but no significant interaction between UHR and other factors, including age, smoking, alcohol consumption, education level, marital status, household income poverty ratio and physical activity. Stratified analyses of these factors showed that high levels of UHR were significantly associated with risk of depression in groups who were female, younger, had never smoked, were alcohol drinkers, had higher levels of education, were cohabiters, had the highest and lowest household incomes, and were physically active.

CONCLUSION

In conclusion, UHR was positively associated with an increased risk of depression, suggesting that UHR levels can be used as a comprehensive indicator for the early identification of depression risk.

The association between red blood cell distribution width-to-albumin ratio and risk of depression: A cross-sectional analysis of NHANES

BACKGROUND

The red blood cell distribution width-to-albumin ratio (RAR) serves as an indicator of systemic inflammation and nutritional status. This study examines the relationship between RAR and depressive disorder in U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

We applied logistic regression to evaluate the link between RAR and depressive risk, with its corresponding odds ratios (OR) and 95 % confidence intervals (CI) calculated. Restricted cubic spline (RCS) was adopted to assess the potential linear association, while the receiver operating characteristic (ROC) curve was used to evaluate the ability of RAR to predict the depressive risk, with the result presented as an area under the curve (AUC).

RESULTS

After adjusting for relevant covariates, a positive association between RAR and clinically relevant depression persisted (OR = 1.33, 95 % CI: 1.18-1.51, P < 0.001). Participants in the highest RAR quartile exhibited a greater risk of clinically relevant depression than those in the lowest quartile (OR = 1.36, 95 % CI: 1.10-1.67, P = 0.005). A linear relationship between RAR and clinically relevant depression was identified (P for non-linear = 0.473), with RAR showing a strong predictive ability for depressive risk (AUC = 0.7467). Stratified analysis showed significant interactions among smoking (P = 0.045), marital status (P < 0.001), and RAR's effect on depression outcome.

CONCLUSIONS

Elevated RAR is independently linked to clinically relevant depression, indicating its potential as a novel biomarker for mental health risk assessment. Further longitudinal studies are necessary to establish causality and evaluate its clinical relevance.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD): data from the NHANES III (1988-1994)

BACKGROUND

The prognostic value of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. This study aimed to evaluate the associations between the NHHR and all-cause and cause-specific mortality in patients with MASLD.

METHODS

Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES III and the National Death Index (NDI). The NHHR was calculated according to the formula. The results of mortality associated with the NDI were recorded as of December 31, 2019. We used a multivariate Cox proportional hazard model and restricted cubic spline (RCS) regression to assess the associations between the NHHR and all-cause and cause-specific mortality. In addition, subgroup analyses were performed to explore the relationships between the NHHR and all-cause and cause-specific mortality.

RESULTS

This study included 3155 patients with a definite diagnosis of MASLD. A total of 1,381 (43.8%) patients with MASLD died, and 1,774 (56.2%) survived. Multivariate Cox proportional hazards model analysis showed that NHHR was not significantly associated with all-cause mortality in MASLD patients. The RCS curve showed a significant nonlinear trend between the NHHR and all-cause mortality in patients with MASLD. Subgroup analysis revealed that the NHHR was better suited to predict cardiovascular mortality in patients without advanced fibrosis.

CONCLUSIONS

Our study revealed the clinical value of the NHHR in the prediction of mortality in the MASLD population. The NHHR can be used as a biomarker for follow-up in people without advanced fibrosis.

Association between dietary patterns and suicide ideation among depressed adults: Insights from NHANES 2007-2020

BACKGROUND

Dietary patterns are strongly linked to the risk of major depressive disorder (MDD). However, research on the relationship between dietary patterns and MDD with suicidal ideation (MDD + SI) are limited. The Healthy Eating Index (HEI)-2015, Dietary Inflammatory Index (DII), Comprehensive Dietary Antioxidant Index (CDAI), Oxidative Balance Score (OBS), and Dietary Index for Gut Microbiota (DI-GM) are five validated tools for assessing dietary patterns based on inflammation, antioxidant capacity, and gut microbiota diversity. This study aims to investigate the association between these dietary indices and MDD + SI.

METHODS

A total of 23,621 participants from the 2007-2020 National Health and Nutrition Examination Survey were included in this study. MDD and SI were assessed using the PHQ-9. Weighted multivariable logistic regression, subgroup analyses, and restricted cubic spline (RCS) models were applied to analyze the relationships between five dietary indices and the risks of MDD and MDD + SI.

RESULTS

All five dietary indices showed associations with MDD to varying degrees; however, only DI-GM exhibited a significant negative association with MDD + SI after adjustment for confounding factors. Subgroup and stratified linear trend analyses revealed that this association was stronger among former smokers, obese individuals and those with hypertension or diabetes. RCS analysis showed a significant non-linear relationship between DI-GM and MDD, while a significant linear dose-response relationship was observed for DI-GM and MDD + SI.

LIMITATIONS

Cross-sectional study designs cannot establish causality.

CONCLUSION

The findings of this study revealed a significant association between DI-GM and MDD + SI. Dietary interventions that promote gut microbiota diversity may help reduce the risk of MDD + SI.

Study on the relationship between the non-HDL/HDL cholesterol ratio (NHHR) and endometriosis: a cross-sectional analysis utilizing the NHANES dataset

BACKGROUND

Numerous previous studies have suggested dyslipidemia is possibly linked to endometriosis (EMs). The connection between endometriosis and NHHR remains largely unexplored. Thus, this investigation examined whether NHHR is correlated with endometriosis development among adult women in the United States of America.

METHODS

Data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) were analyzed in a cross-sectional study, with a final sample of 4,990 participants. To investigate the potential association between NHHR and the likelihood of developing endometriosis, we employed two statistical models: a weighted multivariate logistic regression model and a restricted cubic spline model. Data visualization included scatter plots with locally estimated scatterplot smoothing (LOESS) curves to illustrate the relationship between NHHR and the probability of endometriosis. To ensure the reliability of our findings, we subsequently conducted subgroup analyses and interaction tests to assess their stability.

RESULTS

In this study, after accounting for all potential confounders, it was found that for every one-point elevation in NHHR, the risk of developing endometriosis increased by 17% (95% CI: 1.05-1.35, p = 0.04). A linear dose-response association was identified that connected NHHR with the risk of endometriosis (P for nonlinear = 0.1315). Interaction results from subgroup analyses suggested that an association between NHHR and risk of endometriosis was largely unaffected by race, educational background, or marital status, among others.

CONCLUSION

NHHR and the probability of developing endometriosis are significantly correlated in the U.S. population, suggesting that further research on NHHR could assist in non-invasive diagnosis of endometriosis.

Investigating the association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and tinnitus: Evidence from a nationally representative observational study

BACKGROUND

Tinnitus, a condition with substantial psychological and physical implications, significantly impacts quality of life; however, its relationship with lipid metabolism remains underexplored.

METHODS

This population-based observational study included 4991 participants. Weighted multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and tinnitus. Subgroup and sensitivity analyses were conducted to evaluate the consistency and robustness of findings across sociodemographic and health-related subgroups.

RESULTS

A total of 791 participants reported tinnitus, with a prevalence of 15.85 %. A significant positive association was observed between NHHR and tinnitus risk. In the final model with all covariates adjusted, when NHHR increased by one unit, the risk of tinnitus would increase by 12 % (odds ratio [OR] = 1.12, 95 % confidence interval (CI), 1.02-1.22, P = 0.022). Compared to the lowest NHHR tertile, the highest NHHR tertile had a higher risk of tinnitus (OR = 1.46; 95 % CI, 1.02-2.07, P = 0.040). RCS analysis revealed that NHHR was linearly associated with tinnitus (P for nonlinearity = 0.923). Subgroup analyses confirmed that this association remained stable across various sociodemographic and health subgroups (P for interaction >0.05).

CONCLUSIONS

These findings suggest that NHHR is positively and linearly associated with tinnitus risk, highlighting the essential role of NHHR in the development of tinnitus. The findings underscore the need for integrated metabolic and psychosomatic approaches in tinnitus prevention and management.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and sarcopenia: evidence from CHARLS

Background

Recent studies have highlighted an association between lipid disorders and sarcopenia. The role of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has not been explored among Chinese adults. This study aimed to investigate the association between the NHHR and incident sarcopenia in the Chinese population.

Methods

The study included a total of 4,046 participants aged 50 years and older without a history of sarcopenia, from the China Health and Retirement Longitudinal Study (CHARLS). A multivariate logistic regression model and a restricted cubic spline model were used to investigate the association between NHHR and sarcopenia. Subgroup and sensitivity analyses were conducted to assess the robustness of the findings.

Results

A total of 309 (7.6%) participants were newly diagnosed with sarcopenia in the 2015 wave. Participants in the highest NHHR quartile (≥3.99) had a significantly lower adjusted odds ratio for sarcopenia (OR = 0.40; 95% CI, 0.280.58; p < 0.001) compared with those in the lowest quartile (<2.24). Restricted cubic spline analysis revealed a nonlinear relationship between NHHR and sarcopenia risk (p for nonlinearity <0.05). In piecewise regression models, the adjusted OR for sarcopenia was 0.65 (95% CI, 0.550.78, p < 0.001) among participants with NHHR <4.4, whereas no significant correlation was observed among those with NHHR ≥ 4.4. No significant interactions were found between NHHR and age, sex, hypertension, or diabetes in stratified analysis (p for interaction >0.05).

Conclusion

There is an inverse relationship between NHHR and sarcopenia risk in the Chinese population. A higher NHHR is associated with a lower risk of sarcopenia below the inflection point, beyond which NHHR is no longer significantly associated with sarcopenia risk.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricemia: evidence from the CHARLS study

Background and aims

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an innovative composite lipid measure. This study aims to examine the correlation between NHHR and hyperuricemia in the middle-aged and elderly demographic in China.

Methods

This investigation comprised 4,639 individuals who were devoid of hyperuricemia at baseline in 2011, utilizing data from the China Health and Retirement Longitudinal Study (CHARLS). We utilized multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis to investigate the relationship between NHHR and hyperuricemia.

Results

A total of 499 participants (10.76%) experienced hyperuricemia at the 4-year follow-up. The incidence of hyperuricemia was 176% higher for participants in the highest quartile of NHHR than for those in the lowest quartile (OR 2.76, 95% CI 2.10-3.62, p < 0.001). The risk of hyperuricemia was 64% higher in the highest quartile of NHHR than in the lowest quartile in a fully adjusted model (OR 1.64, 95% CI 1.16-2.31, p = 0.005). The risk of hyperuricemia and NHHR had a linearly positive connection, according to restricted cubic spline (RCS) analysis (P for non-linearity > 0.05). Subgroup analysis showed that among women, non-smokers, and those over 60, the relationship between NHHR and hyperuricemia was more significant.

Conclusion

NHHR and hyperuricemia have a substantial linear positive connection, indicating that NHHR might be used as a tool for assessing hyperuricemia risk and offering valuable information for both prevention and therapy.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a predictor of all cause and cardiovascular mortality in United States adults with NAFLD: a prospective cohort study

BACKGROUND

The non-HDL cholesterol to HDL cholesterol ratio (NHHR) is a novel composite lipid index. However, its relationship with mortality, particularly in individuals with non-alcoholic fatty liver disease (NAFLD), remains unclear. The aim of this study was to explore the association between NHHR and both all-cause and cardiovascular mortality in adults with NAFLD in the United States.

METHODS

This study included 12,648 adult participants with NAFLD from the National Health and Nutrition Examination Survey (NHANES) database (1999-2018). Multivariate Cox proportional hazards models and restricted cubic spline (RCS) methods were employed to assess all-cause and cardiovascular mortality. Subgroup analyses were performed to verify the consistency of these associations.

RESULTS

Over a median follow-up of 99.27 months, 1,659 participants died from all causes, including 460 from cardiovascular disease. RCS analysis revealed a U-shaped relationship between NHHR and all-cause mortality, no association was found between NHHR and cardiovascular mortality. The inflection points for all-cause mortality were 2.67. Subgroup analysis showed that a stronger association between NHHR and all-cause mortality in those with diabetes(P = 0.048).

CONCLUSIONS

NHHR is associated with all-cause mortality in NAFLD patients, with distinct non-linear relationships, while it is not associated with cardiovascular mortality. NHHR monitoring may be valuable for assessing mortality risk, particularly in those with diabetes.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a predictor of NAFLD prevalence and steatosis severity

Altered lipid metabolism is a crucial jeopardy cause for developing non-alcoholic fatty liver disease (NAFLD). Among various lipid metrics, the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) has recently emerged as a promising indicator showing significant potential in predicting the prevalence of NAFLD. This study aimed to provide novel insights for the prevention of NAFLD by examining the relationship between NHHR and the prevalence of NAFLD. To identify the connection between NHHR and NAFLD, this study utilized descriptive analysis, multivariate logistic regression, and restricted cubic spline regression to investigate data collected by the National Health and Nutrition Examination Survey performed from 2017 to 2020. Furthermore, the connection between NHHR and the controlled attenuation parameter (CAP) was assessed using multiple linear regression, smoothed curve fitting, and threshold effect analysis. The NAFLD group showed higher NHHR levels than the non-NAFLD group (2.990 vs 2.240, P < 0.001). Multiple logistic and linear regression analyses indicated significant positive associations between NHHR and its quartiles with both the prevalence of NAFLD and CAP levels. Additionally, NHHR was positively associated with the prevalence of NAFLD in a linear dose-response relationship. Furthermore, smoothed curve fitting demonstrated a positive relationship between NHHR and CAP, with a threshold effect at an inflection point of 3.398. Higher NHHR levels were significantly associated with the prevalence of NAFLD and steatosis, and maintaining NHHR in the appropriate range may reduce these conditions.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and Helicobacter pylori infection

Evidence on the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and Helicobacter pylori (H. pylori) infection remains limited. This study investigates this correlation based on the U.S. population. This cross-sectional research included data on 834 U.S. participants from the National Health and Nutrition Examination Survey 1999-2000. The association between the NHHR and H. pylori infection was examined using logistic regression models, restricted cubic spline (RCS) curve and subgroup analyses. Individuals with H. pylori infection exhibited significantly higher NHHR value. A significant positive association between NHHR and H. pylori infection was observed across all three models, even after adjusting for potential confounders, with a stronger association noted in males, individuals under 60 years of age, and non-Hispanic White participants. These findings suggest NHHR may act as a non-invasive biomarker for detecting H. pylori infection in U.S. populations.

Non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio as a biomarker for liver health: Insights from National Health and Nutrition Examination Survey data

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), a lipid-related biomarker, remains underexplored in relation to the risk of advanced fibrosis and hepatic steatosis. The present study aimed to investigate the potential association between the NHHR and these hepatic conditions. A total of 6,907 individuals aged 20 years and older from the National Health and Nutrition Examination Survey 2017-2020 were included in the present study. Advanced fibrosis and hepatic steatosis were assessed using hepatic vibration-controlled transient elastography. Multivariate regression analysis and subgroup analysis were performed to explore the independent association between the NHHR and the presence of advanced fibrosis and hepatic steatosis. Among the 6,907 adults included in the present study (mean age, 50.56±17.21 years; 3,398 male patients and 3,509 female patients), 409 (5.92%) were diagnosed with advanced fibrosis and 3,034 (43.93%) were diagnosed with hepatic steatosis. Following multivariable adjustment (age, sex, ethnicity, education level, family income-to-poverty ratio, smoking status, alcohol use and vigorous physical activity), logistic regression analysis demonstrated that an elevated NHHR was positively associated with increased possibility for advanced fibrosis [odds ratio (OR), 1.10; 95% confidence interval (CI), 1.03-1.17; P=0.005]. The restricted cubic spline model indicated a linear dose-response association between the NHHR and advanced fibrosis. The NHHR also exhibited a significant association with a higher risk of hepatic steatosis after full adjustment for covariates (OR, 1.61; 95% CI, 1.53-1.68; P<0.001). Using a two-segment linear regression model, an S-shaped relationship was identified between the NHHR and hepatic steatosis, with an inflection point at 3.83. In conclusion, the present study established a robust association of the NHHR with advanced fibrosis and hepatic steatosis. The NHHR may serve as a straightforward anthropometric index for predicting these conditions.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of ischemic heart disease in type 2 diabetes mellitus participants: a large-scale cohort study from the UK Biobank

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator used for assessing the risk of cardiovascular diseases. This study was performed to explore the association between NHHR and the risk of ischemic heart disease (IHD) in type 2 diabetes mellitus (T2DM) patients.

METHODS

This large-scale prospective cohort study included 19,925 participants from the UK Biobank. Cox proportional hazards regression models were used to assess the association between the NHHR and the risk of IHD in T2DM participants and restricted cubic spline (RCS) analysis was conducted to assess the dose-response association. Subgroup analysis and several sensitivity analyses were carried out to examine the robustness of our findings.

RESULTS

During the follow-up (median 12.7 years), 3,600 T2DM participants developed IHD. The association between the NHHR and the risk of IHD in T2DM participants was significant in the highest NHHR quartile (quartile 4), whereas this association was not stable in quartile 2 or quartile 3. Four sensitivity analyses showed similar results. RCS analysis did not reveal a significant nonlinear relationship between the NHHR indicator and the risk of IHD in T2DM participants (P for nonlinearity = 0.9490). In the subgroup analysis, drinking status was found to have a joint effect with the NHHR on the incidence of IHD in T2DM patients (P for interaction = 0.038).

CONCLUSIONS

A high level of NHHR is associated with a high risk of IHD in T2DM patients, indicating the great importance of using NHHR in the lipid management of T2DM patients.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and pulmonary function: evidence from NHANES 2007-2012

Background

This research aims to explore the potential association between lung function and the ratio of non-high-density lipoprotein cholesterol (NHL) to high-density lipoprotein cholesterol (NHHR). Previous research has shown that lipid metabolism imbalance is closely linked to cardiovascular disease, however, there is a lack of information regarding its impact on lung function.

Methods

This research used information from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2012, including a large-scale sample of 9,498 adults aged 20 years and older. A cross-sectional study employing multivariable regression models was aimed at examining the relevance between NHHR and indicators of lung function (FEV1, FVC, and FEV1/FVC). Adjustments were made for a wide range of confounding factors, encompassing race, gender, age, BMI, smoking status, physical activity, diabetes, alcohol consumption, and education level. Data analysis included categorizing NHHR into quartiles and using trend tests to evaluate dose-response relationships between NHHR quartiles and lung function. Sensitivity analyses were conducted by excluding participants with asthma and COPD to ensure the reliability of the results.

Results

The results manifested a significant correlation between decreased FEV1 and FVC values and elevated NHHR, most notably within the highest quartile of NHHR (Q4), where the association was most pronounced. Additionally, trend test results indicated a significant linear negative correlation between NHHR and both FEV1 and FVC. However, the correlation between FEV1/FVC and NHHR showed a nonlinear U-shaped pattern. Suggesting differential impacts of NHHR on various lung function indicators. The findings' robustness was shown by sensitivity analysis, which revealed that even after omitting people with asthma and COPD, the negative correlation between NHHR and FEV1 and FVC remained significant.

Conclusion

This research emphasizes the significance of tracking lipid levels in evaluating respiratory health and offers early evidence in favor of NHHR as a probable biomarker for respiratory function. Further longitudinal research has occasion to prove the causal relationship between NHHR and lung function and to explore its underlying biological mechanisms.

Machine learning for predicting metabolic-associated fatty liver disease including NHHR: a cross-sectional NHANES study

OBJECTIVE

Metabolic - associated fatty liver disease (MAFLD) is a common hepatic disorder with increasing prevalence, and early detection remains inadequately achieved. This study aims to explore the relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and MAFLD, and to establish a predictive model for MAFLD using NHHR as a key variable.

METHODS

All participants were selected from the NHANES cohort, spanning from 2017 to March 2020. Multiple linear regression models were employed to examine the relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the controlled attenuation parameter (CAP). To explore the non-linear association between NHHR and CAP, smooth curve fitting and restricted cubic splines (RCS) of the adjusted variables were utilized. Subgroup analyses were conducted to identify variations in the relationships between the independent and dependent variables across different populations. Finally, a metabolic - associated fatty liver disease (MAFLD) prediction model was developed using seven machine learning methods, including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Multilayer Perceptron (MLP), Random Forest, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and logistic regression. The SHAP (SHapley Additive exPlanations) value was employed to interpret the importance of various features.

RESULT

Weighted multiple linear regression models revealed a significant positive correlation between the NHHR and the CAP (Beta =  7.42, 95% CI: 5.35-9.50, P <  0.001). Smooth curve fitting and RCS demonstrated a non-linear relationship between NHHR and CAP. Subgroup analyses indicated that this relationship was more pronounced in females. Among the seven machine learning predictive models incorporating NHHR, the XGBoost algorithm exhibited the highest predictive performance, with an area under the curve (AUC) of 0.828. Furthermore, NHHR was identified as the second most important feature in the SHAP analysis, following body mass index (BMI), highlighting its potential in predicting MAFLD.

CONCLUSION

A significant positive correlation was identified between the NHHR and the CAP. The inclusion of NHHR in the XGBoost predictive model for MAFLD demonstrated robust predictive capability, providing a valuable tool for the early detection of MAFLD with considerable clinical application potential.

The inverse relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and testosterone in adult males in the United States: a cross-sectional study based on the NHANES database

Background

Testosterone is a crucial hormone for male health, influencing metabolism, cardiovascular function, bone density, and cognitive abilities. Elevated non-HDL cholesterol to HDL cholesterol ratio (NHHR) has been implicated in lipid metabolism disorders, which may adversely affect testosterone levels. This study investigates the association between NHHR and testosterone levels in adult males, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

Methods

This cross-sectional study analyzed data from 2,859 adult males from the NHANES cycles 2011-2016. Total testosterone levels were measured using isotope dilution liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS). NHHR was calculated and analyzed as both a continuous variable and in quartiles. Multivariable linear and logistic regression models, adjusted for demographic, biochemical, lifestyle factors, and medical comorbidities, were used to assess the relationship between NHHR and total testosterone levels and the risk of testosterone deficiency (TD).

Results

Higher NHHR was significantly associated with lower total testosterone levels and increased risk of TD. In fully adjusted models, each unit increase in NHHR was associated with a decrease in total testosterone levels (β = -16.31, 95% CI: -26.58 to -6.04, P = 0.003) and an increased risk of TD (OR = 1.24, 95% CI: 1.07 to 1.44, P = 0.01). When NHHR was analyzed in quartiles, participants in the highest quartile (Q4) had significantly lower testosterone levels (β = -54.98, 95% CI: -86.21 to -23.74, P = 0.001) and a higher risk of TD (OR = 2.04, 95% CI: 1.20 to 3.49, P = 0.01) compared to those in the lowest quartile (Q1). Subgroup analyses confirmed these findings across different age groups, BMI categories, smoking status, and presence of comorbidities. Smooth curve fitting demonstrated a linear relationship among them.

Conclusion

Our study is the first to identify a significant association between elevated NHHR and both reduced total testosterone levels and increased risk of TD in a large, representative sample of adult American males. These findings suggest that NHHR could serve as a valuable marker for early identification of individuals at risk for testosterone decline and TD, enabling timely and targeted clinical interventions.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of prostate cancer: a retrospective study

Background

Prostate cancer is one of the most frequent malignancies in the world, with significant morbidity and death rates. Identifying novel biomarkers is critical to reducing morbidity and mortality from the illness today. Although lipids have been linked to an increased risk of prostate cancer, it is unclear if the non-high-density lipoprotein cholesterol (NHDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) is related to prostate cancer. Therefore, we assessed the relationship between NHHR and prostate cancer risk.

Methods

This study comprised 1,718 individuals who attended the First Affiliated Hospital of Xinjiang Medical University between March 2020 and March 2024. A pathological examination of a prostate puncture biopsy was utilized to confirm the diagnosis of prostate cancer. The study collected information on participants' clinical and laboratory examinations, used propensity score matching to eliminate potential confounders, and analyzed the relationship between NHHR and prostate cancer, using logistic regression models combined with restricted cubic spline (RCS) and receiver operating characteristic (ROC) curve. Furthermore, sensitivity analyses were undertaken to assess the robustness of the results.

Results

(1) There were statistically significant differences in neutrophils, erythrocytes, triglycerides, alkaline phosphatase, and NHHR between the two groups; (2) after adjusting for all covariates, logistic regression revealed a negative association between NHHR and prostate cancer (0.91 (0.83∼0.99), P = 0.028). Participants in the second quartile had a significantly lower risk of prostate cancer after comprehensive adjustment (0.69 (0.50∼0.96), P = 0.026); (3) the restrictive cubic spline curve shows a non-linear relationship between NHHR and prostate cancer risk, with a turning point of 1.824; (4) the results of the ROC curve showed that the NHHR had an area under the curve (AUC) of 0.73; the results of the decision curve suggested that the model was able to provide a high benefit value for patients, with a threshold range of approximately 0.01-0.98 and a maximum net benefit of 0.52, and the calibration curve demonstrated that the model was accurate and reliable.

Conclusions

There is a non-linear dose-response relationship between NHHR and prostate cancer risk, which may be associated with a reduced risk of prostate cancer. The finding can be used to detect high-risk groups and prevent prostate cancer.

Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with coronary heart disease: Establishment and validation of a clinical nomogram model

The purpose of this study is to investigate the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) as a novel compound lipid index for atherosclerosis and explore its relationship with coronary heart disease (CHD). This study also aims to establish NHHR as a sensitive indicator for early prevention of CHD and to construct a clinical prediction model to further predict the occurrence of CHD. This study selected 707 patients who visited the First People's Hospital of Mengcheng County from January 2020 to May 2024, including 466 patients with CHD and a control group. Logistic regression analysis was used to analyze the correlation between NHHR and CHD. Patients were randomly divided into a training set and validation set in a 7:3 ratio. Multivariable logistic regression was used to screen for risk factors, and a nomogram model was constructed and validated. After adjusting for confounding factors, the results showed that for each increase of 1 standard deviation in NHHR, the risk of CHD increased by 42%, with a P-value of .003. In model 3, the risk of CHD for the highest quartile increased by 144%, with a P-value of .01. The smoothed curve fitting showed a nonlinear relationship between NHHR and CHD. Multivariable logistic analysis indicated that age, body mass index, smoke, hypertension, white blood cells, fasting plasma glucose, uric acid, and NHHR were independent risk factors for predicting the occurrence of CHD (P < .05), and a risk prediction nomogram model was constructed. The receiver operating characteristic curve analysis of the training set showed an AUC of 0.922 (95% CI: 0.900-0.945), and the AUC of the validation set was 0.902 (95% CI: 0.856-0.948), indicating good model accuracy. Calibration curve analysis showed that the calibration curves of the nomogram model were very close for predicting the occurrence of CHD in the training set and validation set, and the decision curve analysis also showed a good clinical net benefit of the nomogram model. The study results indicated a strong and nonlinear correlation between NHHR and CHD. Our constructed nomogram model has a certain predictive ability for the occurrence of CHD.

Non high density lipoprotein to high density lipoprotein cholesterol ratio and type 2 diabetes in Middle aged and Elderly Chinese

The aim of this study was to assess the potential association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and type 2 diabetes mellitus (T2DM) in a middle-aged and elderly Chinese population using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Methods We used data from CHARLS 2011 as baseline data and follow-up data from 2015. NHHR was used as a continuous and categorical variable, and multivariate logistic regression modeling was used to explore its relationship with T2DM. Three models were developed to adjust for the possible effects of 14 factors on the outcomes. Restricted cubic spline was used to check for possible nonlinear associations, and subgroup and interaction analyses were used to assess differences between groups. Results A total of 7847 subjects were enrolled in the study, of whom 948 (12.1%) were diagnosed with T2DM. The last NHHR quartile group (Q4) presented the highest risk of T2DM (OR, 1.115, 95% CI, 1.088-1.141) after accounting for all covariates. Restricted cubic spline regression modeling revealed a nonlinear relationship between NHHR and T2DM (p for nonlinear = 0.001). The results of the subgroup analyses were consistent across the categories, indicating a significant positive correlation. Interaction analyses revealed significant interactions between NHHR and age, gender and marital status. Conclusion In the middle-aged and elderly population in China, there is a strong correlation between elevated NHHR and increased risk of T2DM onset. The relationship between NHHR and T2DM can be further investigated in the future to provide reference for the development of more accurate prediction models.

Association between the NHHR and hepatic steatosis and liver fibrosis: a population-based study

Non-alcoholic fatty liver disease (NAFLD) is strongly associated with dyslipidemia, and the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a more comprehensive indicator of lipids. This study aimed to investigate the association between NHHR and hepatic steatosis and liver fibrosis. The 2017-2020 national health and nutrition examination survey (NHANES) dataset was used for the cross-sectional survey. NHHR was calculated by lipid profiling, and the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were determined by vibration-controlled transient elastography (VCTE). Multiple linear regression models were used to test the linear association between NHHR and hepatic steatosis and liver fibrosis. Fitted smoothing curves and threshold effect analysis were used to describe the nonlinear relationships. This population-based study included 6575 adults (≥ 18 years). After adjusting for covariates, we found a U-shaped association between NHHR and hepatic steatosis, with a breakpoint of 1.26. There was a negative association on the left side of the breakpoint (OR [95% CI] - 24.31 [- 43.92, - 4.70]) and a positive association on the right side of the breakpoint (OR [95% CI] 3.82 [2.05, 5.59]). There was no significant association between NHHR and liver fibrosis. In addition, subgroup analyses and interaction tests showed stable results. In summary, NHHR has a U-shaped association with hepatic steatosis and no significant association with liver fibrosis. Keeping NHHR below 1.26 may be an effective option to reduce the risk of hepatic steatosis. NHHR is a more efficient and cost-effective marker for NAFLD surveillance that can be utilized in future clinical practice.

The joint and interactive effects of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and body mass index on the risk of depression, as well as the mediating role of NHHR: results from NHANES 2005-2023

BACKGROUND

Various research in the past has indicated that the NHHR, which represents the ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI) each act independently as contributors to depression risk. Nonetheless, studies exploring the combination of NHHR with BMI in relation to depression are limited. Consequently, the central aim of this study is investigating the joint and interactive effects of NHHR and BMI on depression risk, as well as the mediating role of NHHR.

METHODS

Encompassing participants aged 20 years or over, this research incorporated a total of 39,704 individuals from the National Health and Nutrition Examination Survey (NHANES), which covered the period of 2005 to 2023. To analyze the impact of NHHR and its combination with BMI on depression, our analytical approach included multivariate logistic regression, restricted cubic spline modeling, interaction testing and subgroup analyses. Additionally, we studied the joint effects of NHHR and BMI. Finally, we applied a four-way decomposition analysis method to examine the interactions and mediating effects within the aforementioned relationships.

RESULTS

Among all participants in this study, the prevalence of depressive disorder (Patient Health Questionnaire-9 score ≥ 10) was 9.2%. Both the NHHR and BMI were associated with depression, which remained significant even after full adjustment for covariates [NHHR, OR (95% CI): 1.07 (1.04-1.09); BMI, OR (95% CI): 1.02 (1.02-1.03)]. Compared with the reference group, the OR (95% CI) for the highest groups of NHHR, BMI, and their product term NHHR-BMI were 1.41 (1.24-1.61), 1.35 (1.18-1.54), and 1.59 (1.37-1.84), respectively. Participants with NHHR in the fourth quartile and BMI exceeding 30 kg/m², had higher depression risk compared to other participants with NHHR in the first quartile and BMI below 25 kg/m² [OR (95% CI): 1.64 (1.34-2.00)]. Results of the four-way decomposition analyses indicated that NHHR played a mediating role in the association between BMI and depression, with the mediating effect accounting for 17.6%. Similarly, NHHR also mediated 11.0% of the mediating effect between BMI and PHQ-9 score. However, no interaction between NHHR and BMI related to depression was found in the general population. After stratifying by gender, it was found that the mediated interaction between NHHR and BMI had a statistically significant effect on depression and PHQ-9 score in males.

CONCLUSIONS

Depression risk is linked to both NHHR and BMI, and NHHR has a significant mediating impact on the association between BMI and depression. Notably, there is a non-negligible mediated interaction effect between BMI and NHHR in male participants. Compared to considering NHHR or BMI individually, participants had a higher risk of depression when the combined terms of the two were in the higher quartiles. These findings suggest that the combined assessment of these two indicators may help deepen the understanding and evaluation of depression, enhance the accuracy of risk stratification, and is worthy of further research.

Association between lipid ratios and sarcopenia and the mediating roles of inflammatory biomarkers in a cross-sectional study from NHANES 2011-2018

Sarcopenia, which leads to reduced quality of life and increased medical burden, is challenging to diagnose in a timely manner. Lipid metabolism plays a role in sarcopenia, and this study explored the associations between blood lipid profile parameters and sarcopenia. Using data from the National Health and Nutrition Examination Survey 2011-2018, we conducted weighted multivariate logistic regression to investigate the associations between lipid ratios and sarcopenia, including non-high-density lipoprotein cholesterol (non-HDL-C) to HDL-C, triglyceride (TG) to HDL-C, low-density lipoprotein cholesterol (LDL-C) to HDL-C, and remnant cholesterol (RC) to HDL-C ratios. We performed subgroup analyses to assess interactions with other covariates and used mediation models to evaluate the mediating roles of inflammatory biomarkers. We included a total of 9500 non-sarcopenic and 849 sarcopenic participants aged 18-59 years. While we observed modest correlations between individual lipid components and sarcopenia, we obtained significant positive associations for lipid ratios. Specifically, non-HDL/HDL-C (OR = 1.09; 95% CI 1.03-1.15; P = 0.003), TG/HDL-C (OR = 1.02; 95% CI 1.02-1.04; P = 0.014), LDL/HDL-C (OR = 1.27; 95% CI 1.11-1.45; P < 0.001), and RC/HDL-C ratios (OR = 1.55; 95% CI 1.16-2.07; P = 0.004) showed strong associations with sarcopenia. These associations were more pronounced in younger participants, those with lower family economic status, and those without self-reported diabetes. Furthermore, there were significant mediation effects of inflammatory biomarkers on the association between non-HDL/HDL-C, LDL/HDL-C, and RC/HDL-C and sarcopenia risk, with proportions ranging from 2.90 to 6.36%. In conclusion, our study demonstrated the positive associations between lipid ratios and sarcopenia in middle-aged adults, suggesting the potential of these lipid ratios for improving sarcopenia case identification. Further research is required to explore the underlying mechanisms.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hepatic steatosis and liver fibrosis among US adults based on NHANES

Recently, the non-high-density to high-density lipoprotein cholesterol ratio (NHHR) has gained growing attention as an indicator for predicting diseases associated with lipid metabolism. Hepatic steatosis and fibrosis are tightly associated lipid metabolism. Our study aims to analyze the correlations among NHHR, hepatic steatosis, and fibrosis. This study analysed data from 14,578 adults in the US National Health and Nutrition Examination Survey (2005-2018). The degree of hepatic steatosis was measured through the Fatty Liver Index (FLI), while liver fibrosis severity was evaluated with the Fibrosis-4 (FIB-4) index. Multivariate linear regression assessed the association between NHHR and the FLI and FIB-4 score. Smooth curve describing the relationship between NHHR and FLI or FIB-4. Additionally, a two-part linear regression model adopted in order to more accurately account for the nonlinear relationship, with threshold effects estimated through its two components. To confirm the robustness of the findings, interaction tests and subgroup analyses were conducted. The multivariate logistic regression analysis demonstrated a significantly positive correlation of lnNHHR with FLI across all three models. In Model 3, the association was (β = 11.14, 95%CI:10.38,11.90). Curve fitting indicated a nonlinear relationship. The positive correlation between lnNHHR and FLI persists across gender, BMI, and physical activity groups. Nevertheless, a notable negative correlation between lnNHHR and FIB-4 was observed in all three models. In Model 3, the relationship between lnNHHR and FIB-4 was as follows: (β = -0.20; 95% CI: -0.22, -0.17). Curve fitting revealed a V-shaped relationship, with threshold effect analysis identifying a breakpoint at 1.51. Above this threshold, the relationship was found to be statistically insignificant (p-value = 0.424). Receiver operating characteristic (ROC) curve analysis demonstrated that NHHR exhibited better predictive performance for MASLD compared to non-HDL-C, HDL-C, and LDL-C/HDL-C. The current study's findings suggest that elevated levels of NHHR correlate with a greater risk of hepatic steatosis among adults in the U.S. Our findings imply that NHHR may be a valuable tool in improving MASLD prevention strategies in the general population.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hand grip strength in U.S. adults

Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an indicator of imbalance in lipid metabolism and has been associated with a variety of metabolic diseases. Hand Grip Strength (HGS) is an important indicator for assessing muscle function and overall health. The aim of this study was to investigate the relationship between NHHR and HGS, with the aim of revealing how lipid metabolism affects muscle strength and may provide an early indication of metabolic health and muscle dysfunction. We collected demographic and clinical data from 6,573 adults aged 20-60 years from the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2014.NHHR is defined as the ratio of total cholesterol minus high-density lipoprotein levels (HDL-C) divided by HDL-C. HGS is expressed as relative grip strength and is defined as the sum of the maximum readings for each hand/body mass index ratio. Among the data analysis techniques used in this study were multifactor linear regression, smoothed curve fitting, subgroups, and interactions. There was a negative correlation between NHHR and HGS in the 6573 participants included. After adjusting for all covariates, each unit increase in log2-NHHR was associated with a 0.28 [-0.28 (-0.31, -0.26)] decrease in HGS, and this negative correlation remained stable across subgroups (p < 0.01 for the test of trend). The analyses also identified a nonlinear association between NHHR and HGS with an inflection point of 1.74. Interaction tests showed that the negative correlation between NHHR and HGS differed significantly across age, gender, and stratification by diabetes status. Our study suggests that there may be a negative correlation between HGS and NHHR in adults aged 20-60 years in the U.S. Considering that a decline in HGS is an important manifestation of sarcopenia, it may be relevant to the prevention and control of sarcopenia through close detection and management of NHHR.

J-Shaped Association Between Non-HDL Cholesterol to HDL Cholesterol Ratios and Gout in US Adults With Gout

Background and Aim

This study aims to assess the potential association between NHHR and gout risk among the US adult population.

Methods and Results

Utilizing data from the NHANES spanning from 2007 to 2018, we performed a cross-sectional analysis. A weighted multivariable logistic regression model, generalized additive model (GAM) and a restricted cubic spline model were applied to elucidate the association between NHHR and gout risk. In addition, subgroup and sensitivity analyses were conducted to ensure the stability of our findings. This study cohort included 27,731 participants. Multivariate logistic regression analysis indicated a significant correlation between NHHR and the likelihood of gout. This association was sustained after accounting for a range of potential confounding confounders. The risk of gout was observed to escalate with increasing quartiles of NHHR quartiles, with a 67% increased risk in the fourth quartile. Both RCS and curve fitting results indicated a J-shaped relationship between NHHR and gout. The association remained significant in several subgroup analyses. The interaction test did not yield statistically significant effects on this association.

Conclusion

The NHHR is nonlinearly correlated with the risk of gout in US adults. Further investigation research into the role of NHHR in gout could offer new perspectives on the prevention and treatment of gout. However, additional large-scale prospective studies are necessary to validate and reinforce these results.

Investigation of the correlation between urinary aromatic amines and the risk of depression through an examination of the NHANES data from 2013 to 2014

BACKGROUND

The relationship between aromatic amines (AA)s and depressive disorder remains elusive. The aim of this investigation was to examine the potential link between urinary AA levels and the likelihood of depression in American adults.

METHODS

Through the analysis of data from 1175 participants in the 2013-2014 NHANES, our study delved into the association between urinary AA levels and the incidence of depression. Assessment of depression severity was conducted using the PHQ-9 questionnaire, alongside measuring levels of six urinary AAs. We explored this correlation in the overall population and various subgroups by employing a multivariable logistic model, restricted cubic spline (RCS) analysis, and a sensitivity analysis model while adjusting for potential confounding variables.

RESULTS

Participants diagnosed with depression exhibited elevated levels of 1-Aminonaphthalene, 2-Aminonaphthalene and 2,6-Dimethylaniline compared to non-depressed individuals. Specifically, the presence of 2-Aminonaphthalene was correlated with an elevated likelihood of depression in continuous and categorical models (OR: 1.013, CI: 1.004-1.023, p = 0.006; Q4 vs. Q1: OR: 1.687, CI: 1.015-2.805, p = 0.037) after fully adjusted for gender, RIP, education level, BMI, smoking, hypertension and diabetes. The likelihood of depression showed a statistically significant linear dose-response relationship with 2-Aminonaphthalene (Plinear = 0.001) after adjusting for confounding variables. Furthermore, subgroup analyses showed revealed a correlation between urinary 2-Aminonaphthalene levels and depression among female individuals and smokers, which remained consistent with sensitivity analyses.

CONCLUSION

Elevated levels of certain amino acids in urine were associated with a higher likelihood of depression. Notably, 2-aminonaphthalene appeared to be a significant contributing factor, particularly among smokers.

Association Between Triglyceride-Glucose Related Index and Endometriosis Varies According to Educational Level

BACKGROUND

The association between the triglyceride-glucose (TyG) level, its obesity-related derivatives, and the occurrence of endometriosis (EMS) remains ambiguous, particularly in individuals with higher levels of education. This study sought to explore the relationship between TyG, its obesity-related derivatives, and EMS across various educational backgrounds.

METHODS

This study utilized a substantial dataset obtained from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006. To explore the relationship between TyG, its obesity-related derivatives, and EMS, we employed a variety of analytical methods, including multivariable logistic regression models, smooth curve fitting, threshold effect analysis, and subgroup analysis, which were applied to participants with varying educational levels.

RESULTS

Among the 2347 participants, 203 (8.65%) were diagnosed with EMS. In the overall population, only the TyG, TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) variables demonstrated a positive association with EMS. However, within the group with high educational attainment, TyG, TyG-WHtR, TyG-WC, and TyG-body mass index (TyG-BMI) all exhibited positive correlations with EMS. These associations remained robust after adjustment for multiple potential confounding variables. The subgroup analysis demonstrated that these associations were consistent across different subgroups (p > 0.05). Furthermore, both linear and nonlinear relationships were observed between TyG and its obesity-related derivatives and EMS, as evidenced by the smooth curve fittings and threshold effect analyses. In contrast, no significant associations were identified in the group with lower levels of education.

CONCLUSIONS

Our study suggests that there is variation in the association between TyG and its obesity-related derivatives and EMS across different educational levels, warranting further investigation. In individuals with higher education, elevated levels of TyG and its obesity-related derivatives were associated with a higher prevalence of EMS. Conversely, this correlation was not observed among those with lower educational levels.

Association between non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio and macroalbuminuria: evidence from NHANES 1999-2018

Purpose

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a crucial lipid marker associated with various cardiovascular diseases. However, its relationship with kidney injury, particularly albuminuria, remains poorly understood. This study aims to investigate the association between NHHR and macroalbuminuria in U.S. adults.

Patients and methods

This cross-sectional study utilized data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). NHHR was calculated as (Total cholesterol - HDL cholesterol)/HDL cholesterol. Macroalbuminuria was defined by an albumin-creatinine ratio (ACR) >300 mg/g. Logistic regression, smoothed curve fitting, subgroup analyses, and sensitivity analysis were employed to assess the relationship between NHHR and macroalbuminuria.

Results

A total of 41,225 participants were included in the analysis. Higher NHHR was significantly associated with an increased likelihood of macroalbuminuria (OR = 1.34, 95% CI: 1.13-1.59, p=0.0007). Subgroup analysis revealed a stronger association in participants with BMI ≥30 kg/m2(OR = 1.89, 95% CI: 1.44-2.47, p<0.01). Sensitivity analysis revealed that the association remained robust even after excluding participants taking medications that affect lipid metabolism.

Conclusion

In U.S. adults, an increased likelihood of incident NHHR levels of macroalbuminuria is positively associated and is more pronounced in those with a BMI ≥30kg/m2.

Association between stroke and fracture and the mediating role of depression: a cross-sectional study from NHANES 2017 to 2020

Background

Stroke is a significant health threat, and its complex interplay with fractures warrants further investigation. Depression, a critical psychological mediator in various health conditions, may also play a role. This study aims to clarify the intricate relationships among stroke, depressive symptoms, and fracture risk, potentially informing more holistic clinical strategies.

Methods

Utilizing the most recent data from the National Health and Nutrition Examination Survey (NHANES, 2017 to 2020), this study encompassed 4,979 valid samples. T-test and chi square test are conducted to compare the differences between fracture and non fracture subgroups. Subsequently, regression models were applied to assess the mediating impact of depression, with Sobel's test and the bootstrap method deployed to substantiate the mediation pathways.

Results

In this study, we conducted subgroup and regression analyses to investigate factors influencing fractures in stroke patients using NHANES data. Subgroup analysis revealed significant associations with gender, race, osteoporosis, and depression. Female stroke patients had a higher fracture rate (73.86% vs. 47.78%, p < 0.001), and those with post-stroke depression (29.67% vs. 13.16%, p < 0.001) or osteoporosis (33.33% vs. 15.81%, p < 0.05) were at increased risk of fractures. Logistic regression models showed a positive association between stroke and fractures in the unadjusted (OR = 1.862, 95% CI: 1.348-2.573, p < 0.001) and adjusted I models (OR = 1.789, 95% CI: 1.240-2.581, p < 0.01), but not in the adjusted II model. Depression was significantly correlated with fractures in all models (unadjusted OR = 2.785, 95% CI: 1.271-6.101, p < 0.05; Model 1 OR = 3.737, 95% CI: 1.470-9.498, p < 0.01; Model 2 OR = 3.068, 95% CI: 1.026-9.175, p < 0.05). Mediation analysis using Sobel and bootstrap tests indicated that depression mediates 7.657% of the relationship between stroke and fractures (Z = 2.31, p < 0.05), with significant indirect (Z = 2.80, p < 0.01), direct (Z = 3.61, p < 0.001), and total effects (Z = 3.92, p < 0.01). The direct effect of stroke on fracture was 0.079 (95% CI: 0.036-0.121), the total effect was 0.085 (95% CI: 0.043-0.128), and the indirect effect mediated by depressive symptoms was 0.007 (95% CI: 0.002-0.011). These results suggest that depressive symptoms following stroke may contribute to an increased risk of fractures.

Conclusion

Depressive symptoms serve as a critical mediator in the link between stroke and fracture risk. Consequently, our study concludes that holistic prevention strategies for fractures in stroke patients must incorporate a focus on mental health to effectively address this complex clinical challenge.

Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018

Background

It is unclear how the estimated glucose disposal rate (eGDR) index relates to osteoarthritis (OA). The goal of this research is to explore the possible link between the eGDR index and the likelihood of OA development.

Methods

The study encompassed 9,051 individuals from the National Health and Nutrition Examination Survey (2011-2018). Participants were divided into quartiles according to their eGDR, calculated with the equation: eGDR (mg/kg/min) = 21.158 - (0.09 × waist circumference) - (3.407 × hypertension) - (0.551 × glycosylated hemoglobin). We assessed the independent correlation between the eGDR metric and the incidence of OA through weighted multivariate regression, stratified analysis, and threshold effect evaluation.

Results

The study encompassed 9,051 participants, who had an average eGDR of 7.09. Participants with OA had lower eGDR levels compared to those without OA (6.27 ± 0.09 vs 7.31 ± 0.06, P < 0.001). The odds ratios (ORs) for OA associated with the eGDR index in the logistic regression models were 0.87 (95% confidence interval [CI]: 0.84, 0.89) in the unadjusted model I and 0.87 (95% CI: 0.84, 0.91) in model II (adjusted for all covariates). Higher eGDR index was associated with a reduced risk of OA when compared to the lowest quartile (Q1). A restricted cubic spline analysis indicated a linear negative relationship between eGDR and OA risk.

Conclusion

An increased eGDR index is inversely related to the risk of OA. The eGDR may serve as a valuable biomarker for the detection of OA and offers a new perspective for the assessment and management of the condition.

Increased atherogenicity in mood disorders: a systematic review, meta-analysis and meta-regression

BACKGROUND

Major depressive disorder (MDD) and bipolar disorder (BD) often coexist with metabolic syndrome. Both are linked to increased atherogenicity and a higher risk of cardiovascular diseases. Nevertheless, a comprehensive analysis of key atherogenic biomarkers in MDD/BD is still lacking.

OBJECTIVES

This meta-analysis evaluates the relationship between atherogenic indices and MDD/BD, while identifying the most effective atherogenic biomarker.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched electronic databases, including PubMed, Google Scholar, and Web of Science, for articles published up to August 1, 2024.

RESULTS

We included 85 eligible studies (14 on BD and 71 on MDD), covering 70,856 participants: 18,738 patients and 52,118 healthy controls. MDD/BD patients showed significant increases (p < 0.001) in the Castelli Risk Index 2 (CRI2), Atherogenic Index of Plasma (AIP), and (triglyceride or TG + low-density lipoprotein + very low-density lipoprotein)/(high-density lipoprotein cholesterol or HDL + Apolipoprotein A or ApoA) ratio, but not CRI1 and ApoB/ApoA ratio. Significant lower HDL and lecithin: cholesterol acyltransferase activity, and higher TG levels were observed in MDD/BD patients compared with controls. There were no significant differences between MDD and BD patients. Most included studies lacked the most essential information on the inclusion and exclusion of important confounders.

CONCLUSIONS

AIP is the most effective atherogenicity index for mood disorders. Regular lipid profiling and metabolic syndrome screening are crucial in MDD/BD. Early intervention with lipid-lowering therapies is recommended to prevent the worsening of atherogenicity and disease progression.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and sarcopenia: A cross-sectional study

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a newly developed lipid parameter that's used to evaluate cardiovascular disease risk. However, its association with sarcopenia risk has not been explored before.

METHODS

Data on NHHR and sarcopenia were based on the secondary analysis of the years 2011-2018 of National Health and Nutrition Examination Survey (NHANES) dataset. NHHR was nature log-transformed (LnNHHR) to achieve a normal distribution. A multivariate logistic regression and a restricted cubic spline (RCS) model adjusted for associated factors were utilized to evaluate the correlation between NHHR and sarcopenia. Subgroup and sensitivity analyses were conducted to verify the robustness of the findings.

RESULTS

The study cohort comprised 7069 participants, of whom 6497 (91.91 %) were sarcopenia-free, and 572 (8.09 %) exhibited sarcopenia. A significant increase in NHHR was observed in the sarcopenia group compared to the non-sarcopenic group (P < 0.001). Multivariate logistic regression analysis revealed that sarcopenia was independently linked to NHHR [odds ratio (OR): 1.394, P = 0.007]. A linear relationship was identified between NHHR and sarcopenia risk (Pnon-linear = 0.108). Interaction analysis indicated that the relationship between NHHR and sarcopenia risk was not significantly modified by gender, sex, poverty income ratio, education, smoking status, or race.

CONCLUSION

NHHR was significantly associated with an elevated risk of sarcopenia among U.S. adults. Further research is warranted to elucidate the underlying physiological mechanisms through which NHHR influences sarcopenia development.

Association of non-highdensity lipoprotein cholesterol to highdensity lipoprotein cholesterol ratio (NHHR) and subsequent hypertension and heart diseases: findings from the CHARLS cohort

PURPOSE

NHHR, the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, is a novel lipid marker associated with the risk of heart diseases and various health conditions. However, there is limited evidence regarding the relationship between NHHR and the onset of hypertension and heart diseases. The aim of this study was to investigate the association between NHHR and the new-onset hypertension and heart diseases among the Chinese middle-aged and older general population.

METHODS

This prospective cohort study utilized data from a nationally representative sample of Chinese residents aged 45 and older, sourced from the China Health and Retirement Longitudinal Study (CHARLS). The primary outcomes of the study were new-onset hypertension and heart diseases. To investigate the relationship between the NHHR and the risk of new-onset hypertension and heart diseases, multivariate logistic regression models and the restricted cubic spline (RCS) method were employed. Additionally, the mediating effects of hypertension on the association between NHHR and heart diseases were assessed using the bootstrap method.

RESULTS

A total of 5349 participants were included in the final analysis and three groups of NHHR were identified, including low-stable, medium-stable, and high-stable NHHR. By 2020, 1,631 participants (30.5%) had been newly diagnosed with hypertension, while 1233 (23.1%) developed heart diseases. Compared to those with a low-stable NHHR, individuals in the other two groups showed a significantly increased risk of developing hypertension and heart diseases. The findings remained consistent across various sensitivity analyses. According to the RCS analysis, a partial U-shaped relationship existed between the NHHR and the risk of developing hypertension and heart diseases (P for nonlinear < 0.001). Furthermore, hypertension was found to partially mediate the association between NHHR and heart diseases.

CONCLUSION

The NHHR was closely associated with an increased risk of developing hypertension and heart diseases. In addition, the NHHR partially mediated the development of heart diseases by promoting hypertension progression. In the prevention and treatment of heart diseases, managing both lipid levels and blood pressure is crucial.

Non-high-density to high-density lipoprotein cholesterol ratio and its association with infertility in U.S. women: a cross-sectional study

Objective

To investigate the relationship between Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) and infertility in US female adults aged 20 to 45.

Methods

Our research team utilized data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) to conduct a cross-sectional study. Multivariable logistic regression was conducted to examine the association between NHHR and infertility, with trend tests providing additional insight into this relationship. Further, smoothed curve fitting was applied for a more detailed exploration. To ensure the robustness of our results, we conducted subgroup and sensitivity analyses.

Results

Between 2013 and 2018, our study included 2,947 participants, with 342(11.6%) self-reported infertility. A positive association was found between NHHR and infertility (OR=1.17,95%CI:1.07-1.27). Compared with the first trimester, the third trimester of NHHR was associated with an OR of 1.79(95% CI: 1.31-2.44) in model 3. The results of subgroup analyses revealed that the association between NHHR and infertility was nearly consistent.

Conclusion

NHHR demonstrated a positive correlation with infertility among U.S. female adults. Further investigation is needed to explore their association better and the underlying mechanisms.

Cross-sectional analysis of non-HDL/HDL cholesterol ratio as a marker for cardiovascular disease risk in middle-aged and older adults: Evidence from the CHARLS study

BACKGROUND

While cardiovascular disease is linked to abnormal lipid metabolism, the relationship between NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio), a new lipid metric, and cardiovascular disease in middle-aged and older adults in China is still unclear.

METHODS

This cohort study, based on a population sample, examined the incidence of cardiovascular disease (CVD) events, including stroke and heart disease. It utilized self-reported diagnoses from the study's inception and during Wave 4, involving 9259 participants from the China Health and Retirement Longitudinal Study (CHARLS). The research employed restricted cubic spline models and multivariate logistic regression to investigate possible non-linear relationships. Additionally, subgroup analyses were conducted to assess the influence of socio-demographic factors on the outcomes.

RESULT

During the seven-year follow-up period, 1,139 participants developed CVD, including 742 cases of heart problems and 582 strokes. In Model 3, it was observed that for each unit increase in the highest NHHR group, the risk of developing CVD increased by 98%, the risk of stroke increased by 48%, and the risk of heart problems increased by 115%. Subgroup analyses indicated that this correlation was more pronounced among individuals under 60 years of age and those with hypertension.

CONCLUSIONS

According to the current study, elevated NHHR ratio is an important risk factor for CVD in middle-aged and elderly Chinese. Early intervention in patients with higher NHHR ratios may help to further reduce the incidence of CVD.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a predictive indicator of CKD risk in NAFLD patients: NHANES 2017-2020

Background

Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are both closely related to dyslipidemia. However, the relationship between dyslipidemia in patients with NAFLD and CKD is not yet clear. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an innovative and comprehensive lipid index. The purpose of this study was to investigate the correlation between NHHR and CKD risk in NAFLD patients with or without fibrosis.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020 for analysis, including a total of 4,041 subjects diagnosed with NAFLD. Among the NAFLD subjects, 3,315 individuals without liver fibrosis and 726 individuals with fibrosis. Weighted multivariate linear regression, weighted logistic regression, restricted cubic spline (RCS) curves, and subgroup analysis were used to evaluate the correlation between NHHR and CKD in patients with NAFLD.

Results

Our findings indicate that in NAFLD subjects without liver fibrosis, the highest tertile of NHHR, as compared to the lowest tertile, was inversely related to glomerular filtration rate (eGFR) (β: -2.14, 95% CI: -3.97, -0.32, p < 0.05) and positively related to CKD (OR: 1.67, 95% CI: 1.12, 2.49, p < 0.05). No significant associations were observed between NHHR and eGFR, urinary albumin to creatinine ratio (ACR) in NAFLD subjects with liver fibrosis. The RCS revealed a linear relationship between NHHR and ACR, CKD in NAFLD subjects without liver fibrosis, while a U-shaped relationship was observed between NHHR and ACR, CKD in NAFLD subjects with liver fibrosis.

Conclusion

In patients with non-fibrotic NAFLD, a significantly elevated NHHR is closely associated with an increased risk of CKD and shows a linear relationship with CKD. In patients with fibrotic NAFLD, NHHR shows a U-shaped relationship with CKD. LD, Our findings underscore the practical utility of NHHR as a biomarker for early risk stratification of CKD in patients with NAFLD.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and prevalence of urinary stones in US adults: a cross-sectional NHANES study

BACKGROUND

This study examines the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and urinary stones in American adults.

METHODS

We conducted a cross-sectional study utilizing the 2007-2018 National Health and Nutrition Examination Survey (NHANES) data set. The prevalence of urinary stones was determined based on patient-reported experiences of renal colic. We converted NHHR to natural logarithm (ln-NHHR) to align it better with our statistical analyses. Our analysis methods included weighted multivariate logistic regression, generalized additive model (GAM), and application of smoothed curves to better elucidate the association between ln-NHHR and the prevalence of urinary stones. In addition, we conducted subgroup analyses and employed multiple imputation for sensitivity analyses.

RESULTS

This study involved a total of 30,903 participants, with a 9.97% prevalence of urinary stones and reported colic experience. Elevated ln-NHHR levels were linked with a higher likelihood of urinary stones (OR = 1.20, 95% CI 1.07-1.35). Smooth curve fitting revealed an inverted U-shaped relationship, pinpointing a significant increase in urinary stone risk at ln-NHHR levels below 1.43 (OR = 1.40, 95% CI 1.19-1.64, p < 0.001). Notably, this correlation was stronger among Non-Hispanic Whites and those married or living with a partner. Multiple imputation analyses strengthened the confidence in our results.

CONCLUSIONS

Our findings suggest a reverse U-shaped association between urinary stone occurrence and NHHR level, with a positive association at ln-NHHR < 1.43. This correlation was more pronounced in the Non-Hispanic White population and among those married or living with a partner.

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol is associated with diabetic kidney disease: A cross-sectional study

Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) is a significant indicator of atherosclerosis. However, its association with diabetic kidney disease (DKD) remains unclear. This study aims to explore the relationship between NHHR and the prevalence of DKD among the U.S. adults using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2020. Participants were selected based on the stringent inclusion and exclusion criteria. We utilized single-factor analysis, multivariate logistic regression, and smooth curve fitting to investigate the relationship between NHHR and DKD. Our study included 8,329 diabetic individuals, who were categorized into DKD and non-DKD groups based on the presence or absence of kidney damage. A significant difference in NHHR was observed between these groups. After adjusting for potential confounders, we found that NHHR was positively associated with the prevalence of DKD. Specifically, each one-unit increase in NHHR corresponded to a 6% rise in the prevalence of DKD, with this association remaining significant across stratified NHHR values. Threshold effect analysis revealed an inflection point at an NHHR of 1.75, beyond this point, each unit increase in NHHR was associated with a 7% increase in the prevalence of DKD. Subgroup analysis confirmed the robustness of these findings. Our study demonstrates a significant correlation between NHHR and DKD prevalence, suggesting that monitoring NHHR could be an effective strategy for reducing DKD prevalence.

Association between depression and liver function biomarkers among US cancer survivors in NHANES 2005-2020

Depression frequently comorbidities with cancer, adversely affecting survivors' quality of life. Liver dysfunction is also prevalent among cancer survivors. However, the association between these two conditions remains unclear. This study aimed to explore the relationship between depression and liver function biomarkers in US cancer survivors. A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2005-2020. Cancer survivors were screened and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and 18 liver function biomarkers were included. Survey-weighted generalized linear models with multiple covariables adjusted were employed to examine the associations between depression and liver function biomarkers. A total of 4118 cancer survivors were included, representing a weighted population of 21 501 237. After adjusted with age, gender, race, marital status, education level, family income-to-poverty ratio, and number of cancer types, 8 biomarkers demonstrated positive correlations with depression in cancer survivors, included alanine aminotransferase (ALT, OR = 1.007, 95% CI: 1.000 to 1.013), alkaline phosphatase (ALP, 1.006 [1.002, 1.010]), gamma glutamyl transferase (GGT, 1.004 [1.001, 1.007]), lactate dehydrogenase (LDH, 1.004 [1.000, 1.009]), total protein (TP, 1.040 [1.009, 1.072]), globulin (GLB, 1.060 [1.030, 1.091]), total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) ratio (1.162 [1.050, 1.286]), and low-density lipoprotein cholesterol (LDL-C) to HDL-C ratio (1.243 [1.012, 1.526]); while 4 other biomarkers exhibited negative correlations, included HDL-C (0.988 [0.980, 0.997]), total bilirubin (TBi, 0.501 [0.284, 0.883]), aspartate aminotransferase (AST) to ALT ratio (0.588 [0.351, 0.986]), albumin (ALB) to GLB ratio (0.384 [0.229, 0.642]). Following sensitivity analysis, 5 biomarkers included LDH, HDL-C, TBi, AST/ALT and LDL-C/HDL-C lost their statistical significance for the association. This study identified certain associations between 7 liver function biomarkers and depression in US cancer survivors. Further research, particularly prospective longitudinal studies, is warranted to elucidate the causal relationships and explore the potential of improving liver function for the management of depression in cancer patients.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of post-stroke depression: A cross-sectional study

BACKGROUND

Limited observational research has explored the relationship between the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and the risk of post-stroke depression (PSD). This study aims to investigate the potential associations between NHHR and PSD.

METHODS

A cross-sectional study was conducted using data from stroke participants aged 20 and older, sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018. Depression was assessed using the PHQ-9 questionnaire. The association between NHHR and PSD risk was evaluated through weighted multivariate logistic regression and restricted cubic spline (RCS) models. Subgroup and sensitivity analyses were performed to validate the findings.

RESULTS

In the continuous model, the NHHR value for the PSD group (3.23±1.84) was significantly higher than that of the non-PSD group (2.79±1.40, p=0.015). Logistic regression analysis in the fully adjusted model revealed a positive association between NHHR and PSD (OR 1.16, 95 % CI 1.03-1.30, p=0.016). Interaction tests showed no significant differences across strata (p > 0.05 for interaction). Restricted cubic spline results indicated a linear dose-response relationship between NHHR and PSD risk (P for non-linearity = 0.6). This association persisted in various subgroup analyses.

CONCLUSION

NHHR was significantly correlated with an increased risk of PSD among U.S. adults. Further re-search on NHHR could contribute to the prevention and treatment of PSD.

Gender-specific association between a lipid composite index and asthma among US adults: insights from a population-based study

BACKGROUND

Abnormalities in lipid metabolism are common among adult asthmatics. However, the precise directionality linking asthma to blood lipid levels remains controversial. Our study aimed to evaluate the association between the Non-HDL to HDL Ratio (NHHR), a lipid composite index, and asthma prevalence among the adult population in the United States.

METHODS

Utilizing adult participants' data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2009 to 2018, the study employed a multivariable logistic regression model, adjusting for covariables, to establish the relationship between NHHR levels and the prevalence of asthma. Furthermore, smoothing curve fitting and subgroup analyses were conducted to investigate the robustness of this association.

RESULTS

This study included 26,023 adult individuals (mean age = 49.63 ± 17.66). In the fully adjusted model, a significant inverse association was observed between log-transformed NHHR values and asthma prevalence (OR = 0.85, 95% CI: 0.79-0.93). Subgroup analysis revealed that gender served as a modulator, altering the association between NHHR levels and asthma prevalence. A more pronounced negative association between lnNHHR and asthma prevalence was noted among male participants [(Male: OR = 0.78, 95% CI: 0.69-0.88) vs. (Female: OR = 0.92, 95% CI: 0.83-1.03), P for interaction = 0.0313].

CONCLUSIONS

Our study revealed an inverse association between NHHR levels and the prevalence of asthma in the US adult population, which is influenced by gender. NHHR measurement may be a potential tool for early identification and prediction of adult asthmatics in specific populations.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and angina pectoris in US adults: a cross-sectional retrospective study based on NHANES 2009-2018

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in cardiovascular diseases. However, its association with angina pectoris remains unclear. Herein, we aimed to explore their relationship.

METHODS

This cross-sectional retrospective study included the 2009-2018 data from 22,562 adults diagnosed with angina pectoris, retrieved from the National Health and Nutrition Examination Survey (NHANES) database. NHHR was estimated from laboratory data, and angina pectoris diagnosis was ascertained from the NHANES questionnaire.

RESULTS

Angina pectoris risk was greater in the highest than in the lowest NHHR tertile (odds ratio [OR] = 1.61; 95% confidence interval (CI), 1.15-2.54; P = 0.006). Weighted logistic regression showed a positive association between NHHR and angina pectoris in the fully adjusted model (OR = 1.17; 95% CI, 1.07-1.28; P = 0.001). Restricted cubic spline analysis showed a linear association (P = 0.6572). Subgroup analyses indicated no significant differences across different stratifications (P > 0.05, all). Random forest analyses and Boruta algorithm corroborated that NHHR is a strong predictor of angina pectoris. Among the eight machine-learning models evaluated for predictive capabilities, the logistic regression model demonstrated the strongest predictive capability, with an area under the curve of 0.831.

CONCLUSIONS

Our study suggests that NHHR is a risk factor for angina pectoris and may be used for risk prediction and to inform future intervention programs to reduce its incidence.

Association of non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) with gout prevalence: a cross-sectional study

Background

The non-high-density lipoprotein cholesterol (non-HDL-C)-to-high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) is a strong lipid marker that has been associated with atherogenic features. This study aimed to investigate the potential association between the NHHR and gout prevalence.

Methods

This study investigated the relationship between the NHHR and gout by analyzing data gathered from the National Health and Nutrition Examination Survey (NHANES), a research study conducted in the United States from 2007 to 2018. All participants in NHANES provided written informed consent prior to participation. The NHHR was calculated as the ratio of non-HDL-C to HDL-C. Total cholesterol (TC) and HDL-C levels were sourced from NHANES laboratory data. Gout was assessed using a questionnaire. Weighted logistic regression analysis, subgroup analysis, and smoothed curve fitting were performed.

Results

This study included 30,482 participants. The fully adjusted models showed that for each unit increase in NHHR in continuous variables, there was a 10% higher likelihood of gout prevalence (OR: 1.10, 95% CI: 1.05, 1.16). Analysis of the NHHR quartiles revealed that patients in the highest quartile had a notably greater probability of developing gout than those in the lowest quartile. (Q4 vs. Q1, OR: 1.34, 95% CI: 1.05, 1.71). Subgroup analyses yielded consistent results across categories, indicating a significant positive association between the NHHR and gout. E-value analysis suggested robustness to unmeasured confounding. Interaction tests showed that the race, education level, marital relationship, poverty-income ratio (PIR), hypertension, smoking habits, estimated glomerular filtration rate (eGFR), lipid-lowering therapy, and diabetes had no discernible effects on this association. The p-values for all the interactions were > 0.05. Nevertheless, the relationship between the NHHR and gout was significantly affected by the age and sex of the participants (interaction p < 0.05).

Conclusion

Among adults in the United States, elevated NHHR levels are correlated with increased odds of gout prevalence.

The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and non-alcoholic fatty liver disease in US adults: a cross-sectional study

The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to HDL-C (NHHR) is a novel lipid parameter used to assess the risk of cardiovascular disease. Previous studies have demonstrated an association between the NHHR and risk of non-alcoholic fatty liver disease (NAFLD). Owing to the lack of research exploring this relationship in specific populations, this study aimed to determine the potential link between the NHHR and risk of NAFLD among American adults in the United States. Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) spanning 2017-2020. After excluding individuals with other liver diseases, alcohol abuse, and missing lipid data, a total of 6809 eligible adults were included for analysis. The NHHR was calculated as the ratio of (non-HDL-C) to HDL-C, while NAFLD was identified by liver steatosis detected by transient elastography. Multivariable weighted logistic regression models and restricted cubic spline (RCS) models were employed to investigate the relationship between the NHHR and risk of NAFLD. Subgroup and sensitivity analyses were also conducted to test the robustness of the results. As the NHHR increased, the prevalence of NAFLD rose progressively (5.88% vs. 8.75% vs. 12.24% vs. 15.77%, p < 0.001). In the overall population, after adjusting for confounding factors, each unit increase in the NHHR was associated with a 25% increase in NAFLD risk (OR = 1.25, 95% CI: 1.03-1.53, p = 0.0372). When the NHHR was analyzed as a categorical variable (quartiles), participants in the highest quartile had a significantly higher risk of NAFLD than those in the lowest quartile (OR = 2.6, 95% CI: 1.75-3.85, p = 0.009). RCS analysis further indicated a nonlinear dose-response relationship between the NHHR and risk of NAFLD (p non-linearity < 0.0001). This association remained significant in both subgroup and sensitivity analyses. This study confirmed that the NHHR, particularly at higher levels, was an independent risk factor for NAFLD. As a comprehensive lipid indicator, the NHHR had the potential to predict NAFLD risk. These findings provided new insights for the prevention and clinical management of NAFLD.

Lipid metabolism and hearing loss: association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with adolescent hearing health

BACKGROUND

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) is a novel lipid measure for assessing the risk of cardiovascular disease. Lipid metabolism disorders are reportedly associated with hearing impairment. This study aimed to investigate the potential association between NHHR and hearing.

METHODS

The data used in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) cycles of 2005-2010 and 2017-2018, including 4,296 participants aged 6-19 years. The NHHR was calculated from lipid profiles, and hearing was assessed using pure-tone audiometry. Weighted multivariate logistic regression analyses were used to investigate the association between the NHHR and hearing loss. Subgroup and sensitivity analyses were performed to verify the robustness of the results.

RESULTS

Univariate analysis revealed significant associations between the NHHR and hearing threshold at all categorized frequency (low, speech, or high-frequency) (P < 0.001). Three models were used: an unadjusted model, a model adjusted for age, sex, and race, and a model further adjusted for PIR, BMI, and diabetes. Multiple regression analysis confirmed these associations consistently across all models. When considered as a continuous variable, NHHR had a significant association with enhanced hearing thresholds at all categorized frequencies: low-frequency (β:0.56, 95% CI: 0.36-0.75), speech-frequency (β:0.55, 95% CI: 0.36-0.7), and high-frequency (β:0.55, 95% CI: 0.36-0.74). The adjusted models showed persistent positive correlations after controlling for covariates. The NHHR was consistently positively associated with hearing loss. The NHHR and auditory thresholds showed a general dose-response association across all frequencies.

CONCLUSIONS

NHHR is a promising biomarker for predicting adolescent hearing threshold shifts and hearing loss. The study highlights the importance of early lipid monitoring and management as strategies to prevent or reduce hearing impairment.

The association between different leisure-time physical activity patterns and the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in adults: national health and nutrition examination survey 2007-2018

BACKGROUND

Despite the potential superiority of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) as a diagnostic and predictive marker, no study has investigated the link between different leisure-time physical activity (LTPA) patterns and the NHHR. This study aims to explore this relationship.

METHODS

Data was extracted from the National Health and Nutrition Examination Survey (NHANES) cycles spanning from 2007 to 2008 to 2017-2018. Participants (N = 14,211) were classified into four groups based on their LTPA patterns: (1) inactive (LTPA = 0 min/week); (2) insufficiently active (LTPA < 150 min/week); (3) weekend warrior (LTPA ≥ 150 min/week within 1 or 2 sessions); and (4) regularly active (LTPA ≥ 150 min/week in more than 2 sessions). Weighted multiple linear regression analysis was employed twice, using inactive and regular active groups as reference groups, respectively. Weighted stratification analyses and interaction tests were performed by demographics.

RESULTS

Compared to the inactive group, each additional unit of LTPA time was associated with a significant 0.23-unit greater decrease in the NHHR in the regularly active group [-0.23 (-0.29; -0.16)]. However, no significant decrease was observed in the "Weekend Warrior" [-0.11 (-0.22; 0.008)] or insufficiently active groups [-0.03 (-0.11; 0.04)]. Moreover, compared to the regularly active group, the insufficiently active [0.21 (0.13; 0.29)], "Weekend Warrior" [0.13 (0.004; 0.25)], and inactive [0.26 (0.20; 0.32)] groups had significantly higher NHHR. The associations between the NHHR and various LTPA patterns did not significantly differ by demographic factors, except for race.

CONCLUSION

The regularly active pattern is significantly associated with a lower NHHR, but no significant difference in the NHHR was detected between the insufficiently active and "Weekend Warriors" patterns. The study suggests that frequency and regularity of PA are crucial for optimal lipid management, supporting clinical recommendations to meet or exceed 150 min of PA in more than two sessions per week.

Muscle quality index is associated with depression among non-elderly US adults

PURPOSE

Muscle Quality Index (MQI), defined as the muscle strength per unit of muscle mass, is considered an emerging indicator of health and physical function. This study aims to explore the relationship between MQI and the risk of depression among non-elderly US adults.

METHODS

This cross-sectional study collected data from participants aged between 20 and 59 years old, utilizing the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. The MQI was calculated by dividing the handgrip strength (HGS, kg) by the arm and appendicular skeletal muscle mass (ASM, kg). Depression assessments were conducted using the Patient Health Questionnaire (PHQ-9). The relationship between MQI and the risk of depression was explored by weighted logistic regression, smooth curve fitting, and subgroup analyses.

RESULTS

A total of 4773 participants were included in this study. After adjusting for confounding factors, low MQI levels were identified as an independent risk factor for depression (OR = 0.800, 95%CI:0.668-0.957, P = 0.015). Smooth curve fitting analysis indicated a nonlinear relationship. Subgroup analysis did not identify any specific populations.

CONCLUSIONS

Higher MQI levels were closely associated with a lower risk of depression among non-elderly US adults. MQI could enhance our understanding of the link between muscle and depression and might serve as a simple functional measure for evaluating and predicting depression.

A cross-sectional study of the correlation of the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) with obstructive sleep apnea (OSA) in adult populations: NHANES (2005-2008 and 2015-2020)

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, abbreviated as NHHR, represents a brand-new lipid biomarker for assessing cardiovascular disease risk. Research has suggested a link between lipid metabolism and obstructive sleep apnea (OSA). To delve deeper, this study was carried out using data derived from the NHANES to ascertain whether NHHR and OSA are associated. In this research, a cross-sectional analysis was executed based on data derived from NHANES across the years 2005 to 2008 and 2015 to 2020. After adjusting for confounders such as demographic characteristics, lifestyle, and health status, the link between NHHR and the likelihood of developing OSA was examined via weighted binary logistic regression as well as restricted cubic spline (RCS) models. In addition, subgroup analysis was completed to check if the obtained results were reliable. The study included 16,265 adult participants. Following comprehensive adjustment for confounders, results obtained suggested that, for each additional unit increment of NHHR, there is a 9% increased chance of developing OSA. Compared to the lowest quartile, the highest quartile of NHHR notably increased the risk of developing OSA in the overall population (OR: 1.65; 95% CI: 1.38-1.98; P < .001). The RCS curve indicated a linear positive correlation between NHHR and OSA, which remained significant in subsequent subgroup analyses (all P for interaction > .05). This suggested that the correlation between NHHR and OSA was stable across populations with different characteristics. Confounders such as demographics, lifestyle, and health status did not significantly affect this positive correlation. Findings from this study uncovered a strong connection between NHHR and an increased possibility of developing OSA in American adults. Further exploration of NHHR could offer insights into OSA prevention and treatment. However, owing to the constraints inherent in cross-sectional studies, more studies are required to establish a concrete link between NHHR and OSA.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: a retrospective study

BACKGROUND

Dyslipidemia is prominently associated with adverse outcomes in patients with coronary artery disease (CAD). The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel comprehensive lipid index. However, limited evidence exists on the relationship of the NHHR with the risk of adverse outcomes in patients with CAD. This study aimed to explore the associations between the NHHR and adverse outcomes and identify the optimal NHHR ranges linked to the lowest adverse outcome risk in patients with CAD undergoing percutaneous coronary intervention (PCI).

METHODS

Among 2253 patients with CAD undergoing PCI, 2251 with available total cholesterol and HDL-C levels were analyzed. Furthermore, all patients were classified into quintiles based on the NHHR. The primary outcome was the incidence of MACCEs, comprising cardiac mortality, acute myocardial infarction, stroke, and repeat revascularization. Multivariable logistic regression analysis was used to assess the relationship between the NHHR and MACCEs. Moreover, restricted cubic spline (RCS) analysis was performed to quantify nonlinearity. Lastly, the consistency between these associations was confirmed by conducting subgroup and interaction analyses.

RESULTS

A total of 270 patients experienced MACCEs over a median follow-up of 29.8 months (interquartile range, 25.6-34 months). After adjustment for confounding variables, the adjusted ORs (95% CIs) of the patients in quintiles 2, 3, 4, and 5 were 0.79 (0.52-1.20), 0.64 (0.42-0.99), 1.00 (0.67-1.48), and 1.17 (0.74-1.64), respectively (reference group: quintile 1). Additionally, RCS analysis demonstrated a U-shaped relationship between the NHHR and MACCEs, with an inflection point at an NHHR of 3.119 using a two-piecewise regression model. This relationship was consistent across the various subgroups, while significant interactions were not observed in these associations.The ORs and 95% CIs to the left and right of the inflection point were 0.734 (0.551-0.978) and 1.231 (1.038-1.460), respectively.

CONCLUSIONS

This study reveals a U-shaped association between baseline NHHR and MACCE incidence in patients with CAD undergoing PCI.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and diabetic kidney disease in patients with diabetes in the United States: a cross-sectional study

BACKGROUND

This paper investigated the link between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and diabetic kidney disease (DKD) in adult diabetic patients and identified the optimal NHHR value for impacting DKD.

METHODS

This cross-sectional research made use of records from the National Health and Nutrition Examination Survey (NHANES) executed between 2005 and 2016. The link of NHHR to DKD risk was analyzed by logistic regression and restricted cubic spline (RCS) models. The stability and reliability of the results were assessed by subgroup analysis and sensitivity analysis.

RESULTS

In total, 4,177 participants were involved. As a continuous variable, NHHR was markedly connected to an increased risk of DKD (OR 1.07, 95% CI 1.02, 1.12, P < 0.01). When NHHR was grouped in quartiles, relative to the reference set, the highest NHHR group was also linked to a heightened risk of DKD (OR 1.23, 95% CI 1.01, 1.50, P < 0.05). The outcome of RCS show a "J" shaped correlation between NHHR and DKD risk (P for nonlinear = 0.0136). The risk of developing DKD was the lowest when NHHR equals 2.66. Subgroup analysis revealed that the link of NHHR to DKD persisted in participants aged below 40, females, non-smokers, and those without hyperuricemia. Sensitivity analysis demonstrated a certain robustness in this association.

CONCLUSION

A meaningful link is present between NHHR and DKD. An NHHR value of around 2.66 could represent the ideal cutoff for assessing DKD risk.