Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and Sarcopenic obesity in U.S. adults: a cross-sectional study

Abstract

Objective: This study examines the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and sarcopenic obesity in U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods: We analysed data from NHANES collected between 2011 and 2018. Multivariable regression models assessed the NHHR-sarcopenic obesity relationship, and limited cubic spline analysis investigated potential non-linearity. We employed likelihood ratio tests to evaluate model fit and performed subgroup analyses to verify the consistency of our findings. Results: The analysis included 8601 participants with an average age of 39.94 ± 11.45 years. In the fully adjusted model, each unit increase in NHHR was associated with a 76 % higher likelihood of sarcopenic obesity (odds ratio [OR]: 1.76, 95 % confidence interval [CI]: 1.18–2.63). The relationship between NHHR and sarcopenic obesity was non-linear, with a significant breakpoint at 3.36. Below this threshold, each unit increase in NHHR significantly increased the risk of sarcopenic obesity (OR: 1.53, 95 % CI: 1.32–1.78), while above this threshold, NHHR had no significant effect on sarcopenic obesity prevalence. Conclusions: These results indicate a positive and non-linear association between NHHR and sarcopenic obesity, suggesting that NHHR, as a simple and widely available lipid marker, may assist in the early identification of individuals at risk of sarcopenic obesity. Further large-scale longitudinal studies are needed to validate its predictive value across broader age groups and to clarify its potential utility in personalized risk assessment and clinical screening.