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

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.