Association Between the Non-High-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio and Sarcopenia in...

Objective To investigate the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio （NHHR） and the risk of sarcopenia in older Chinese men. Methods This study was based on the baseline data from the China Health and Retirement Longitudinal Study，including 1 849 men aged≥60 years.Missing data were handled through multiple imputation.Participants were categorized into quartiles of NHHR （Q1-Q4）.Multivariable Logistic regression models were constructed with stepwise adjustment for demographic factors，lifestyle，chronic diseases，and body mass index （BMI） to estimate odds ratios （OR） and 95%CI.Restricted cubic spline analysis was performed to examine potential non-linear associations.Subgroup and sensitivity analyses （with possible sarcopenia as an alternative outcome） were performed. Results NHHR was significantly and inversely associated with sarcopenia.In models without BMI adjustment，the highest NHHR quartile （Q4） showed a lower risk of sarcopenia than the lowest quartile （Q1） （OR=0.199，95%CI=0.112-0.338，P<0.001）.However，the association was attenuated after adjustment for BMI （OR=0.403，95%CI=0.220-0.709，P=0.002；the OR for each 1-standard-deviation increase in NHHR was approximately 0.680）.Restricted cubic spline analysis indicated a linear association （P_overall<0.001，P_non-linear=0.793）.In sensitivity analyses，NHHR remained significantly and inversely associated with possible sarcopenia.The fully adjusted model showed that the risk of possible sarcopenia was lower in the Q4 group than in the Q1 group （OR=0.613，95%CI=0.404-0.924，P=0.020），and each 1-standard-deviation increase in NHHR was associated with a reduced risk of possible sarcopenia （OR=0.849，95%CI=0.728-0.987，P=0.035）.Subgroup analyses showed that the inverse association between NHHR and sarcopenia risk was directionally consistent across strata of age，smoking，drinking，and hypertension，while the association in the diabetes subgroup did not reach statistical significance，possibly owing to the limited sample size （OR=0.46，95%CI=0.16-1.37，P=0.164）. Conclusions NHHR is inversely associated with sarcopenia risk among older Chinese men，while this association is substantially attenuated after adjustment for BMI，suggesting it may be largely confounded by body size or obesity-related factors.These findings should be interpreted with caution，and future longitudinal studies incorporating direct muscle mass measurements，such as dual-energy X-ray absorptiometry and bioelectrical impedance analysis，are warranted to clarify the independent role of NHHR in sarcopenia.