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White Blood Cell to HDL-C Ratio and Sarcopenia: A Dual-Cohort Analysis Including Exploratory Insights on Hepatitis B
Wenshuo Cheng1, Huiling Xiang2
1The Third Central Clinical College of Tianjin Medical University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin University Central Hospital (Tianjin Third Central Hospital), Tianjin, China.
Background:
Sarcopenia, driven by inflammation and lipid dysregulation, lacks inexpensive screening tools. The white blood cell to HDL-C ratio (WHR) integrates these pathways, but its utility for sarcopenia screening remains unvalidated.
Objective:
This study evaluated the WHR-sarcopenia association in dual cohorts, validated it using machine learning, and explored potential effect modification of hepatitis B virus (HBV) status.
Methods:
We analyzed 10 131 NHANES (2011-2018) and 7872 KNHANES (2010-2011) adults. Sarcopenia was defined via DXA using FNIH/AWGS criteria. Weighted logistic regression, restricted cubic splines, and machine learning (LASSO, XGBoost) were applied.
Results:
Higher ln(WHR) was independently associated with sarcopenia in NHANES (adjusted OR = 2.50; 95% CI: 2.01-3.10) and consistently validated in KNHANES (OR = 1.85; 95% CI: 1.49-2.29). WHR ranked among the top predictive features across machine learning models. Exploratory stratified analysis suggests that the association between ln(WHR) and sarcopenia appears to be stronger in the HBV-exposed subgroup. However, although the formal interaction test was not significant (p = 0.270), these findings are hypothesis-generating results.
Conclusion:
WHR, a cost-free routine metric, is robustly linked to sarcopenia. Integrating it into geriatric assessments could facilitate early high-risk identification for timely interventions, while exploratory findings suggesting a possible modifying role of HBV history require prospective validation.