Association Between the Non-High-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio and Sarcopenia in Older Chinese Men

Jinjiang LI, Chunyan HAO

Acta Academiae Medicinae Sinicae ›› 2026, Vol. 48 ›› Issue (4) : 660-670.

PDF(1452 KB)
Home Journals Acta Academiae Medicinae Sinicae
Acta Academiae Medicinae Sinicae

Abbreviation (ISO4): Acta Academiae Medicinae Sinicae      Editor in chief: Xuetao CAO

About  /  Aim & scope  /  Editorial board  /  Indexed  /  Contact  / 
PDF(1452 KB)
Acta Academiae Medicinae Sinicae ›› 2026, Vol. 48 ›› Issue (4) : 660-670. DOI: 10.3881/j.issn.1000-503X.17026
Original Articles

Association Between the Non-High-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio and Sarcopenia in Older Chinese Men

Author information +
History +

Abstract

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 (Poverall<0.001,Pnon-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=0.034).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.

Key words

non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio / sarcopenia / China Health and Retirement Longitudinal Study

Cite this article

Download Citations
Jinjiang LI , Chunyan HAO. Association Between the Non-High-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio and Sarcopenia in Older Chinese Men[J]. Acta Academiae Medicinae Sinicae. 2026, 48(4): 660-670 https://doi.org/10.3881/j.issn.1000-503X.17026

References

[1]
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia:European consensus on definition and diagnosis[J]. Age Ageing, 2010, 39(4):412-423.DOI:10.1093/ageing/afq034.
[2]
Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia:2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3):300-307.e2.DOI:10.1016/j.jamda.2019.12.012.
[3]
Cruz-Jentoft AJ, Sayer AA. Sarcopenia[J]. Lancet, 2019, 393(10191):2636-2646.DOI:10.1016/S0140-6736(19)31138-9.
[4]
Hsu W, Wang S, Chao Y, et al. Novel metabolic and lipidomic biomarkers of sarcopenia[J]. J Cachexia Sarcopenia Muscle, 2024, 15(5):2175-2186.DOI:10.1002/jcsm.13567.
[5]
Xu Z, You W, Chen W, et al. Single-cell RNA sequencing and lipidomics reveal cell and lipid dynamics of fat infiltration in skeletal muscle[J]. J Cachexia Sarcopenia Muscle, 2021, 12(1):109-129.DOI:10.1002/jcsm.12643.
[6]
Al Saedi A, Debruin DA, Hayes A, et al. Lipid metabolism in sarcopenia[J]. Bone, 2022, 164:116539.DOI:10.1016/j.bone.2022.116539.
[7]
Petrenko V, Sinturel F, Riezman H, et al. Lipid metabolism around the body clocks[J]. Prog Lipid Res, 2023, 91:101235. DOI:10.1016/j.plipres.2023.101235.
[8]
Zeng Q, Gong Y, Zhu N, et al. Lipids and lipid metabolism in cellular senescence:emerging targets for age-related diseases[J]. Ageing Res Rev, 2024, 97:102294.DOI:10.1016/j.arr.2024.102294.
[9]
Gebhard C, Rhainds D, Tardif JC. HDL and cardiovascular risk:is cholesterol in particle subclasses relevant[J]. Eur Heart J, 2015, 36(1):10-12.DOI:10.1093/eurheartj/ehu306.
[10]
Yu B, Li M, Yu Z, et al. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) as a predictor of all-cause and cardiovascular mortality in US adults with diabetes or prediabetes:NHANES 1999-2018[J]. BMC Med, 2024, 22(1):317.DOI:10.1186/s12916-024-03536-3.
[11]
Qi X, Wang S, Huang Q, et al. 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[J]. J Affect Disord, 2024, 344:451-457.DOI:10.1016/j.jad.2023.10.064.
[12]
Yang T, Liu Y, Li L, et al. Correlation between the triglyceride-to-high-density lipoprotein cholesterol ratio and other unconventional lipid parameters with the risk of prediabetes and type 2 diabetes in patients with coronary heart disease:a RCSCD-TCM study in China[J]. Cardiovasc Diabetol, 2022, 21(1):93.DOI:10.1186/s12933-022-01531-7.
[13]
Jiang Y, Xu B, Zhang K, et al. The association of lipid metabolism and sarcopenia among older patients:a cross-sectional study[J]. Sci Rep, 2023, 13(1):17538.DOI:10.1038/s41598-023-44704-4.
[14]
Giacona JM, Petric UB, Kositanurit W, et al. HDL-C and apolipoprotein A-I are independently associated with skeletal muscle mitochondrial function in healthy humans[J]. Am J Physiol Heart Circ Physiol, 2024, 326(4):H916-H922.DOI:10.1152/ajpheart.00017.2024.
[15]
Lee SH, Park SY, Choi CS. Insulin resistance:from mechanisms to therapeutic strategies[J]. Diabetes Metab J, 2022, 46(1):15-37.DOI:10.4093/dmj.2021.0280.
[16]
Shigehara K, Kato Y, Izumi K, et al. Relationship between testosterone and sarcopenia in older-adult men:a narrative review[J]. J Clin Med, 2022, 11(20):6202.DOI:10.3390/jcm11206202.
[17]
Hu H, Fukunaga A, Yokoya T, et al. Non-high-density lipoprotein cholesterol and risk of cardiovascular disease:the Japan Epidemiology Collaboration on Occupational Health Study[J]. J Atheroscler Thromb, 2022, 29(9):1295-1306.DOI:10.5551/jat.63118.
[18]
Wen X, Wang M, Jiang CM, et al. Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults[J]. Asia Pac J Clin Nutr, 2011, 20(4):551-556.DOI:10.6133/apjcn.2011.20.4.08.
[19]
Walowski CO, Braun W, Maisch MJ, et al. Reference values for skeletal muscle mass:current concepts and methodological considerations[J]. Nutrients, 2020, 12(3):755.DOI:10.3390/nu12030755.
[20]
Chen X, Ji Y, Liu R, et al. Mitochondrial dysfunction:roles in skeletal muscle atrophy[J]. J Transl Med, 2023, 21(1):503.DOI:10.1186/s12967-023-04369-z.
[21]
Paris MT, Bell KE, Mourtzakis M. Myokines and adipokines in sarcopenia:understanding cross-talk between skeletal muscle and adipose tissue and the roleof exercise[J]. Curr Opin Pharmacol, 2020, 52:61-66.DOI:10.1016/j.coph.2020.06.003.
[22]
Mann G, Mora S, Madu G, et al. Branched-chain amino acids:catabolism in skeletal muscle and implications for muscle and whole-body metabolism[J]. Front Physiol, 2021, 12:702826. DOI:10.3389/fphys.2021.702826.
[23]
Huang H, Yu X, Jiang S, et al. The relationship between serum lipid with sarcopenia:results from the NHANES 2011-2018 and bidirectional Mendelian randomization study[J]. Exp Gerontol, 2024, 196:112560.DOI:10.1016/j.exger.2024.112560.
[24]
Hua N, Qin C, Wu F, et al. High-density lipoprotein cholesterol level and risk of muscle strength decline and sarcopenia in older adults[J]. Clin Nutr, 2024, 43(10):2289-2295. DOI:10.1016/j.clnu.2024.08.017.
[25]
Prado CM, Batsis JA, Donini LM, et al. Sarcopenic obesity in older adults:a clinical overview[J]. Nat Rev Endocrinol, 2024, 20(5):261-277.DOI:10.1038/s41574-023-00943-z.
[26]
Lin Y, Shi X, Wu W, et al. Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and sarcopenia in elderly adults[J]. Front Nutr, 2025, 12:1614263.DOI:10.3389/fnut.2025.1614263.
[27]
高天, 张勇, 张丹, 等. 骨骼肌干细胞及其微环境调控肌少症的研究进展[J]. 中国医学科学院学报, 2024, 46(6):958-964.DOI:10.3881/j.issn.1000-503X.16114.
[28]
Tian X, Lou S, Shi R. From mitochondria to sarcopenia:role of 17β-estradiol and testosterone[J]. Front Endocrinol (Lausanne), 2023, 14:1156583.DOI:10.3389/fendo.2023.1156583.
[29]
Batsis JA, Villareal DT. Sarcopenic obesity in older adults:aetiology,epidemiology and treatment strategies[J]. Nat Rev Endocrinol, 2018, 14(9):513-537.DOI:10.1038/s41574-018-0062-9.

Footnotes

利益冲突 所有作者声明无利益冲突

PDF(1452 KB)

Accesses

Citation

Detail

Sections
Recommended

/