The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and bone mineral density in adult men: NHANES (2011-2018)

Background The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) represents a novel lipid marker. This study examined the correlation between NHHR and lumbar bone mineral density (BMD) in adult men. Methods Data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) were utilized in this study, including 5,434 men aged 20-59 years. To analyze the relationship between NHHR and lumbar BMD, multivariate linear regression models and stratified analyses were employed. Fitted smoothing curves and threshold effect analysis were also applied to examine the nonlinear association of NHHR with lumbar BMD. Results After adjusting for covariates, weighted multivariable linear regression models revealed a negative relationship between NHHR and lumbar BMD (β = -0.005, 95% CI: -0.008 to -0.002, P < 0.001). Subgroup analyses stratified by race, age, and BMI demonstrated this negative association in non-Hispanic black (β = -0.015, 95% CI: -0.025 to -0.005, P = 0.003) and other race (β = -0.006, 95% CI: -0.012 to -0.001, P = 0.013), participants aged 40-49 years (β = -0.011, 95% CI: -0.017 to -0.004, P = 0.001), BMI<25 (β = -0.009, 95% CI: -0.017 to -0.001, P = 0.022) and 25≤BMI<30 (β = -0.010, 95% CI: -0.015 to -0.005, P < 0.001). For the total cohort, other race individuals, and participants aged 30-39 years, a nonlinear relationship was explored with inflection points at 4.76, 5.00, and 2.83, respectively. Conclusions In adult men aged 20 to 59 years, our research identified a negative relationship between NHHR and lumbar BMD. Among the overall cohort, as well as in other race individuals and participants aged 30-39 years, the relationship exhibited a nonlinear curve with inflection points at 4.76, 5.00, and 2.83, respectively. Consequently, NHHR measurement may serve as a sensitive biomarker for early osteoporosis detection and therapeutic guidance.