Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of endometrial cancer among US adults: A population-based study.

123 Background: Endometrial cancer, as one of the metabolic-related malignancies, is becoming a significant public health concern worldwide. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has emerged as a comprehensive biomarker of various lipid-related metabolic disorders. However, the association of NHHR with endometrial cancer risk remains unclear to date. Therefore, we conducted this nationwide cross-sectional study to investigate the association of NHHR with the risk of endometrial cancer among US adults. Methods: Data were obtained from the National Health and Nutrition Examination Survey (1999–2018). Female participants who provided complete data on the NHHR and endometrial cancer were enrolled. The association of the NHHR with endometrial cancer was assessed by multivariate logistic regression analyses, adjusted by multiple potential confounders. Meanwhile, sensitivity analyses and subgroup analyses were conducted. Results: A total of 25,411 eligible participants were enrolled, including 214 (0.8%) women with endometrial cancer. The fully-adjusted multivariate logistic model showed a significantly positive association of NHHR with the endometrial cancer risk (odds ratio [OR] 1.15, 95% confidence interval [CI]: 1.05–1.25; P=0.003). Comparing the highest to the lowest quartile of NHHR, the fully-adjusted OR was 1.52 (95% CI: 1.02–2.28, P for trend=0.017). In subgroup analyses, the significantly positive association between NHHR and the risk of endometrial cancer was also found in non-obese women (OR 1.18, 95% CI: 1.04–1.35, P=0.012), women without diabetes (OR 1.15, 95% CI: 1.02–1.30, P=0.027), women with hypertension (OR 1.15, 95% CI: 1.03–1.28, P=0.012), women who use oral contraceptives (OR 1.16, 95% CI: 1.04–1.30, P=0.009) and in parous women(OR 1.15, 95% CI: 1.05–1.27, P=0.003). Additionally, in the sensitivity analysis by excluding participants with NHHR below 5% or above 95% in total cohort, the positive association of NHHR with endometrial cancer risk remained significant (OR 1.21, 95% CI: 1.03–1.42, P=0.018). Conclusions: This population-based study found that a higher NHHR correlated with an increased risk of endometrial cancer among the US population. Our findings suggested that NHHR might be a promising tool for the risk assessment of endometrial cancer. Prospective studies are necessary to further verify these findings. [Table: see text]