The relationship between non-HDL cholesterol to HDL cholesterol ratio (NHHR) and anemia: A cross-sectional study of NHANES, 2009 to 2016

The non-HDL cholesterol to HDL cholesterol ratio (NHHR) is a newly developed metric that represents the ratio of non-HDL cholesterol to HDL cholesterol. Anemia is a prevalent public health concern affecting all age groups. Our purpose is to investigate the connection between NHHR and the prevalence of anemia, as well as to explore their potential interactions. A total of 17,019 participants were incorporated into this research. NHHR was calculated as the scale of non-HDL cholesterol to HDL cholesterol. According to WHO criteria, anemia at sea level is diagnosed with a hemoglobin level (g/dL) of <12 for women and <13 for men. This study utilized multivariate linear regression, threshold effect analysis, smooth curve fitting, multivariate logistic regression as well as subgroup analysis, to investigate the linkage between the NHHR and anemia. After complete adjustment, the model indicated a strong inverse relationship between NHHR and the prevalence of anemia (the odds ratio [OR] was 0.82 with a 95% confidence interval of 0.78-0.86), suggesting that an incremental increase in NHHR correlates with an 18% decrease in the prevalence of anemia. Segmenting NHHR into quartiles maintained this significant association. The prevalence of anemia was 51% lower among participants in the highest NHHR quartile compared to those in the lowest quartile, with an OR of 0.49 (95% CI: 0.41-0.59; P for trend < .0001). Subsequent analysis revealed a significant improvement in the threshold effect value to 4.28 for the potential relationship between NHHR and anemia. Subgroup analysis showed an inverse correlation in some subgroups. Alcohol consumption significantly affects the relationship between NHHR and anemia (interaction P < .05). Our study revealed that NHHR is inversely proportional to the prevalence of anemia in U.S. adults.