Association Between Neutrophil-to-HDL Ratio and Full-Spectrum Dysglycemia: Insights from a Large Middle Eastern Population Study

<b>Background:</b> Chronic low-grade inflammation and dyslipidemia contribute to metabolic disorders such as diabetes. Dysglycemia, an early stage of glucose dysregulation, reflects this interplay. The neutrophil-to-HDL cholesterol ratio (NHR) integrates inflammatory and lipid pathways, but its role in dysglycemia, particularly in Middle Eastern populations, remains unclear. This study evaluated the association between NHR and glycemic abnormalities, including impaired fasting glucose (IFG) and hyperglycemia (HG). <b>Methods:</b> A retrospective cross-sectional investigation involving 13,121 individuals at a major health setting in Saudi Arabia was conducted. The association between NHR and glycemic status was comprehensively evaluated, with subgroup analyses stratified by age and gender. Risk and diagnostic performance of NHR for dysglycemia were evaluated. Correlation and linear regression analyses were conducted to examine the relationships between NHR and fasting glucose, as well as HbA1c. <b>Results:</b> NHR levels were significantly associated with dysglycemia, showing progressive elevation from normoglycemia (5.30: 3.453-7.755) to IFG (6.00: 3.904-8.663) and HG (7.177: 4.917-10.17). Elevated NHR was more prevalent among individuals with dysglycemia and was associated with an increased risk of IFG (OR = 1.48, 95% CI: 1.36-1.61, <i>p</i> < 0.0001) and HG (OR = 2.38, 95% CI: 2.13-2.65, <i>p</i> < 0.0001). In the FBG context, NHR showed better discrimination of HG from NG than CRP (AUC = 0.650 vs. 0.570; <i>p</i> < 0.0001). <b>Conclusions:</b> Elevated NHR is significantly associated with dysglycemia, particularly hyperglycemia. These findings suggest that NHR may serve as a supportive tool for identifying individuals at increased risk of dysglycemia, especially in populations with limited diagnostic resources. Future longitudinal studies are warranted to validate its predictive and prognostic value in clinical practice.