Association Between Non-HDL/HDL Cholesterol Ratio and Urinary Incontinence in US Women:NHANES 2005-2018

Zhemin Yao,1 Shuangshuang Huang,2 Hao Chen1 1Department of Urinary Surgery, Yueqing Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325600, People’s Republic of China; 2Operating Departments, Yueqing Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325600, People’s Republic of ChinaCorrespondence: Hao Chen, Department of Urinary Surgery, Yueqing Affiliated Hospital of Wenzhou Medical University, No. 338 Qingyuan Road, Yueqing, Wenzhou, Zhejiang, 325600, People’s Republic of China, Tel +86-13567778100, Email [email protected]: Urinary incontinence (UI) is a common health issue among women, and dyslipidemia has been suggested as a potential novel risk factor. The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) provides a comprehensive assessment of lipid metabolism imbalance. However, its association with UI remains unclear. This study aimed to investigate the relationship between NHHR and UI in adult women.Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. A total of 13,885 adult women were included. UI and its subtypes were assessed via structured questionnaires, and NHHR was calculated accordingly. Multivariable logistic regression models were used to examine the association between NHHR and UI. Smooth curve fitting and threshold effect analysis were applied to explore potential nonlinear relationships. Subgroup analyses were conducted to evaluate heterogeneity across different populations. Sensitivity analyses were conducted to verify the robustness of the study results.Results: NHHR was significantly positively associated with stress urinary incontinence (SUI). In the fully adjusted model, each 1-unit increase in NHHR was associated with a 7.5% higher risk of SUI (OR = 1.075, 95% CI: 1.027– 1.126). Participants in the highest NHHR quartile (Q4) had a 32.0% higher risk of SUI compared to those in the lowest quartile (Q1) (OR = 1.320, 95% CI: 1.133– 1.539). Smooth curve fitting revealed a nonlinear relationship between NHHR and UI, with an inflection point at 3.281. The positive association between NHHR and SUI was more pronounced among women with body mass index (BMI) ≥ 30 kg/m² and those with insufficient physical activity. However, after adjusting for potential confounders, no significant associations were observed between NHHR and urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI). The results of the sensitivity analyses were consistent with the main findings.Conclusion: NHHR showed a positive association with SUI, particularly among women with obesity and low physical activity. These findings underscore the potential of NHHR as a novel biomarker for SUI risk stratification and suggest that targeting lipid imbalances through lifestyle interventions could contribute to reducing the burden of SUI. Further research is warranted to elucidate the underlying mechanisms and to evaluate the potential of NHHR as a therapeutic target in the prevention and management of SUI.Keywords: urinary incontinence, stress urinary incontinence, NHHR, NHANES