The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cancer prevalence among US adults: A cross-sectional study

Lipid metabolism is recognized as a key player in carcinogenesis, but the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and overall cancer prevalence remains unclear in the US population. This study aimed to investigate the association between NHHR and cancer prevalence based on self-reported lifetime cancer diagnoses in a nationally representative US population. We utilized data from the National Health and Nutrition Examination Survey from 2007 to 2016. The primary exposure was NHHR, and the primary outcome was self-reported lifetime cancer diagnosis. Associations were assessed using weighted multivariable logistic regression models, with NHHR modeled as both a continuous variable and tertiles. Model 1 was unadjusted; Model 2 adjusted for age, sex, race/ethnicity, education level, marital status, and family income-to-poverty ratio; and Model 3 further adjusted for total cholesterol, glycated hemoglobin, physical activity, and drinking status. The analysis included adults aged 18 years or older with available NHHR and cancer-related information. Exploratory cancer-specific analyses were performed for prostate, breast, colorectal, and lung cancers. Among 26,416 participants, 2451 (9.0%) reported a lifetime cancer diagnosis. The mean age of the participants was 49.48 ± 17.67 years, and the mean NHHR was 2.96 ± 1.48. In the fully adjusted model, each unit increase in NHHR corresponded to 7% higher odds of cancer prevalence (odds ratio: 1.07 [95% confidence interval: 1.01-1.13]). NHHR tertiles were defined as T1 (0.45-2.11), T2 (2.11-3.11), and T3 (3.11-15.03). Compared with participants in the lowest tertile, those in the highest tertile had 22% higher odds of cancer prevalence (odds ratio: 1.22 [95% confidence interval: 1.04-1.48], P = .035). Subgroup analyses suggested potential effect modification by sex. Elevated NHHR levels were positively associated with cancer prevalence in US adults, suggesting that NHHR may be a potential biomarker warranting further investigation.