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. 2025 Apr 25;24(1):157.
doi: 10.1186/s12944-025-02571-0.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and preserved ratio impaired spirometry: NHANES 2007-2012

Qilei Zhu  1 , Ran He  2 , Yiqin Yan  1 , Lihan Xiang  1 , Yarong Li  1 , Yi Yang  3 , Dandan Hu  4 , Liming Lou  5
Affiliations

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and preserved ratio impaired spirometry: NHANES 2007-2012

Qilei Zhu et al. Lipids Health Dis. .

Abstract

Background: Preserved ratio impaired spirometry (PRISm) refers to a form of lung function deterioration, and previous studies have established the association with Chronic Obstructive Pulmonary Disease (COPD). Research has also shown the association between COPD and lipid metabolism disturbances. Despite these findings, the association between lipid metabolism markers and PRISm remains poorly understood.

Methods: This analysis was conducted on the 2007-2012 data from the National Health and Nutrition Examination Survey (NHANES), including a total of 9,431 participants. The Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) was calculated based on lipid profiles, and PRISm patients were classified according to pulmonary function tests. To explore the association between NHHR and PRISm, multivariable logistic regression analysis was used.

Results: A strong linear association was observed between NHHR and PRISm. In Adjusted Model 2, the weighted multivariable logistic regression analysis revealed that each unit increase in NHHR increased the chance of developing PRISm by 8% (OR:1.08, 95%CI:1.01-1.16, P = 0.039).Participants within the highest NHHR tertile demonstrated a 1.36-fold increased likelihood of presenting with PRISm compared to those in the lowest NHHR tertile (OR:1.36, 95% CI: 1.01-1.83, P = 0.048). Additionally, weighted Restricted Cubic Spline affirmed a linear association between NHHR and PRISm (P for non-linearity = 0.637), while clear non-linear associations were found between NHHR and FEV1% predicted (P for non-linearity = 0.010) and FEV1/FVC (P for non-linearity = 0.023). Subgroup analysis and interaction tests revealed a significant interaction effect among different waist circumference categories (P for interaction = 0.020). Notably, in individuals without abdominal obesity, NHHR showed a strong positive association with PRISm (OR = 1.23, 95% CI: 1.07-1.42, P = 0.01).

Conclusion: These results indicate that NHHR is positively associated with PRISm and is significantly associated with the decline in lung function. This study offers distinctive perspectives that may contribute to the avoidance and management of early-stage pulmonary dysfunction.

Keywords: Cross-sectional study; Lipid metabolism; NHANES; NHHR; PRISm.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The NHANES protocol was approved by the Ethics Review Board of the NCHS. Each participant provided written informed consent during the survey. This study is a secondary analysis based on the publicly available NHANES database, and therefore, does not require further ethical review by the hospital's ethics committee. Consent for publication: The authors gave their approval for the publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study participants
Fig. 2
Fig. 2
Exposure–response associations for NHHR and PRISm derived by restricted cubic spline modeling (weighted). A A linear association exists between NHHR and PRISm. B A linear association exists between FEV1 and PRISm. C A linear association exists between FVC and PRISm. D A non-linear association exists between NHHR and FEV1/FVC. E A non-linear association exists between NHHR and FEV1%
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