{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:13:18Z","timestamp":1787026398717,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an emerging composite lipid marker. Prediabetes, characterized by an asymptomatic state with moderate hyperglycemia, is more prevalent than diabetes. This study aimed to elucidate the potential correlation between NHHR and the risk of diabetes and prediabetes among adults with hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional survey, we screened National Health and Nutrition Examination Survey (NHANES)-collected data during 2009-2018, identifying a qualifying population of 10,250 individuals. Weighted multivariate logistic regression and curve fitting evaluated the correlation between the NHHR and the incidence of diabetes and prediabetes. To test differences between subgroups, stratified analyses were performed. Additionally, prediction accuracy of the NHHR was assessed using receiver operating characteristic (ROC) curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 10,250 patients with hypertension (mean age, 56.31 \u00b1 16.06 years) including 2,198 with diabetes and 4,138 with prediabetes\u2014a combined prevalence of 61.81%. The fully adjusted model indicated each unit increase in NHHR was associated with a 21% higher risk of diabetes\/prediabetes (OR 1.21; 95% CI, 1.15-1.25). Adjustment using multivariable classification models revealed that compared to the lowest NHHR quartile, the odds increased by 41% (OR 1.37; 95% CI, 1.27-1.59, p&amp;lt;0.001) in Q3 and (OR 1.82; 95% CI, 1.62-1.98, p&amp;lt;0.001) in Q4. In patients with hypertension, the NHHR was positively correlated with the prevalence of diabetes and prediabetes, with a nonlinear trend in the fitted curve (nonlinearity, P=0.007). The threshold effect analysis showed that the inflection point for NHHR and the risk of diabetes and prediabetes was 7.09. In particular, when NHHR was below 7.09, a positive correlation was found between NHHR and the risk of diabetes and prediabetes in this population (OR 1.34; 95% CI, 1.28\u20131.39). Subgroup analyses showed consistent associations across most groups, with a significant interaction in sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NHHR is positively and non-linearly correlated with diabetes\/prediabetes in patients with hypertension, particularly among women. It may serve as a valuable tool for early risk assessment and management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1523016","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:11:21Z","timestamp":1746663081000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Associations of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with diabetes and prediabetes among adults with hypertension: a cross-sectional study"],"prefix":"10.3389","volume":"16","author":[{"given":"Qing","family":"Meng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengqiang","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoping","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dezhou","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianghui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shugang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9 edition","volume":"157","author":"Saeedi","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"14790","DOI":"10.1038\/s41598-020-71908-9","article-title":"Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025","volume":"10","author":"Lin","year":"2020","journal-title":"Sci Rep"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2016.06.007","article-title":"Prediabetes: A worldwide epidemic","volume":"45","author":"Edwards","year":"2016","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60283-9","article-title":"Prediabetes: a high-risk state for diabetes development","volume":"379","author":"Tab\u00e1k","year":"2012","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2337\/db12-1814","article-title":"Sugar, uric acid, and the etiology of diabetes and obesity","volume":"62","author":"Johnson","year":"2013","journal-title":"Diabetes"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2024.103327","article-title":"Association between the oxidative balance score and all-cause and cardiovascular mortality in patients with diabetes and prediabetes","volume":"76","author":"Xu","year":"2024","journal-title":"Redox Biol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12933-019-0962-6","article-title":"ILERVAS project collaborators. Characteristics of atheromatosis in the prediabetes stage: a cross-sectional investigation of the ILERVAS project","volume":"18","author":"S\u00e1nchez","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.10.064","article-title":"The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of depression among US adults: A cross-sectional NHANES study","volume":"344","author":"Qi","year":"2024","journal-title":"J Affect Disord"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.03.027","article-title":"Non-HDL-cholesterol\/HDL-cholesterol is a better predictor of metabolic syndrome and insulin resistance than apolipoprotein B\/apolipoprotein A1","volume":"168","author":"Kim","year":"2013","journal-title":"Int J Cardiol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.12650","article-title":"Non-high-density lipoprotein cholesterol:\u2009\u2009High-density lipoprotein cholesterol ratio is an independent risk factor for diabetes mellitus: Results from a population-based cohort study","volume":"10","author":"Zhang","year":"2018","journal-title":"J Diabetes"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107991","article-title":"Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of post-stroke depression: A cross-sectional study","volume":"33","author":"Xiong","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1186\/s12889-024-19265-4","article-title":"Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and kidney stone: Evidence from NHANES 2007-2018","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Public Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000001700","article-title":"Exploration of the association of a lipid-related biomarker, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), and the risk of breast cancer in American women aged 20 years and older","volume":"110","author":"Luo","year":"2024","journal-title":"Int J Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2018.11.006","article-title":"Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment","volume":"51","author":"Carr","year":"2019","journal-title":"Pathology"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-003-1111-y","article-title":"Diabetic dyslipidaemia: From basic research to clinical practice","volume":"46","author":"Taskinen","year":"2003","journal-title":"Diabetologia"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3987065","article-title":"Comparative lipid-lowering\/increasing efficacy of 7 statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus: Systematic review and network meta-analyses of 50 randomized controlled trials","volume":"2020","author":"Zhang","year":"2020","journal-title":"Cardiovasc Ther"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2017.06.018","article-title":"Associations of lipid parameters with insulin resistance and diabetes: A population-based study","volume":"37","author":"Lin","year":"2018","journal-title":"Clin Nutr"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2012.01607.x","article-title":"Utility of non-high-density lipoprotein cholesterol in assessing incident type 2 diabetes risk","volume":"14","author":"Ley","year":"2012","journal-title":"Diabetes Obes Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3945\/an.115.009258","article-title":"Update on NHANES dietary data: Focus on collection, release, analytical considerations, and uses to inform public policy","volume":"7","author":"Ahluwalia","year":"2016","journal-title":"Adv Nutr"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.7326\/M17-3203z","article-title":"Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 american college of cardiology\/american heart association hypertension guideline","volume":"168","author":"Carey","year":"2018","journal-title":"Ann Intern Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12933-019-0898-x","article-title":"Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study","volume":"18","author":"Zhao","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2015.03.001","article-title":"Diagnostic criteria for malnutrition - an ESPEN consensus statement","volume":"34","author":"Cederholm","year":"2015","journal-title":"Clin Nutr"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S355980","article-title":"Utility of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in evaluating incident diabetes risk","volume":"15","author":"Sheng","year":"2022","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107712","article-title":"Association of non-HDL-C\/HDL-C ratio and its dynamic changes with incident type 2 diabetes mellitus: The Rural Chinese Cohort Study","volume":"34","author":"Han","year":"2020","journal-title":"J Diabetes Complications"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.5551\/jat.43968","article-title":"Positive association between small dense low-density lipoprotein cholesterol concentration and biomarkers of inflammation, thrombosis, and prediabetes in non-diabetic adults","volume":"26","author":"Hsu","year":"2019","journal-title":"J Atheroscler Thromb"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1556\/650.2016.30441","article-title":"Diabeteses dyslipidaemia \u00e9s atherosclerosis [Diabetic dyslipidaemia and the atherosclerosis","volume":"157","author":"M\u00e1rk","year":"2016","journal-title":"Orv Hetil"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab075","article-title":"HDL particle subspecies and their association with incident type 2 diabetes: the PREVEND study","volume":"106","author":"Sokooti","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B28","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12933-021-01348-w","article-title":"Triglyceride-rich lipoprotein and LDL particle subfractions and their association with incident type 2 diabetes: the PREVEND study","volume":"20","author":"Sokooti","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1046\/j.1462-8902.2003.0310.x","article-title":"Lipoprotein abnormalities and their consequences for patients with type 2 diabetes","volume":"5","author":"Krentz","year":"2003","journal-title":"Diabetes Obes Metab"},{"key":"B30","doi-asserted-by":"publisher","first-page":"5","DOI":"10.2337\/db24-1279-P","article-title":"1279-P: Cumulative exposure to high triglyceride\u2013to\u2013HDL cholesterol ratio and risk of type 2 diabetes in young adults","volume":"73","author":"Lee","year":"2024","journal-title":"Diabetes"},{"key":"B31","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2337\/diaclin.26.1.3","article-title":"Peters; clinical relevance of non-HDL cholesterol in patients with diabetes","volume":"26","author":"Anne","year":"2008","journal-title":"Clin Diabetes 1 January"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1003-8507.2022.7.xdyfyx202207005","article-title":"Associations between non -HDL -c\/HDL-c, its dynamics changes and incident type 2 diabetes mellitus in a prospective cohort study","volume":"49","author":"Yu","year":"2022","journal-title":"Modern Preventive Meacine"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.14172","article-title":"High-density lipoprotein in diabetes: Structural and functional relevance","volume":"15","author":"Lui","year":"2024","journal-title":"J Diabetes Investig"},{"key":"B34","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/978-3-319-09665-0_1","article-title":"Structure of HDL: Particle subclasses and molecular components","volume":"224","author":"Kontush","year":"2015","journal-title":"Handb Exp Pharmacol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.843219","article-title":"High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus","volume":"119","author":"Drew","year":"2009","journal-title":"Circulation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"165613","DOI":"10.1016\/j.bbadis.2019.165613","article-title":"Apolipoprotein A-I primes beta cells to increase glucose stimulated insulin secretion","volume":"1866","author":"Nilsson","year":"2020","journal-title":"Biochim Biophys Acta Mol basis Dis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.molmet.2019.03.006","article-title":"Point mutations in the PDX1 transactivation domain impair human \u03b2-cell development and function","volume":"24","author":"Wang","year":"2019","journal-title":"Mol Metab"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1242\/jcs.02906","article-title":"Abnormal sterols in cholesterol-deficiency diseases cause secretory granule malformation and decreased membrane curvature","volume":"119","author":"Gondr\u00e9-Lewis","year":"2006","journal-title":"J Cell Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1210\/en.2008-0161","article-title":"Inhibition of cholesterol biosynthesis impairs insulin secretion and voltage-gated calcium channel function in pancreatic beta-cells","volume":"149","author":"Xia","year":"2008","journal-title":"Endocrinology"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-010-1691-2","article-title":"Cholesterol efflux via ATP-binding cassette transporter A1 (ABCA1) and cholesterol uptake via the LDL receptor influences cholesterol-induced impairment of beta cell function in mice","volume":"53","author":"Kruit","year":"2010","journal-title":"Diabetologia"},{"key":"B41","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/CM9.0000000000003230","article-title":"Oxidative stress in diabetes mellitus and its complications: From pathophysiology to therapeutic strategies","volume":"138","author":"Chen","year":"2025","journal-title":"Chin Med J (Engl)"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1210\/en.2009-0252","article-title":"Low- and high-density lipoproteins modulate function, apoptosis, and proliferation of primary human and murine pancreatic beta-cells","volume":"150","author":"R\u00fctti","year":"2009","journal-title":"Endocrinology"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-007-0642-z","article-title":"Human high-density lipoprotein particles prevent activation of the JNK pathway induced by human oxidised low-density lipoprotein particles in pancreatic beta cells","volume":"50","author":"Abderrahmani","year":"2007","journal-title":"Diabetologia"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.2010.02237.x","article-title":"Obesity, insulin resistance and diabetes: sex differences and role of oestrogen receptors","volume":"203","author":"Meyer","year":"2011","journal-title":"Acta Physiol (Oxf)"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90676-9","article-title":"Waist circumference and abdominal sagittal diameter: Best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women","volume":"73","author":"Pouliot","year":"1994","journal-title":"Am J Cardiol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1523016\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:11:23Z","timestamp":1746663083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1523016\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":45,"alternative-id":["10.3389\/fendo.2025.1523016"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1523016","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]},"article-number":"1523016"}}