{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:16:53Z","timestamp":1787026613352,"version":"build-2736575974"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"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. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the association between the high-sensitivity C-reactive protein\/high-density lipoprotein cholesterol (Hs-CRP\/HDL-C) ratio and sarcopenia among U.S. population by using composite marker integrating systemic inflammation and lipid metabolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study included participants from the 2015\u20132018 of the National Health and Nutrition Examination Survey (NHANES). Sarcopenia was diagnosed based on the skeletal muscle index (SMI) by using dual-energy X-ray absorptiometry (DXA) technology. The Hs-CRP\/HDL-C ratio was derived from laboratory examinations, was categorized into quartiles. Multivariate logistic regression models, adjusted for demographic and clinical covariates, were employed to assess the association between the Hs-CRP\/HDL-C ratio and sarcopenia. Subgroup analysis and restricted cubic splines (RCS) were used to examine potential nonlinear relationships and threshold effects. Receiver operating characteristic (ROC) curve was used to evaluate the performance of\u00a0the Hs-CRP\/HDL-C ratio, Hs-CRP, and HDL-C indicators in predicting sarcopenia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study finally recorded 4,152 participants from NHANES from 2015\u20132018 for analysis. Elevated Hs-CRP\/HDL-C ratios were significantly associated with an increased risk of sarcopenia, with a dose-response relationship observed across quartiles (\n                      <jats:italic>p<\/jats:italic>\n                      for trend &amp;lt;0.05). The fully adjusted model revealed that each unit increase in the Hs-CRP\/HDL-C ratio corresponded to a 6% higher risk of sarcopenia (OR=1.06, 95% CI: 1.04\u20131.08,\n                      <jats:italic>p<\/jats:italic>\n                      =0.004). Participants in the highest quartile (\u22652.75) of the Hs-CRP\/HDL-C ratio had a 122% higher risk of sarcopenia compared to those in the lowest quartile (\n                      <jats:italic>p<\/jats:italic>\n                      =0.005). Subgroup analyses showed a stronger association in adults aged \u226540 years, with notable differences across races, especially among non-Hispanic Whites and other race. RCS model identified a non-linear association, with a threshold effect at a ratio of 0.86. The combined inflammatory and lipid markers Hs CRP\/HDL-C showed stronger predictive performance (AUC: 0.685, 95% CI 0.666-0.703).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Hs-CRP\/HDL-C ratio can serve as a practical indicator to identify individuals at higher risk of sarcopenia, capturing the combined effects of chronic inflammation and lipid metabolism issues. This ratio may be useful for early detection and prevention efforts targeting sarcopenia. However, more prospective research is needed to confirm these findings.\ufeff<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1600421","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:13:34Z","timestamp":1750292014000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Hs-CRP\/HDL-C ratio as a predictive inflammatory-lipid marker for sarcopenia: evidence from NHANES 2015\u20132018"],"prefix":"10.3389","volume":"16","author":[{"given":"Xin-Yan","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Wen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/127.5.990S","article-title":"Sarcopenia: origins and clinical relevance","volume":"127","author":"Rosenberg","year":"1997","journal-title":"J Nutr"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1616338","article-title":"Aerobic or resistance exercise, or both, in dieting obese older adults","volume":"376","author":"Villareal","year":"2017","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2011.01.003","article-title":"Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia","volume":"12","author":"Fielding","year":"2011","journal-title":". J Am Med Dir Assoc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2020.04.024","article-title":"Macronutrient composition and sarcopenia in the oldest-old men: The Helsinki Businessmen Study (HBS)","volume":"39","author":"Jyv\u00e4korpi","year":"2020","journal-title":"Clin Nutr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2017.e1","DOI":"10.1016\/j.jamda.2020.05.005","article-title":"Biomarkers profile of people with sarcopenia: A cross-sectional analysis from UK biobank","volume":"21","author":"Petermann-Rocha","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.3390\/antiox12051063","article-title":"Sarcopenic obesity: involvement of oxidative stress and beneficial role of antioxidant flavonoids","volume":"12","author":"Jung","year":"2023","journal-title":"Antioxidants (Basel)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2016.09.008","article-title":"Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis","volume":"35","author":"Kalinkovich","year":"2017","journal-title":"Ageing Res Rev"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1684\/abc.2017.1232","article-title":"Immunoanalytical characteristics of C-reactive protein and high sensitivity C-reactive protein","volume":"75","author":"Moutachakkir","year":"2017","journal-title":"Ann Biol Clin (Paris)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12901","article-title":"Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review","volume":"13","author":"Li","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B10","doi-asserted-by":"publisher","first-page":"6617","DOI":"10.1038\/s41598-025-90131-y","article-title":"Association between lipid ratios and sarcopenia and the mediating roles of inflammatory biomarkers in a cross-sectional study from NHANES 2011-2018","volume":"15","author":"Yin","year":"2025","journal-title":"Sci Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"101185","DOI":"10.1016\/j.arr.2020.101185","article-title":"Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis","volume":"64","author":"Tuttle","year":"2020","journal-title":"Ageing Res Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1186\/s12877-024-04761-4","article-title":"Dyslipidemia is associated with sarcopenia of the elderly: a meta-analysis","volume":"24","author":"Bi","year":"2024","journal-title":"BMC Geriatr"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2024.08.017","article-title":"High-density lipoprotein cholesterol level and risk of muscle strength decline and sarcopenia in older adults","volume":"43","author":"Hua","year":"2024","journal-title":"Clin Nutr"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab884","article-title":"Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis","volume":"107","author":"Feng","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","first-page":"103814","DOI":"10.1016\/j.numecd.2024.103814","article-title":"Associations of the hs-CRP\/HDL-C ratio with cardiovascular disease among US adults: Evidence from NHANES 2015-2018","volume":"3","author":"Li","year":"2024","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"4029","DOI":"10.1038\/s41598-025-88685-y","article-title":"Nonlinear associations of the hs-CRP\/HDL-C index with metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in US adults: insights from NHANES 2017-2018","volume":"15","author":"Liang","year":"2025","journal-title":"Sci Rep"},{"key":"B17","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1186\/s12872-024-04446-1","article-title":"The predictive role of the hs-CRP\/HDL-C ratio for long-term mortality in the general population: evidence from a cohort study","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2016.03.028","article-title":"Sarcopenia, sarcopenic obesity and inflammation: Results from the 1999\u20132004 National Health and Nutrition Examination Survey","volume":"35","author":"Batsis","year":"2016","journal-title":"Clin Nutr"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2017.08.016","article-title":"Does nutrition play a role in the prevention and management of sarcopenia","volume":"37","author":"Robinson","year":"2018","journal-title":"Clin Nutr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"15039","DOI":"10.3390\/ijms232315039","article-title":"Inflammaging: implications in sarcopenia","volume":"23","author":"Antu\u00f1a","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-07-2599","article-title":"The origins of age-related proinflammatory state","volume":"105","author":"Ferrucci","year":"2005","journal-title":"Blood"},{"key":"B22","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/S0047-6374(03)00027-7","article-title":"Circulating levels of TNF-alpha and IL-6-relation to truncal fat mass and muscle mass in healthy elderly individuals and in patients with type-2 diabetes","volume":"124","author":"Pedersen","year":"2003","journal-title":"Mech Ageing Dev"},{"key":"B23","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1159\/000356760","article-title":"Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options - a mini-review","volume":"60","author":"Ali","year":"2014","journal-title":"Gerontology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3","DOI":"10.18632\/aging.102740","article-title":"Macrophages in skeletal muscle aging","volume":"12","author":"Cui","year":"2020","journal-title":"Aging (Albany NY)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.3390\/cells12091214","article-title":"Macrophage involvement in aging-associated skeletal muscle regeneration","volume":"12","author":"Cui","year":"2023","journal-title":"Cells"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.13646","article-title":"GABA prevents sarcopenia by regulation of muscle protein degradation and inflammaging in 23- to 25-month-old female mice","volume":"15","author":"Song","year":"2024","journal-title":"J\u00a0Cachexia Sarcopenia Muscle"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1172\/JCI18921","article-title":"Hirschfield GM","volume":"111","author":"Pepys","year":"2003","journal-title":"C-reactive protein: Crit update J Clin Invest"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1684\/abc.2017.1232","article-title":"Immunoanalytical characteristics of C-reactive protein and high sensitivity C-reactive protein","volume":"75","author":"Moutachakkir","year":"2017","journal-title":"Ann Biol Clin (Paris)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"155585","DOI":"10.1016\/j.metabol.2023.155585","article-title":"Diet, exercise, and pharmacotherapy for sarcopenia in people with diabetes","volume":"144","author":"Hashimoto","year":"2023","journal-title":"Metabolism"},{"key":"B30","doi-asserted-by":"publisher","first-page":"111330","DOI":"10.1016\/j.exger.2021.111330","article-title":"Association of circulating C-reactive protein and high-sensitivity C-reactive protein with components of sarcopenia: A systematic review and meta-analysis of observational studies","volume":"150","author":"Shokri-Mashhadi","year":"2021","journal-title":"Exp Gerontol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac605","article-title":"High-density lipoprotein revisited: biological functions and clinical relevance","volume":"44","author":"von Eckardstein","year":"2023","journal-title":"Eur Heart J"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1038\/nri3793","article-title":"Cholesterol, inflammation and innate immunity","volume":"15","author":"Tall","year":"2015","journal-title":"Nat Rev Immunol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1186\/s12916-022-02672-y","article-title":"Obese visceral fat tissue inflammation: from protective to detrimental","volume":"20","author":"Kolb","year":"2022","journal-title":"BMC Med"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1159\/000538980","article-title":"Association of high-density lipoprotein cholesterol with sarcopenia in chinese community-dwelling middle-aged and older adults: evidence from 4-year longitudinal study","volume":"70","author":"Wang","year":"2024","journal-title":"Gerontology"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S194690","article-title":"MRI assessment of ectopic fat accumulation in pancreas, liver and skeletal muscle in patients with obesity, overweight and normal BMI in correlation with the presence of central obesity and metabolic syndrome","volume":"12","author":"Pie\u0144kowska","year":"2019","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes366","article-title":"Association of serum C-reactive protein and erythrocyte sedimentation rate with muscle strength in patients with knee osteoarthritis","volume":"52","author":"Sanchez-Ramirez","year":"2013","journal-title":"Rheumatol (Oxford)"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2002.50605.x","article-title":"Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels","volume":"50","author":"Ferrucci","year":"2002","journal-title":"J Am Geriatr Soc"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.18632\/aging.101529","article-title":"Inverse relationship between serum hsCRP concentration and hand grip strength in older adults: a nationwide population-based study","volume":"10","author":"Kim","year":"2018","journal-title":"Aging (Albany NY)"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/80.15.1198","article-title":"Regression models in clinical studies: determining relationships between predictors and response","volume":"80","author":"Harre","year":"1988","journal-title":"J Natl Cancer Inst"},{"key":"B40","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12876-025-03641-4","article-title":"Blood pressure, gallstones, and age at first cholecystectomy in U.S. adults: a cross-sectional study","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Gastroenterol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1529223","article-title":"Lipoprotein cholesterol ratios and cardiovascular disease risk in US adults: a cross-sectional study","volume":"12","author":"Yang","year":"2025","journal-title":"Front Nutr"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1600421\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T05:22:21Z","timestamp":1751433741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1600421\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":41,"alternative-id":["10.3389\/fimmu.2025.1600421"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1600421","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"article-number":"1600421"}}