Nonlinear association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and gout risk in insulin-resistant individuals: evidence from NHANES 2013-2018

Ming-Jie Jia ^1,2* Shen Wang ^3* Hui-Lin Li ^4*

• ¹ Guangzhou University of Chinese Medicine, Guangzhou, China
• ² The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
• ³ School of Public Health, China Medical University, Shenyang, Liaoning Province, China
• ⁴ Shenzhen Traditional Chinese Medicine Hospital, Shenzhen ，Guangdong, China

BackgroundRecent studies have revealed a relationship between insulin resistance (IR) and gout, with lipid metabolism playing a critical role. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has been associated with cardiovascular and metabolic diseases, but its role in gout, particularly among individuals with IR, remains unexplored. This study aims to examine the association between the NHHR and the risk of gout in IR patients, utilizing data from the NHANES (2013-2018).MethodsIn this study, logistic regression analysis and restricted cubic spline (RCS) curves were used to assess the relationship between the ratio of non-high-density lipoprotein cholesterol (NHHR) to high-density lipoprotein cholesterol (HDL cholesterol) and the risk of gout in insulin-resistant patients using data from the National Health and Nutrition Examination Survey (NHANES). The study also adjusted for covariates such as age, body mass index, hypertension, and diabetes mellitus, and model fit was assessed by the Hosmer-Lemeshow test.In constructing the multivariate logistic regression model, we first selected covariates that are known to be associated with gout risk, such as age, body mass index, hypertension, and diabetes. To further optimize the model, we used stepwise regression (forward selection) to select the variables with the most predictive value. Variables were included in the model based on their significance (p < 0.05) and logistic rationality, and we confirmed the stability and applicability of the final model through cross-validation and model evaluation.ConclusionThis study investigated the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and the risk of gout in insulin-resistant patients. It showed that NHHR was significantly associated with gout risk in insulin-resistant patients, especially in high body mass index population. This finding provides support for the use of NHHR as a simple, easy-to-use clinical screening tool with potential clinical applications, especially in assessing high-risk populations.