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ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition, Psychology and Brain Health
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1525348
The Nonlinear Association of Ratio of Total Cholesterol to High Density Lipoprotein with Cognition Ability : Evidence from A Community Cohort in China
Provisionally accepted- 1 Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian Province, China
- 2 Department of Neurology,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- 3 Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- 4 Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- 5 Fujian Provincial Hospital, Fuzhou, China
- 6 Department of Neurology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, China
Background: Cholesterol is a critical component of the human body, particularly within the brain, where it plays an essential role in maintaining cellular structure and function. In addition, the blood lipid profile has been recognized as a significant factor influencing cognitive performance. However, the association between the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) and cognitive function remains unclear.Method: This community-based, cross-sectional study was conducted using data from middle-aged and older adults (aged ≥45 years) participating in the China Health and Retirement Longitudinal Study (CHARLS). The primary exposure of interest was the ratio of TC to HDL-C, while the main outcome was cognitive function, assessed using cognition scores. The association between the TC-HDL-C ratio and cognitive performance was examined using multiple linear regression analyses and restricted cubic spline modeling to assess potential nonlinear relationships.Results: A total of 8,914 participants were included in the analysis. Within a certain range, a higher TC-HDL-C ratio was significantly associated with improved cognitive scores (p < 0.05) among middle-aged and older adults. This relationship remained significant even after adjusting for sociodemographic and health-related factors. Moreover, restricted cubic spline analyses revealed a significant nonlinear association (p for nonlinearity < 0.05) between the TC-HDL-C ratio and cognition scores. Subgroup analyses further highlighted differential effects of the TC-HDL-C ratio across specific population subgroups. Sensitivity analyses consistently supported the robustness of the observed relationship between the TC-HDL-C ratio and cognitive function.Our findings confirm a significant nonlinear relationship between the TC-HDL-C ratio and cognitive performance in middle-aged and elderly individuals, even after adjusting for sociodemographic factors. These results underscore the potential importance of maintaining an appropriate TC-HDL-C ratio to support cognitive health in aging populations.
Keywords: Cholesterol, Cognition ability, CHARLS, TC-HDL-C ratio, Middle-aged, Elderly
Received: 30 Nov 2024; Accepted: 10 Feb 2025.
Copyright: © 2025 Zhou, Xu, Lin, Chen, Ye and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Qin-Yong Ye, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
Zhen-Hua Zhao, Fujian Provincial Hospital, Fuzhou, China
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