ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1564206
This article is part of the Research TopicBiological Markers of Healthy AgingView all 3 articles
Cross-sectional association between hs-CRP/ HDL-C ratio and physical frailty among middle-aged and older adults: findings from a population-based study
Provisionally accepted
- Central South University, Changsha, China
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Background: Frailty, characterized by functional decline and disability, is an emerging public health concern in aging populations. Chronic inflammation and low high-density lipoprotein cholesterol (HDL-C) levels are key contributors to the progression of frailty. This study aims to examine the association between the ratio of high-sensitivity C-reactive protein (hs-CRP) to HDL-C and frailty among middle-aged and older adults in the United States.Methods: Our study included participants aged 45 years and older from the 2015-2020 National Health and Nutrition Examination Survey (NHANES). Logistic regression and restricted cubic spline (RCS) analysis were utilized to assess the relationship between the hs-CRP/HDL-C ratio and frailty, adjusting for potential confounding covariates. Mediation analysis was performed to determine whether plasma proteins mediated this association. Least absolute shrinkage and selection operator (LASSO) regression was employed to identify variables strongly correlated with frailty, and a nomogram was subsequently developed based on these variables.Results: Our study included 3,626 middle-aged and older participants, among whom 787(21.7%) were identified as frailty. After adjusting for all covariates, a high hs-CRP/HDL-C ratio was identified as a significant risk factor for frailty (OR = 1.736, 95% CI: 1.009-2.988). RCS analysis disclosed a nonlinear correlation between the hs-CRP/HDL-C ratio and frailty incidence. Furthermore, mediation analysis suggested that albumin and globulin partially mediated this association, accounting for 37.82% and 11.23% of the indirect effect, respectively. A nomogram, constructed using variables selected via LASSO regression, exhibited promising discriminative ability, with an area under the curve (AUC) of 79.7% (95% CI: 77.7-81.75%).Conclusion: Our findings suggest that a higher hs-CRP/HDL-C ratio is associated with an increased risk of frailty among middle-aged and older adults. Albumin and globulin partially mediate this relationship. Additionally, the nomogram developed in our study shows strong predictive ability for identifying individuals at high risk of frailty in this population.
Keywords: Frailty, Hs-CRP, HDL-C, NHANES, plasma proteins
Received: 21 Jan 2025; Accepted: 14 Apr 2025.
Copyright: © 2025 Wang, Su and Wang. 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: Yang Wang, Central South University, Changsha, China
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