Neutrophil-to-HDL Cholesterol Ratio and associated with Gallstone Disease Risk: Insights from NHANES 2017-2020 Data

Gallstone disease (GSD) is one of the most frequent and expensive gastrointestinal disorders caused by cholesterol, bile pigment, and mixed stones, with cholesterol stones outranking the three. They are caused by the oversaturation of calcium salts and cholesterol in bile, leading to cholesterol deposits. Gallstones have an increased risk of cancer. The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is a novel comprehensive marker of inflammatory responses and lipid metabolism that can detect cardiovascular disease, depression, acute biliary pancreatitis, and hepatocellular carcinoma. Previous research has shown that inflammatory reactions can promote gallstone formation by altering protein and lipid metabolic pathways and increasing bile acid salt concentrations by involving neutrophils and lipids. As there is ambiguity on the association between NHR and gallstones, researchers from Zhejiang Chinese Medical University, China conducted a study on the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.

The study was conducted by collecting data from the National Health and Nutrition Examination Survey (NHANES) between 2017–2020. Data was collected through interviews, health exams, and lab tests. Out of 15,560 participants, 7,894 were included in the study. NHR calculation was done by dividing the neutrophil count by HDL-C levels and the participants were divided into 3 NHR categories based on the count. Gallstone data was reported by the participants based on the physician's diagnosis. Unadjusted and adjusted logistic regression models were used to evaluate the association between NHR and GSD.

Key findings:

• Among the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06.
• An obvious positive association between NHR and the likelihood of GSD was found as per the fully adjusted multivariable logistic regression analysis (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197).
• Subset analyses confirmed the consistency of this association and interaction tests across various subgroups, including those categorized by smoking status and asthma.
• Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.

Thus, the study concluded that a higher NHR is associated with a greater likelihood of having GSD and NHR can be used as a low-cost method to screen patients at risk of GSD. NHR can also be used in early diagnosis so that preventive measures can be taken to reduce the risk of gallstones.

Further reading: Ma D, Ma H, Li Y, Yang L. Association between Neutrophil-to-high-density lipoprotein-cholesterol ratio and gallstones: insights from the national health and nutrition examination survey (2017-2020). Lipids Health Dis. 2024;23(1):355. Published 2024 Oct 31. doi:10.1186/s12944-024-02349-w.