Remnant cholesterol in obesity phenotypes: results from NHANES

Abstract Background The association between remnant cholesterol (RC) with obesity phenotypes remains unclear. Methods This study designed to evaluate the association between RC and obesity phenotypes using data from the National Health and Nutrition Examination Survey (NHANES). The classification sy...

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Main Authors: Tian Yu, Shaohua Liu, Lu Fang, Tingting Du, Zhelong Liu
Format: Article
Language:English
Published: BMC 2025-04-01
Series:Lipids in Health and Disease
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Online Access:https://doi.org/10.1186/s12944-025-02550-5
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author Tian Yu
Shaohua Liu
Lu Fang
Tingting Du
Zhelong Liu
author_facet Tian Yu
Shaohua Liu
Lu Fang
Tingting Du
Zhelong Liu
author_sort Tian Yu
collection DOAJ
description Abstract Background The association between remnant cholesterol (RC) with obesity phenotypes remains unclear. Methods This study designed to evaluate the association between RC and obesity phenotypes using data from the National Health and Nutrition Examination Survey (NHANES). The classification systems for obesity phenotypes encompassed both preclinical/clinical obesity and obesity stages, which were assessed based on two authoritative obesity guidelines: the 2025 clinical obesity guideline, and the 2016 obesity guideline established by the American Association of Clinical Endocrinologists and the American College of Endocrinology (AACE/ACE). Participants were selected according to the diagnostic criteria for obesity proposed in the 2025 clinical obesity guideline and were categorized into tertiles based on their RC levels. Their obesity phenotypes, obesity-related clinical manifestations, obesity-related comorbidities, and characteristics were then described. Logistic regression analyses and restricted cubic spline (RCS) models were used to analyze the relationship between RC and adverse obesity phenotypes. Sensitivity analyses were conducted in patients not receiving lipid-lowering drugs. Results This study comprised 3,207 adult participants, revealing distinct prevalence patterns: 47.80% exhibited preclinical obesity and 17.81% showed clinical obesity, while obesity stage stratification demonstrated 0%, 12.76%, and 21.63% prevalence for stage 0, 1, and 2, respectively. Multivariable regression analyses demonstrated dose-response relationship between RC levels and adverse obesity phenotypes, with individuals in the highest RC tertile showing significantly elevated risks of clinical obesity (OR 1.95, 95% CI 1.19–3.19) and obesity stage progression (OR 1.96, 95% CI 1.06–3.62) compared to the lowest tertile reference group. RCS analyses further revealed similar ”J”-shaped association between RC levels and adverse obesity phenotypes (P for nonlinearity < 0.001), sharing a common inflection point at 0.51 mmol/L. The sensitivity analyses confirmed the consistency of the results among patients who were not receiving lipid-lowering therapy. Conclusions RC was found to be positively and independently associated with adverse obesity phenotypes, particularly when RC levels exceeded 0.51 mmol/L, demonstrating a similar “J”-shaped association. It is recommended that clinicians monitor RC levels for obese patients as a primary screening indicator for adverse phenotypes of obesity.
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spelling doaj-art-fd415ab9e5a34fc4b1c269ab7f725daf2025-08-20T03:10:10ZengBMCLipids in Health and Disease1476-511X2025-04-0124111210.1186/s12944-025-02550-5Remnant cholesterol in obesity phenotypes: results from NHANESTian Yu0Shaohua Liu1Lu Fang2Tingting Du3Zhelong Liu4Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background The association between remnant cholesterol (RC) with obesity phenotypes remains unclear. Methods This study designed to evaluate the association between RC and obesity phenotypes using data from the National Health and Nutrition Examination Survey (NHANES). The classification systems for obesity phenotypes encompassed both preclinical/clinical obesity and obesity stages, which were assessed based on two authoritative obesity guidelines: the 2025 clinical obesity guideline, and the 2016 obesity guideline established by the American Association of Clinical Endocrinologists and the American College of Endocrinology (AACE/ACE). Participants were selected according to the diagnostic criteria for obesity proposed in the 2025 clinical obesity guideline and were categorized into tertiles based on their RC levels. Their obesity phenotypes, obesity-related clinical manifestations, obesity-related comorbidities, and characteristics were then described. Logistic regression analyses and restricted cubic spline (RCS) models were used to analyze the relationship between RC and adverse obesity phenotypes. Sensitivity analyses were conducted in patients not receiving lipid-lowering drugs. Results This study comprised 3,207 adult participants, revealing distinct prevalence patterns: 47.80% exhibited preclinical obesity and 17.81% showed clinical obesity, while obesity stage stratification demonstrated 0%, 12.76%, and 21.63% prevalence for stage 0, 1, and 2, respectively. Multivariable regression analyses demonstrated dose-response relationship between RC levels and adverse obesity phenotypes, with individuals in the highest RC tertile showing significantly elevated risks of clinical obesity (OR 1.95, 95% CI 1.19–3.19) and obesity stage progression (OR 1.96, 95% CI 1.06–3.62) compared to the lowest tertile reference group. RCS analyses further revealed similar ”J”-shaped association between RC levels and adverse obesity phenotypes (P for nonlinearity < 0.001), sharing a common inflection point at 0.51 mmol/L. The sensitivity analyses confirmed the consistency of the results among patients who were not receiving lipid-lowering therapy. Conclusions RC was found to be positively and independently associated with adverse obesity phenotypes, particularly when RC levels exceeded 0.51 mmol/L, demonstrating a similar “J”-shaped association. It is recommended that clinicians monitor RC levels for obese patients as a primary screening indicator for adverse phenotypes of obesity.https://doi.org/10.1186/s12944-025-02550-5Remnant cholesterolPreclinical/clinical obesityObesity stageObesity phenotypesNational health and nutrition examination survey
spellingShingle Tian Yu
Shaohua Liu
Lu Fang
Tingting Du
Zhelong Liu
Remnant cholesterol in obesity phenotypes: results from NHANES
Lipids in Health and Disease
Remnant cholesterol
Preclinical/clinical obesity
Obesity stage
Obesity phenotypes
National health and nutrition examination survey
title Remnant cholesterol in obesity phenotypes: results from NHANES
title_full Remnant cholesterol in obesity phenotypes: results from NHANES
title_fullStr Remnant cholesterol in obesity phenotypes: results from NHANES
title_full_unstemmed Remnant cholesterol in obesity phenotypes: results from NHANES
title_short Remnant cholesterol in obesity phenotypes: results from NHANES
title_sort remnant cholesterol in obesity phenotypes results from nhanes
topic Remnant cholesterol
Preclinical/clinical obesity
Obesity stage
Obesity phenotypes
National health and nutrition examination survey
url https://doi.org/10.1186/s12944-025-02550-5
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AT tingtingdu remnantcholesterolinobesityphenotypesresultsfromnhanes
AT zhelongliu remnantcholesterolinobesityphenotypesresultsfromnhanes