Yu Tian, Liu Shaohua, Fang Lu, Du Tingting, Liu Zhelong
Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Clinical Medical Research Center for Endocrinology and Metabolic Diseases, Hubei, China.
Lipids Health Dis. 2025 Apr 9;24(1):134. doi: 10.1186/s12944-025-02550-5.
The association between remnant cholesterol (RC) with obesity phenotypes remains unclear.
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.
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.
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.
残余胆固醇（RC）与肥胖表型之间的关联尚不清楚。
本研究旨在利用美国国家健康与营养检查调查（NHANES）的数据评估RC与肥胖表型之间的关联。肥胖表型的分类系统涵盖临床前/临床肥胖和肥胖阶段，这是根据两项权威肥胖指南进行评估的：2025年临床肥胖指南，以及美国临床内分泌学家协会和美国内分泌学会（AACE/ACE）制定的2016年肥胖指南。参与者根据2025年临床肥胖指南中提出的肥胖诊断标准进行选择，并根据其RC水平分为三分位数。然后描述他们的肥胖表型、肥胖相关临床表现、肥胖相关合并症和特征。采用逻辑回归分析和受限立方样条（RCS）模型分析RC与不良肥胖表型之间的关系。在未接受降脂药物治疗的患者中进行敏感性分析。
本研究包括3207名成年参与者，呈现出不同的患病率模式：47.80%表现为临床前肥胖，17.81%表现为临床肥胖，而肥胖阶段分层显示0期、1期和2期的患病率分别为0%、12.7%和21.63%。多变量回归分析表明RC水平与不良肥胖表型之间存在剂量反应关系，与最低三分位数参考组相比，RC最高三分位数的个体临床肥胖风险（OR 1.95，95%CI 1.19-3.19）和肥胖阶段进展风险（OR 1.96，95%CI 1.06-3.62）显著升高。RCS分析进一步揭示了RC水平与不良肥胖表型之间类似的“J”形关联（非线性P<0.001），在0.51 mmol/L处有一个共同的拐点。敏感性分析证实了未接受降脂治疗的患者结果的一致性。
发现RC与不良肥胖表型呈正相关且独立相关，特别是当RC水平超过0.51 mmol/L时，呈现出类似的“J”形关联。建议临床医生监测肥胖患者的RC水平，作为肥胖不良表型的主要筛查指标。
