衍生中性粒–淋巴细胞比值与体重调整腰围 指数在肌肉减少性肥胖的相关性研究

Association of Derived Neutrophil-to-Lymphocyte Ratio and Weight-Adjusted Waist Index with Sarcopenic Obesity

摘要: 目的：本研究旨在衍生中性粒细胞与淋巴细胞比值(ln dNLR)与体重调整腰围指数(WWI)在肌肉减少性肥胖(SO)中的关联及潜在机制，为其风险评估与早期干预提供依据。方法：基于1999~2006年及2010~2018年美国国家健康与营养调查(NHANES)数据，共纳入24,264名成年人。采用多因素Logistic回归分析WWI及自然对数转换的dNLR (ln dNLR)与肌肉减少性肥胖的独立关联，限制性立方样条分析剂量–反应关系，交互作用及中介分析探讨二者协同效应及潜在路径。结果：共有肌肉减少性肥胖患者1020例，其WWI与ln dNLR水平均显著高于非患病者(均P < 0.001)。完全校正混杂因素后，WWI与ln dNLR均为SO的独立危险因素。限制性立方样条分析提示二者与SO均存在非线性阈值效应。相加交互分析显示，ln dNLR与WWI存在显著协同作用(RERI = 6.84, 95%CI: 2.31~11.37; AP = 0.26, 95%CI: 0.15~0.38; SI = 1.38, 95%CI: 1.17~1.63, 均P < 0.001)，双高暴露组患病风险最高(OR = 25.85, 95%CI: 15.35~43.54, P < 0.001)。中介分析表明，WWI在ln dNLR与SO的关联中发挥部分中介作用。结论：ln dNLR与WWI升高均会增加肌肉减少性肥胖的发病风险，二者存在显著协同作用，且WWI可部分介导ln dNLR与肌肉减少性肥胖之间的关联。

Abstract: Background: To investigate the associations and potential mechanisms linking the natural log-transformed derived neutrophil-to-lymphocyte ratio (ln dNLR) and weight-adjusted waist index (WWI) with sarcopenic obesity (SO). Methods: Based on data from the National Health and Nutrition Examination Survey (NHANES) 1999~2006 and 2010~2018, a total of 24,264 adults were included. Multivariable logistic regression was performed to examine the independent associations of weight-adjusted waist index (WWI) and natural log-transformed derived neutrophil-to-lymphocyte ratio (ln dNLR) with sarcopenic obesity (SO). Restricted cubic spline analysis was used to evaluate dose-response relationships, while interaction and mediation analyses were conducted to explore synergistic effects and potential pathways. Results: A total of 1020 participants with SO were identified. Both WWI and ln dNLR levels were significantly higher in individuals with SO than in those without (both (P < 0.001)). After full adjustment for confounders, WWI and ln dNLR remained independent risk factors for SO. Restricted cubic spline analysis revealed nonlinear threshold effects of both indicators on SO risk. Additive interaction analysis demonstrated a significant synergistic effect between ln dNLR and WWI (RERI = 6.84, 95% CI: 2.31~11.37; AP = 0.26, 95% CI: 0.15~0.38; SI = 1.38, 95% CI: 1.17~1.63; all (P < 0.001)), with the highest risk observed in the group with both indicators at high levels (OR = 25.85, 95% CI: 15.35~43.54, (P < 0.001)). Mediation analysis showed that WWI partially mediated the association between ln dNLR and SO. Conclusion: Elevated ln dNLR and WWI are independently associated with increased risk of sarcopenic obesity, with a significant synergistic effect between them. Furthermore, WWI partially mediates the association between ln dNLR and SO.