The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a novel marker for periodontitis risk: A cross-sectional study in NHANES 2009-2014.

Periodontitis has been linked to dyslipidemia, but the relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and periodontitis remains unclear. This study aimed to investigate their association and develop a risk prediction model. This cross-sectional study analyzed 9579 adults from the National Health and Nutrition Examination Survey 2009 to 2014. Weighted multivariable logistic regression and restricted cubic spline analyses were used to evaluate the association and potential nonlinearity. A prediction model was developed using least absolute shrinkage and selection operator regression and evaluated by receiver operating characteristic analysis and bootstrap calibration. Higher levels of the NHHR were associated with higher odds of periodontitis after multivariable adjustment. A nonlinear association was observed, with a more pronounced relationship above an inflection point. The final prediction model included 14 variables. The nomogram demonstrated modest-to-moderate discriminative ability (area under the receiver operating characteristic curve = 0.656) and acceptable calibration. Elevated levels of the NHHR were associated with periodontitis in this nationally representative sample. Although the predictive performance was modest, the model may provide preliminary exploratory information for risk stratification and requires further external validation and prospective studies before clinical use.