Neutrophil‐to‐High‐Density Lipoprotein Ratio and Diminished Ovarian Reserve in Reproductive‐Aged Women: A NHANES Perspective

Objective This study aimed to explore the association between the neutrophil‐to‐high‐density lipoprotein cholesterol ratio (NHR) and anti‐Müllerian hormone (AMH) levels, a marker of ovarian reserve, in reproductive‐aged women (18–40 years) using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2023. Methods Data from 2045 women aged 18–40 years were analyzed. NHR was calculated as the ratio of neutrophil count to HDL‐C levels. AMH levels were obtained from standardized laboratory measurements and diminished ovarian reserve (DOR) was defined as AMH < 1.0 ng/mL. Covariates included age, race, education, poverty‐income ratio (PIR), smoking status, body mass index (BMI), waist circumference, blood pressure, diabetes, hypertension, hyperlipidemia, sedentary time, and sleep duration. Statistical analyses were performed using R software (version 4.2.2), with multiple imputation for missing data and regression models to evaluate associations. Results Linear regression models showed a significant inverse association between NHR and AMH levels, with a β of −0.10 (95% CI: −0.17 to −0.04; p = 0.003) in the fully adjusted model. Logistic regression revealed a 56% higher DOR risk in the highest NHR quartile (adjusted OR = 1.56, 95% CI: 1.11–2.20; p = 0.011). Nonlinear analyses identified threshold effects at NHR = 2.09 for AMH and NHR = 5.60 for DOR risk. Subgroup analyses highlighted significant heterogeneity in associations across socioeconomic and metabolic factors. Conclusion Elevated NHR, reflecting systemic inflammation and metabolic dysregulation, is associated with reduced AMH levels and increased DOR risk in reproductive‐aged women. The nonlinear relationships and subgroup heterogeneity underscore the complexity of inflammation‐metabolism interactions in ovarian health. NHR may serve as a low‐cost biomarker for early detection of ovarian reserve decline, emphasizing the importance of addressing metabolic and socioeconomic determinants of reproductive health.