Association Between Uric Acid‐to‐HDL Cholesterol Ratio and Sarcopenia: Sex‐Specific Patterns From NHANES 2011–2018

Objective Sarcopenia, characterized by progressive skeletal muscle mass and strength loss, significantly impacts elderly health. The uric acid‐to‐high‐density lipoprotein cholesterol Ratio (UHR), an emerging metabolic‐inflammatory marker, may be associated with sarcopenia, but large‐scale studies are lacking. Methods We conducted a cross‐sectional analysis using NHANES 2011‐2018 data (weighted N = 112,108,358). Sarcopenia was defined using FNIH criteria (ASM BMI < 0.512 for women, < 0.789 for men) and UHR calculated as (uric acid/HDL‐C) × 100. Models were adjusted for age, sex, race, education, marital status, poverty‐to‐income ratio, smoking, hypertension, diabetes, total cholesterol, and cancer history. Results After multivariable adjustment, UHR showed significant positive association with sarcopenia (OR = 1.060, 95% CI: 1.041–1.080, p < 0.001). The highest UHR tertile demonstrated 124.4% higher odds compared to the lowest (OR = 2.244, 95% CI: 1.713–2.940, p < 0.001). Sex‐stratified analysis revealed distinct patterns: males exhibited monotonically increasing odds with higher UHR, while females displayed an inverted U‐shaped relationship with an inflection point at UHR = 11.111. Conclusion Elevated UHR significantly associates with sarcopenia with pronounced gender differences and may represent a promising, cost‐effective biomarker for improved early detection in aging populations.