Associations of physical activity intensity with the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio and mortality in middle-aged and older adults: New evidence from China

BACKGROUND: The non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) has emerged as a comprehensive lipid index reflecting the balance between atherogenic and anti-atherogenic lipoproteins. However, evidence on how different intensities and durations of physical activity (PA) influence NHHR remains scarce, particularly in aging populations. METHODS: Data were obtained from China Health and Retirement Longitudinal Study. PA was self-reported and categorized as high- (HPA), moderate- (MPA), or low-intensity (LPA). Multivariable linear regression models assessed associations between PA and NHHR, with subgroup, sensitivity, and dose-response analyses further exploring robustness. Cox regression and mediation analyses examined the associations of PA and NHHR with 10-year all-cause mortality. RESULTS: Higher levels of total, moderate-, and high-intensity PA were significantly associated with lower NHHR. The results were generally consistent with a graded pattern, with lower NHHR observed at higher activity durations, particularly for moderate-to-vigorous activity. Exploratory mediation analyses suggested that NHHR may partially account for the inverse association between PA and mortality. CONCLUSIONS: This study adds large-scale, population-based evidence on the associations between different PA intensities and NHHR. Regular moderate-to-vigorous PA is associated with more favorable lipid profiles and lower mortality risk. These findings highlight NHHR as a valuable biomarker linking physical activity to cardiometabolic health and longevity in middle-aged and older adults.