Gamma-Glutamyl Transferase to High-Density Lipoprotein Cholesterol Ratio as a Marker of Cognitive Dysfunction in Older Adults: A Cross‐Sectional Study from NHANES 2011–2014

ORIGINAL ARTICLE
Meng Du, Yanan Zhao, Panpan Zheng, Xian Xiu, Yang Li, Haiyan Gu, Jinghua Sun, Lili Zhang, Zanchao Liu

 
For citation: Du M, Zhao Y, Zheng P, Xiu X, Li Y, Gu H, Sun J, Zhang L, Liu Z. Gamma-Glutamyl Transferase to High-Density Lipoprotein Cholesterol Ratio as a Marker of Cognitive Dysfunction in Older Adults: A Cross‐Sectional Study from NHANES 2011–2014. International Journal of Biomedicine. 2026;16(1):17-25. doi:10.21103/Article16(1)_OA1
 
Originally published March 5, 2026

Abstract: 

Background: The gamma-glutamyl transferase to high-density lipoprotein cholesterol (GGT/HDL-C) ratio has been reported to be associated with various metabolic diseases, but its relationship with cognitive dysfunction remains unclear. This study aimed to investigate the relationship between the GGT/HDL-C ratio and cognitive dysfunction in older adults.
Methods and Results: This cross-sectional study included 2,769 participants with an average age of 69.46±6.79 years and used data from the National Health and Nutrition Examination Survey (NHANES) database (2011~2014). Natural logarithmic (ln) transformation was performed on GGT/HDL-C before analysis. After adjusting for various covariates, logistic regression models showed that the association between ln(GGT/HDL-C) and cognitive dysfunction assessed by total-CF and AFT remained significant [OR (95% CI): 1.374 (1.126~1.676), 1.220 (1.030~1.444)], whereas no significant correlation was found with CERAD W-L or DSST (P>0.05). Then, restricted cubic spline (RCS) regression and threshold effect analyses were conducted, and we observed nonlinear associations between ln(GGT/HDL-C) and cognitive dysfunction measured by total-CF, CERAD W-L and DSST (all Pnonlinear<0.05). Subgroup analyses were performed based on multiple variables, including age, gender, BMI, race, education level, DM, sleep problems, hypertension, drinking, and smoking status. The results suggested that the association between ln(GGT/HDL-C) and cognitive dysfunction was comparable across most subgroups.
Conclusion: Our study suggested that higher levels of ln(GGT/HDL-C) might be associated with an increased risk of cognitive dysfunction in older adults.

Keywords: 
cognitive dysfunction • gamma-glutamyl transferase • high-density lipoprotein cholesterol • cross-sectional study
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Received November 30, 2025.
Accepted January 26, 2026.
©2026 International Medical Research and Development Corporation.