Association Between Atherogenic Index of Plasma and Endometriosis: Evidence from NHANES 1999–2006

Liu L, Su G, Rao J, Peng J, Lin X, Huang Y, Liang F, Feng C, Lin Z
2025 · W7017656953
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This cross-sectional study used nationally representative NHANES 1999–2006 data (n=1817; 146 with endometriosis) to examine whether the atherogenic index of plasma (AIP, calculated as log10[triglycerides/HDL-C]) was associated with endometriosis. Using weighted multivariable logistic regression, restricted cubic spline analyses, subgroup analyses, and XGBoost to compare lipid indicator importance, the authors found that higher AIP was positively associated with endometriosis risk in fully adjusted models (continuous OR=2.578, 95% CI 1.232–5.394, P=0.013), with a higher endometriosis incidence in the highest versus lowest AIP quartile (OR=1.762, 95% CI 1.056–3.103, P=0.047), and a linear relationship in spline models; subgroup interaction tests were not significant. A key caveat is that the analysis is cross-sectional, limiting causal inference, though the study concludes AIP was the most critical lipid indicator. This paper is centrally about endometriosis—quantifying how AIP relates to endometriosis risk using NHANES data.

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Abstract

Liwen Liu,1 Gaosheng Su,1 Jie Rao,1 Juanbao Peng,1 Xiu Lin,2 Yujie Huang,2 Feng Liang,2 Chuanxia Feng,1 Zhong Lin2 1Department of Anesthesia, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People’s Republic of China; 2Department of Gynecology, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of ChinaCorrespondence: Zhong Lin, Email [email protected] and Aims: Due to its association with various diseases, atherogenic index of plasma (AIP) has garnered increasing attention. Exploration of the relationship between AIP and endometriosis risk has not been thorough. This nationwide study will attempt to explore this association. This cross-sectional study aimed to investigate this association using a nationally representative sample.Methods: We utilized a nationally representative dataset from the 1999– 2006 NHANES, including 1817 participants. AIP was defined as log10 (triglycerides/high-density lipoprotein cholesterol). An examination of the relationship between AIP and endometriosis utilized methods including weighted multivariable logistic regression, restricted cubic splines, and subgroup analyses. The relative significance of various lipid indicators was evaluated with the Extreme Gradient Boosting (XGBoost) algorithm.Results: This study analyzed 1817 participants, among whom 146 were diagnosed with endometriosis. Upon full adjustment for relevant covariates, the continuous model through multivariable logistic regression demonstrated a notable association between heightened AIP levels and the risk of endometriosis (OR = 2.578, 95% CI: 1.232– 5.394, P = 0.013). In the categorical model, the incidence of endometriosis in the highest AIP quartile was 1.762 times that in the lowest AIP quartile (OR = 1.762, 95% CI: 1.056– 3.103), P = 0.047). Interaction tests in subgroup analyses did not significantly affect this association. A linear correlation between AIP and endometriosis was observed within the constraints of the restricted cubic spline regression model. The machine learning results indicate that AIP is the most critical lipid indicator.Conclusion: Our analysis confirms a positive correlation between elevated AIP levels and the frequency of endometriosis cases. This indicates that therapeutic strategies aimed at reducing AIP levels might have a beneficial impact on the management of endometriosis.Keywords: AIP, endometriosis, NHANES, cross-sectional study
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International Journal of Women's Health (Jul 2025) Association Between Atherogenic Index of Plasma and Endometriosis: Evidence from NHANES 1999–2006 Abstract Liwen Liu,1 Gaosheng Su,1 Jie Rao,1 Juanbao Peng,1 Xiu Lin,2 Yujie Huang,2 Feng Liang,2 Chuanxia Feng,1 Zhong Lin2 1Department of Anesthesia, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People’s Republic of China; 2Department of Gynecology, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of ChinaCorrespondence: Zhong Lin, Email [email protected] and Aims: Due to its association with various diseases, atherogenic index of plasma (AIP) has garnered increasing attention. Exploration of the relationship between AIP and endometriosis risk has not been thorough. This nationwide study will attempt to explore this association. This cross-sectional study aimed to investigate this association using a nationally representative sample.Methods: We utilized a nationally representative dataset from the 1999– 2006 NHANES, including 1817 participants. AIP was defined as log10 (triglycerides/high-density lipoprotein cholesterol). An examination of the relationship between AIP and endometriosis utilized methods including weighted multivariable logistic regression, restricted cubic splines, and subgroup analyses. The relative significance of various lipid indicators was evaluated with the Extreme Gradient Boosting (XGBoost) algorithm.Results: This study analyzed 1817 participants, among whom 146 were diagnosed with endometriosis. Upon full adjustment for relevant covariates, the continuous model through multivariable logistic regression demonstrated a notable association between heightened AIP levels and the risk of endometriosis (OR = 2.578, 95% CI: 1.232– 5.394, P = 0.013). In the categorical model, the incidence of endometriosis in the highest AIP quartile was 1.762 times that in the lowest AIP quartile (OR = 1.762, 95% CI: 1.056– 3.103), P = 0.047). Interaction tests in subgroup analyses did not significantly affect this association. A linear correlation between AIP and endometriosis was observed within the constraints of the restricted cubic spline regression model. The machine learning results indicate that AIP is the most critical lipid indicator.Conclusion: Our analysis confirms a positive correlation between elevated AIP levels and the frequency of endometriosis cases. This indicates that therapeutic strategies aimed at reducing AIP levels might have a beneficial impact on the management of endometriosis.Keywords: AIP, endometriosis, NHANES, cross-sectional study

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