Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2026
Association of serum creatinine-to-albumin ratio with hyperandrogenemia and low sex hormone-binding globulin in women of reproductive age: a cross-sectional analysis of NHANES 2013-2016.
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Yang Qianying
Аннотация
BACKGROUND: Hyperandrogenemia (HA) and low sex hormone-binding globulin (SHBG) are core features of polycystic ovary syndrome. The creatinine-to-albumin ratio (CAR), a simple renal-nutritional marker linked to female infertility, has not been studied in relation to HA or low SHBG.
OBJECTIVE: To examine the association of CAR with low SHBG and HA, defined by the free androgen index (FAI), in U.S. women of reproductive age.
METHODS: In this cross-sectional analysis of NHANES 2013-2016, we included 683 women aged 18-49 years. CAR (serum creatinine/albumin) was categorized into tertiles; low SHBG was defined as < 30 nmol/L and HA as FAI ≥ 75th percentile. Survey-weighted multivariable logistic regression was used, with multiple imputation (m = 5) as a sensitivity analysis.
RESULTS: In Model 1 (age, race/ethnicity, education, income), the highest CAR tertile was associated with low SHBG (OR 2.93, 95% CI 1.49-5.75; P = 0.003; P for trend = 0.004) and FAI-defined HA (OR 1.87, 95% CI 1.05-3.34; P = 0.036; P for trend = 0.044). In Model 2 (plus smoking, BMI, low HDL-C), associations attenuated (OR 1.95, 95% CI 1.05-3.64 for low SHBG; 1.24, 95% CI 0.65-2.34 for HA-FAI). HA defined by total testosterone was not associated with CAR.
CONCLUSION: Higher CAR was associated with low SHBG and FAI-defined HA after demographic adjustment, with attenuation after metabolic adjustment, suggesting confounding by shared metabolic factors. As CAR derives from routine laboratory tests, it may be a practical marker of reproductive metabolic risk; the cross-sectional design precludes causal inference.
OBJECTIVE: To examine the association of CAR with low SHBG and HA, defined by the free androgen index (FAI), in U.S. women of reproductive age.
METHODS: In this cross-sectional analysis of NHANES 2013-2016, we included 683 women aged 18-49 years. CAR (serum creatinine/albumin) was categorized into tertiles; low SHBG was defined as < 30 nmol/L and HA as FAI ≥ 75th percentile. Survey-weighted multivariable logistic regression was used, with multiple imputation (m = 5) as a sensitivity analysis.
RESULTS: In Model 1 (age, race/ethnicity, education, income), the highest CAR tertile was associated with low SHBG (OR 2.93, 95% CI 1.49-5.75; P = 0.003; P for trend = 0.004) and FAI-defined HA (OR 1.87, 95% CI 1.05-3.34; P = 0.036; P for trend = 0.044). In Model 2 (plus smoking, BMI, low HDL-C), associations attenuated (OR 1.95, 95% CI 1.05-3.64 for low SHBG; 1.24, 95% CI 0.65-2.34 for HA-FAI). HA defined by total testosterone was not associated with CAR.
CONCLUSION: Higher CAR was associated with low SHBG and FAI-defined HA after demographic adjustment, with attenuation after metabolic adjustment, suggesting confounding by shared metabolic factors. As CAR derives from routine laboratory tests, it may be a practical marker of reproductive metabolic risk; the cross-sectional design precludes causal inference.