Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio and endometriosis: a population-based study

J Obstet Gynaecol. 2026 Dec;46(1):2609485. doi: 10.1080/01443615.2025.2609485. Epub 2026 Jan 6.

Abstract

Background: The gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) has recently emerged as a potential biomarker for metabolic and liver diseases. This study aimed to investigate the association between GGT/HDL ratio and endometriosis using a population-based dataset from the National Health and Nutrition Examination Survey (NHANES).

Methods: Data from NHANES 1999 to 2006 were used to assess the relationship between the GGT/HDL ratio and endometriosis. The diagnosis of endometriosis was based on self-reported data from the Reproductive Health Questionnaire. The GGT/HDL ratio was calculated and Ln-transformed for analysis. Multivariable logistic regression and sensitivity analysis were used to estimate the odds ratio (OR) for endometriosis in relation to the GGT/HDL ratio.

Results: A total of 3815 individuals were included, with 307 diagnosed with endometriosis. The Ln-transformed GGT/HDL ratio was positively associated with the endometriosis. Each unit increase in the Ln-GGT/HDL ratio was associated with a 22% higher likelihood of endometriosis (OR = 1.220, 95% CI: 1.003-1.483, p = 0.046). Sensitivity analyses including the use of original GGT/HDL value, the further adjustments of covariates, the exclusion of those with CVD and liver diseases confirmed the robustness of this association.

Conclusions: This study found a significant positive association between the GGT/HDL ratio and endometriosis. Higher GGT/HDL levels may serve as a potential biomarker for identifying women at risk of endometriosis.

Keywords: GGT/HDL; Gamma-glutamyl transferase; NHANES; endometriosis; high-density lipoprotein.

Plain language summary

This study investigated the relationship between the gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) and endometriosis, using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006. GGT/HDL were from laboratory tests and endometriosis diagnosis was based on self-reported information from the Reproductive Health Questionnaire.The study included 3815 individuals, of whom 307 were diagnosed with endometriosis. The results showed that a higher GGT/HDL ratio was associated with a higher risk of endometriosis. Specifically, for each unit increase in the Ln-GGT/HDL ratio, the likelihood of having endometriosis increased by 22%. This association remained robust even after conducting sensitivity analyses.The findings suggested that the GGT/HDL ratio could be a useful biomarker for identifying women at risk of developing endometriosis.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Cholesterol, HDL* / blood
  • Endometriosis* / blood
  • Endometriosis* / epidemiology
  • Female
  • Humans
  • Logistic Models
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • United States / epidemiology
  • Young Adult
  • gamma-Glutamyltransferase* / blood

Substances

  • gamma-Glutamyltransferase
  • Biomarkers
  • Cholesterol, HDL