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BackgroundThe present study aims to investigate the association and dose-response relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and sarcopenia in elderly adults. The ultimate objective is to thereby clarify its predictive value for sarcopenia risk.MethodsA cross-sectional study was conducted using data from the cohort of 368 elderly individuals aged 60 years and over, as part of the Second Affiliated Hospital of Anhui Medical University. A prospective cohort study was also conducted using CHARLS data, encompassing 3,152 elderly individuals aged 60 years and over, with no instances of sarcopenia at the initial baseline. The median follow-up period for this study is 4.5 years. The association was analyzed using both logistic regression and Cox proportional hazards regression, with the results of this analysis subsequently validated by restricted cubic spline (RCS) analysis and subgroup analysis. Subsequently, the mediating role of the triglyceride glucose (TyG)-related indices was elucidated through mediation analysis.ResultsFollowing the adjustment of confounding factors, a unit increase in NHHR was observed to be associated with a 31% reduction in sarcopenia risk in cross-sectional studies (OR = 0.69, 95% CI: 0.56–0.86, P < 0.001). In prospective cohort studies, the risk of sarcopenia decreased by 37% (HR = 0.63, 95% CI: 0.51–0.77, P < 0.001). A stable linear inverse relationship was observed between the two variables, with no threshold effect, and subgroup analyses validated the robustness of this association. Additionally, the TyG-related indices exerted a significant mediating effect on the association between NHHR and sarcopenia risk, with a mediation proportion ranging from 22.48 to 29.47%.ConclusionNHHR is significantly negatively correlated with the risk of sarcopenia in Chinese elderly adults and may serve as a potential biomarker for sarcopenia risk stratification. TyG-related indicators play a partial mediating role in this association.