What is the Neutrophil-to-HDL Cholesterol Ratio (NHR)?
NHR is the quotient of your neutrophil count (×10⁹ /L) divided by your HDL-cholesterol level (mmol/L). It blends two standard markers — one of immune cell activity (neutrophils) and one of lipid-transport and protective cholesterol (HDL) — to provide a more nuanced view of your internal environment than either alone.
Why does it matter for long-term health and wellbeing?
In simple terms, a well-balanced immune-lipid state supports smooth metabolism, vascular function and energy delivery to tissues. Conversely, a higher NHR suggests that immune activation (neutrophils) may be relatively elevated compared to protective HDL-lipid capacity. Studies show that a higher NHR is associated with greater measures of cardiac structural change, and a higher risk of systemic adverse outcomes.
For someone focused on longevity, performance and metabolic optimisation, monitoring NHR provides an early-warning signal that the immune-lipid system might be out of its optimal zone—from which you can make informed lifestyle adjustments.
What’s an optimal level of NHR?
- Typical laboratory reference ranges in Australia for HDL are > 1.0 mmol/L for general healthy adults.
- Typical adult neutrophil counts are ~1.7–7.0 ×10⁹ /L per Australian pathology references. Because NHR is a derived ratio, specific published “normal” ranges for NHR in Australian populations are not yet standardised. However, international studies suggest cut-offs such as NHR > 4.5 being associated with increased risk.
Suggested user benchmarks for tracking (for healthy performance/maintenance, not diagnostic):
- Reference low: ~0.3
- Reference high: ~5.0
- Optimal low: ~0.3
- Optimal high: ~2.0
Note: These are illustrative; always interpret your results in context with your clinician or Vively coach.
What influences NHR levels?
Several factors can shift the ratio:
- An increase in neutrophil count (e.g., from acute or chronic low-grade immune activation, infection, stress, poor sleep, high inflammatory load)
- A decrease in HDL-cholesterol (e.g., from low physical activity, poor dietary habits, excessive alcohol intake, smoking, metabolic strain)
- A combination of both (where low HDL meets higher neutrophil activity)
Lifestyle elements such as sleep quality, movement, dietary pattern (especially healthy fats and fibre), alcohol intake, stress management and body composition all play a role in modulating these.
What does it mean if NHR is outside the optimal range?
If your NHR is elevated beyond your preferred optimal range, it suggests that your immune-lipid balance may be tilted toward higher immune activation relative to HDL-mediated protection. In performance and wellbeing terms, this could indicate that you may not be operating at your metabolic peak or that underlying stressors (even subtle ones) are accumulating. That doesn’t mean disease — just that there’s an opportunity to adapt lifestyle, nutrition, recovery and movement strategies to improve your internal state.
How can I support healthy NHR levels?
To foster a favourable NHR:
- Prioritise regular physical activity — particularly aerobic plus resistance training — which supports higher HDL and modulates immune cell function.
- Focus on a health-promoting diet rich in unsaturated fats (e.g., oily fish, nuts, seeds), a variety of fibre and whole foods — these support HDL health and lower inflammatory burden.
- Ensure quality sleep and effective stress-management (e.g., mindfulness, breathing, recovery routines) to reduce chronic immune activation.
- Maintain healthy body composition (especially lean mass and moderate fat mass) as this supports both HDL and immune health.
- Limit behaviours that compromise HDL or raise neutrophils — such as excess alcohol, smoking or chronic high-intensity training without adequate recovery.
By tracking the NHR over time with your blood tests and viewing trends rather than isolated values, you gain actionable insight into how your lifestyle is influencing your internal resilience and readiness for performance and longevity.
This information is provided for general health and wellness purposes only and does not replace medical advice.
References
- Pan, X., Zhang, X., Ban, J., Yue, L., Ren, L., Chen, S. (2023). Association of neutrophil to high-density lipoprotein cholesterol ratio with cardiac ultrasound parameters and cardiovascular risk: a cross-sectional study based on healthy populations. Journal of Inflammation Research, 16, 1853-1865.
- Utility of neutrophil-to-high-density lipoprotein-cholesterol ratio in coronary disease: a narrative review. (2022). PMC 10107976.
- Chuang, S.-M., Liu, S.-C., Chien, M.-N., Lee, C.-C., Lee, Y.-T., Chien, K.-L. (2024). Neutrophil-to-high-density lipoprotein cholesterol ratio and mortality among patients: a population-based study. Journal of Hypertension.
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