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Background  Small dense LDL cholesterol (sdLDL-c) has been established to be highly associated with metabolic disorder. However, the relationship between circulating sdLDL-c and the presence of metabolic syndrome (MetS) has not been fully established.    Methods  A total of 1065 Chinese males (45.07 ± 11.08 years old) without diabetes and general obesity was recruited into a population-based, cross-sectional study. The MetS was defined based on the updated National Cholesterol Education Program/ Adult Treatment Panel III criteria for Asian Americans. Serum sdLDL-c concentration was measured by a homogeneous assay method and its relationship with MetS and its traits was investigated.    Results  Serum sdLDL-c concentrations increased gradually with increasing numbers of MetS components ( p  < 0.001) and the proportion of patients with MetS increased gradually with increasing sdLDL-c levels ( p  for trend< 0.001). For the second, third, and fourth sdLDL-c quartiles versus the first, the OR (95% CI) for MetS were 4.47(2.41,8.28), 5.47(2.97,10.07) and 8.39(4.58,15.38) ( p  < 0.001 for trend) after multivariate adjustment. The stratified analysis conducted according to LDL-c levels showed that the OR between serum sdLDL-c levels and MetS was greater in those LDL-c levels lower than 3.3 mmol/L (OR = 22.97; 95% CI, 7.64–69.09) than in those LDL-c levels higher than 3.3 mmol/L (OR = 17.49; 95% CI, 4.43–68.98). Mediation analysis showed sdLDL-c mediated 38.6% of the association of waist circumference with triglycerides, while the association between sdLDL-c and MetS components did not mediate by hsCRP.    Conclusions  This study found that high sdLDL-c concentrations were associated with the presence of MetS independently of central obesity and inflammation.    Electronic supplementary material  The online version of this article (10.1186/s12986-019-0334-y) contains supplementary material, which is available to authorized users.

Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation