NCHS Data Brief ■ No. 276 ■ March 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prevalence of Low High-density Lipoprotein Cholesterol 

Among Adults, by Physical Activity: United States, 2011–2014

Marissa L. Zwald, Ph.D., M.P.H, Lara J. Akinbami, M.D., Tala H.I. Fakhouri, Ph.D., M.P.H, and 

Cheryl D. Fryar, M.S.P.H.

Key findings 

Data from the National 

Health and Nutrition 

Examination Survey 

● The prevalence of low 

high-density lipoprotein (HDL) 

cholesterol was significantly 

higher among adults who 

did not meet recommended 

physical activity guidelines 

(21.0%) than adults who met 

the guidelines (17.7%).

● Low HDL cholesterol 

prevalence differed 

significantly for both men 

and women by adherence to 

physical activity guidelines. 

● Prevalence of low HDL 

cholesterol declined as age 

increased for both those who 

did and did not meet the 

physical activity guidelines. 

● Non-Hispanic white and 

non-Hispanic black adults 

who did not meet the physical 

activity guidelines had a higher 

prevalence than those who met 

the guidelines. 

● Low HDL cholesterol 

prevalence declined with 

increasing education level 

regardless of adherence to 

physical activity guidelines.

Regular physical activity can improve cholesterol levels among adults, including 

increasing high-density lipoprotein (HDL) cholesterol (1). HDL cholesterol is 

known as “good” cholesterol because high levels can reduce cardiovascular 

disease risk (2). The 2008 Physical Activity Guidelines for Americans 

recommend that adults engage in 150 minutes or more of moderate-intensity 

aerobic activity per week, 75 minutes of vigorous-intensity aerobic activity 

per week, or an equivalent combination (3). Adherence to these guidelines is 

expected to decrease the prevalence of low HDL cholesterol levels (4–8). This 

report presents national data for 2011–2014 on low HDL cholesterol prevalence 

among U.S. adults aged 20 and over, by whether they met these guidelines.

Keywords: HDL cholesterol • physical activity • NHANES

Prevalence of low HDL cholesterol was higher among adults 

who did not meet the physical activity guidelines compared 

with those who met the guidelines.

Figure 1. Age-adjusted prevalence of low HDL cholesterol among adults aged 20 and over, by 

physical activity and sex: 2011–2014

 

1

Significantly different from subgroup that did not meet physical activity guidelines.

2

Significantly different from women in the same group. 

3

Overall total of low HDL prevalence was 19.0%. 

NOTES: HDL is high-density lipoprotein. Low HDL cholesterol is less than 40 mg/dL based on laboratory measurement. Data are 

age-adjusted by the direct method to the 2000 U.S. Census population, using age groups 20–39, 40–59, and 60 and over. Access 

data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db276_table.pdf#1.

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2011–2014. 
NCHS Data Brief ■ No. 276 ■ March 2017

■  2  ■

● During 2011–2014, the prevalence of low HDL cholesterol was 19.0% among all adults. 

Prevalence was higher among adults who did not meet the physical activity guidelines 

(21.0%) compared with adults who met the guidelines (17.7%) (Figure 1). 

● For men, prevalence of low HDL cholesterol was higher among those who did not meet the 

physical activity guidelines (35.4%) compared with those who met the guidelines (25.0%). 

Prevalence was also higher among women who did not meet the guidelines (11.8%) 

compared with women who met the guidelines (9.1%). 

● Among adults who met the physical activity guidelines, the prevalence of low HDL 

cholesterol was higher among men (25.0%) compared with women (9.1%). 

● For adults who did not meet the physical activity guidelines, prevalence of low HDL 

cholesterol was higher among men (35.4%) compared with women (11.8%). 

The prevalence of low HDL cholesterol declined as age increased, 

regardless of physical activity status. 

● For adults aged 60 and over, those who did not meet the physical activity guidelines had 

a higher prevalence of low HDL cholesterol than those who met the guidelines (18.1% 

compared with 12.6%) (Figure 2). There were no significant differences in the prevalence of 

low HDL cholesterol by physical activity status among adults aged 20–39 and 40–59. 

Figure 2. Prevalence of low HDL cholesterol among adults aged 20 and over, by physical activity and age: 2011–2014

 

1

Significant decreasing linear trend. 

2

Significantly different from subgroup that did not meet physical activity guidelines. 

NOTES: HDL is high-density lipoprotein. Low HDL cholesterol is less than 40 mg/dL based on laboratory measurement. Data are age-adjusted by the direct 

method to the 2000 U.S. Census population, using age groups 20–39, 40–59, and 60 and over. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db276_table.pdf#2.

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2011–2014. 
NCHS Data Brief ■ No. 276 ■ March 2017

■  3  ■

● The prevalence of low HDL cholesterol decreased with increasing age among adults who 

met the physical activity guidelines: 19.4% for adults aged 20–39, 19.0% for those aged 

40–59, and 12.6% for those aged 60 and over. A similar pattern was found among adults 

who did not meet the physical activity guidelines (22.4% for those aged 20–39, 21.4% for 

those aged 40–59, and 18.1% for those aged 60 and over). 

For non-Hispanic white and non-Hispanic black adults, low HDL cholesterol 

prevalence was higher among those who did not meet the physical activity 

guidelines compared with those who met the guidelines. 

● Among non-Hispanic white and non-Hispanic black adults, the prevalence of low HDL

cholesterol was higher among those who did not meet the physical activity guidelines than 

among those who met the guidelines (21.8% compared with 18.1%, and 16.2% compared 

with 12.4%, respectively) (Figure 3). There were no significant differences in the prevalence 

of low HDL cholesterol by physical activity status among non-Hispanic Asian and Hispanic 

adults. 

● For adults who met the physical activity guidelines, prevalence of low HDL cholesterol 

was higher among Hispanic adults (20.7%) compared with non-Hispanic black (12.4%) and 

non-Hispanic Asian (14.4%) adults. Non-Hispanic white adults who met the guidelines had 

higher prevalence than non-Hispanic black adults (18.1% compared with 12.4%). 

Figure 3. Age-adjusted prevalence of low HDL cholesterol among adults aged 20 and over, by physical activity and race 

and Hispanic origin: 2011–2014

 

1

Significantly different from subgroup that did not meet physical activity guidelines.

2

Significantly different from Hispanic persons in the same group. 

3

Significantly different from non-Hispanic white persons in the same group. 

NOTES: HDL is high-density lipoprotein. Low HDL cholesterol is less than 40 mg/dL based on laboratory measurement. Data are age-adjusted by the direct 

method to the 2000 U.S. Census population, using age groups 20–39, 40–59, and 60 and over. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db276_table.pdf#3.

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2011–2014.
NCHS Data Brief ■ No. 276 ■ March 2017

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● Hispanic adults who did not meet the physical activity guidelines (22.4%) had a higher 

prevalence of low HDL cholesterol than non-Hispanic black (16.2%) and non-Hispanic 

Asian (16.3%) adults. Non-Hispanic white adults who did not meet the physical activity 

guidelines (21.8%) also had significantly higher prevalence than non-Hispanic black and 

non-Hispanic Asian adults. 

Low HDL prevalence declined with increasing education level, regardless 

of physical activity status. 

● College graduates who did not meet the physical activity guidelines had a higher prevalence 

of low HDL cholesterol (16.8%) than college graduates who met the guidelines (12.3%) 

(Figure 4). There were no significant differences in low HDL cholesterol prevalence by 

physical activity status among adults with other education levels. 

● Among adults who met the physical activity guidelines, there was a significant decrease 

in low HDL cholesterol prevalence with increasing education: 21.7% for adults with a 

high school education or less, 19.2% for adults with some college education, and 12.3% 

for college graduates. A similar pattern was observed among adults who did not meet the 

physical activity guidelines (23.6% for adults with a high school education or less, 21.0% 

for those with some college education, and 16.8% for college graduates). 

Figure 4. Age-adjusted prevalence of low HDL cholesterol among adults aged 20 and over, by physical activity and 

education: 2011–2014

 

1

Significant decreasing linear trend. 

2

Significantly different from subgroup that did not meet physical activity guidelines.

NOTES: HDL is high-density lipoprotein. Low HDL cholesterol is less than 40 mg/dL based on laboratory measurement. Data are age-adjusted by the direct 

method to the 2000 U.S. Census population, using age groups 20–39, 40–59, and 60 and over. Access data table for Figure 4 at: 

https://www.cdc.gov/nchs/data/databriefs/db276_table.pdf#4. 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2011–2014. 
NCHS Data Brief ■ No. 276 ■ March 2017

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Summary 

During 2011–2014, adults who did not meet physical activity guidelines had a higher prevalence 

of low HDL cholesterol compared with adults who met the guidelines. This pattern was consistent 

across all demographic subgroups, where statistically significant differences were observed 

among men and women, adults aged 60 and over, non-Hispanic white adults, non-Hispanic black 

adults, and college graduates. Regardless of physical activity status, the prevalence of low HDL 

cholesterol was significantly higher among men compared with women, and prevalence decreased 

with age and education level. Previous reports have demonstrated similar differences in low HDL

cholesterol prevalence by sex and age, where men had lower levels of HDL cholesterol than 

women, and the percentage of adults with low HDL cholesterol declined with age (9–11).

Low HDL cholesterol is a risk factor for cardiovascular disease (4–8). Some factors affecting 

HDL cholesterol levels and risk for cardiovascular disease cannot be modified, including sex, age, 

and heredity. However, National Cholesterol Education Program guidelines encourage lifestyle 

changes that can lower risk, including regular aerobic physical activity as it is associated with 

increased HDL cholesterol levels (12). 

Definitions 

Low high-density lipoprotein (HDL) cholesterol: Serum high-density lipoprotein cholesterol less 

than 40 mg/dL based on laboratory measurement. 

Met physical activity guidelines: A summary of reported time spent in the previous week in 

moderate and vigorous activities from work, transportation, and leisure was categorized as 

meeting or not meeting the 2008 Physical Activity Guidelines for Americans. These guidelines 

were issued by the U.S. Department of Health and Human Services (3). Meeting physical 

activity guidelines is defined as engaging in 150 minutes or more of moderate-intensity aerobic 

activity per week, 75 minutes of vigorous-intensity aerobic activity per week, or an equivalent 

combination. 
NCHS Data Brief ■ No. 276 ■ March 2017

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Data source and methods

Data from the 2011–2012 and 2013–2014 National Health and Nutrition Examination Survey 

(NHANES) were used for these analyses. NHANES is a cross-sectional survey designed to 

monitor the health and nutritional status of the civilian noninstitutionalized U.S. population 

(13,14). It is conducted by the National Center for Health Statistics. Survey participants were 

selected using a complex, multistage probability design. Participants were interviewed in their 

homes and then underwent standardized physical examinations in a mobile examination center, 

which included the collection of laboratory specimens. Further details regarding NHANES 

protocols and procedures, including laboratory methods, are available elsewhere (13,14). 

For 2011–2012 and 2013–2014, non-Hispanic black, non-Hispanic Asian, and Hispanic persons 

were oversampled to obtain reliable estimates for these population subgroups. Specific race and 

Hispanic-origin estimates reflect persons reporting only one race. Those reporting “other” race 

and more than one race are included in the analysis but are not reported separately.

Examination sample weights, which account for differential selection probabilities, nonresponse, 

and noncoverage were used in the estimation of national estimates. The standard errors of the 

percentages were estimated using Taylor series linearization, a method that incorporates the 

sample design. Differences between groups were evaluated using a t statistic at the p < 0.05 

significance level. To test for linear trends, the null hypothesis of no linear trend was examined 

using orthogonal polynomials. Pregnant women were excluded from these analyses. Statistical 

analyses were conducted using SAS 9.3 software (SAS Institute Inc., Cary, N.C.) and SUDAAN 

release 11.0 (RTI International, Research Triangle Park, N.C.).

About the authors 

Marissa L. Zwald is with the Centers for Disease Control and Prevention’s Epidemic Intelligence 

Service, assigned to the National Center for Health Statistics’ (NCHS) Division of Health and 

Nutrition Examination Surveys. Lara J. Akinbami, Tala H.I. Fakhouri, and Cheryl D. Fryar are 

with NCHS’ Division of Health and Nutrition Examination Surveys. 
NCHS Data Brief ■ No. 276 ■ March 2017

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References

1. CDC. Physical activity and health. Available from: https://www.cdc.gov/physicalactivity/

basics/pa-health/index.htm.

2. CDC. LDL and HDL: “Bad” and “good” cholesterol. Available from: https://www.cdc.gov/

cholesterol/ldl_hdl.htm. 

3. U.S. Department of Health and Human Services. 2008 Physical activity guidelines for 

Americans. 2008. Available from: https://health.gov/paguidelines/pdf/paguide.pdf. 

4. Franceschini G. Epidemiologic evidence for high-density lipoprotein cholesterol as a risk 

factor for coronary artery disease. Am J Cardiol 88(12A):9–13. 2001.

5. Boden WE. High-density lipoprotein cholesterol as an independent risk factor in 

cardiovascular disease: Assessing the data from Framingham to the Veterans Affairs High-Density 

Lipoprotein Intervention Trial. Am J Cardiol 86(12A):19–22. 2000. 

6. Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, et al. Effect of aerobic exercise 

training on serum levels of high-density lipoprotein cholesterol: A meta-analysis. Arch Intern 

Med 167(10):999–1008. 2007.

7. Gotto AM Jr. Low high-density lipoprotein cholesterol as a risk factor in coronary heart 

disease: A working group report. Circulation 103(17):2213–8. 2001. 

8. Toth PP. High-density lipoprotein and cardiovascular risk. Circulation 109:1809–12. 2004.

9. Carroll MD, Kit BK, Lacher DA. Total and high-density lipoprotein cholesterol in adults: 

National Health and Nutrition Examination Survey, 2009–2010. NCHS data brief, no 92. 

Hyattsville, MD: National Center for Health Statistics. 2012. Available from: https://www.cdc.

gov/nchs/data/databriefs/db92.pdf. 

10. Carroll MD, Kit BK, Lacher DA, Yoon SS. Total and high-density lipoprotein cholesterol in 

adults: National Health and Nutrition Examination Survey, 2011–2012. NCHS data brief, no 132. 

Hyattsville, MD: National Center for Health Statistics. 2013. Available from: https://www.cdc.

gov/nchs/data/databriefs/db132.pdf.

11. Carroll MD, Fryar CD, Kit BK. Total and high-density lipoprotein cholesterol in adults: 

United States, 2011–2014. NCHS data brief, no 226. Hyattsville, MD: National Center for Health 

Statistics. 2015. Available from: https://www.cdc.gov/nchs/data/databriefs/db226.pdf. 

12. National Heart, Lung, and Blood Institute. Third report of the National Cholesterol Education 

Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol 

in adults. 2002. Available from: https://www.nhlbi.nih.gov/files/docs/resources/heart/atp-3-

cholesterol-full-report.pdf. 

13. National Center for Health Statistics. National Health and Nutrition Examination Survey: 

NHANES 2011–2012. Available from: https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/

Default.aspx?BeginYear=2011.

14. National Center for Health Statistics. National Health and Nutrition Examination Survey: 

NHANES 2013–2014. Available from: https://wwwn.cdc.gov/Nchs/Nhanes/ContinuousNhanes/

Default.aspx?BeginYear=2013.
NCHS Data Brief ■ No. 276 ■ March 2017

Suggested citation 

Zwald ML, Akinbami LJ, Fakhouri THI, 

Fryar CD. Prevalence of low high-density 

lipoprotein cholesterol among adults by 

physical activity: United States, 2011–2014. 

NCHS data brief, no 276. Hyattsville, MD: 

National Center for Health Statistics. 2017. 

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

Ryne Paulose-Ram, Ph.D., Associate 

Director for Science

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