# Non-linear association of the uric acid to high-density lipoprotein cholesterol ratio with non-alcoholic fatty liver disease and diabetes effect modification in Chinese adults: a secondary analysis

## TL;DR

A study finds that a blood ratio called UHR is linked to non-alcoholic fatty liver disease in Chinese adults, with a stronger connection in people without diabetes.

## Contribution

The study identifies a non-linear relationship between UHR and NAFLD and shows that diabetes modifies this association.

## Key findings

- Each standard deviation increase in UHR was associated with a 22% higher odds of NAFLD after full adjustment.
- A UHR threshold at Z-score -0.75 showed a 4.6-fold higher NAFLD risk below it, but no association above it.
- Diabetes significantly modified the UHR-NAFLD association, with UHR predicting NAFLD only in non-diabetic individuals.

## Abstract

Global non-alcoholic fatty liver disease (NAFLD) prevalence has risen sharply, highlighting an urgent need for improved non-invasive biomarkers. The uric acid to high-density lipoprotein cholesterol ratio (UHR) integrates key metabolic pathways in NAFLD, but its precise relationship and effect modifiers remain unclear. Herein, we explored the correlation between UHR and NAFLD.

This secondary analysis used data from 1,592 Chinese adults (40–70 years) undergoing health checks. NAFLD was diagnosed via ultrasound. UHR was calculated as serum uric acid (μmol/L) divided by high-density lipoprotein cholesterol ratio (HDL-C) (mmol/L). Association between UHR and NAFLD was assessed using multivariable logistic regression, restricted cubic splines (RCS) for non-linearity, and threshold analysis. Receiver Operating Characteristic analysis was utilized to assess the ability of UHR to predict the NAFLD. Subgroup analyses explored effect modification.

NAFLD prevalence was 61.1%. After full adjustment, each one standard deviation (SD) increase in UHR was associated with 22% higher NAFLD odds [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.03–1.46]. RCS revealed significant non-linearity (p < 0.001). A threshold was identified at UHR Z-score = −0.75: below this, each 1-SD increase conferred a 4.6-fold higher NAFLD risk (OR = 4.64, 95%CI: 1.57–13.68); above it, no association was found. Diabetes significantly modified the association (P-interaction = 0.028): UHR predicted NAFLD in non-diabetics (OR = 1.27, 95% CI: 1.04–1.56) but not diabetics. UHR’s predictive ability (area under the curve = 0.670) exceeded that of uric acid or HDL-C alone.

UHR is an independent, non-linear predictor of NAFLD in Chinese adults, with a distinct risk threshold. Its association with NAFLD is significantly modified by diabetes status. UHR represents a simple, readily available biomarker potentially enhancing NAFLD risk assessment, particularly in non-diabetic individuals.