# Exploring the nonlinear association between serum uric acid and the TG/HDL-C Ratio: insights from school-aged children with adenoid or tonsillar hypertrophy

## TL;DR

This study finds a nonlinear link between high uric acid and poor lipid profiles in children with enlarged adenoids or tonsils.

## Contribution

The study reveals a nonlinear association between serum uric acid and the TG/HDL-C ratio in children with adenoid or tonsillar hypertrophy.

## Key findings

- Serum uric acid levels above 4.40 mg/dL show a stronger link to higher TG/HDL-C ratios.
- Children with elevated uric acid have higher BMI z-scores and more dyslipidemia.
- The nonlinear relationship holds true for both male and female children.

## Abstract

Serum uric acid (SUA) plays a critical role in metabolic dysfunction, including insulin resistance (IR) and lipid dysregulation. This study investigates the association between SUA and the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio in school-aged children with adenoid or tonsillar hypertrophy.

A single-center retrospective study of 3,026 school-aged children with adenoid or tonsillar hypertrophy was conducted. Baseline characteristics, metabolic markers, and the TG/HDL-C ratio were analyzed across SUA quartiles. Spearman’s test was used to explore the associations between clinical parameters and the TG/HDL-C ratio. A restricted cubic splines (RCS) linear regression model was used to explore the nonlinear relationships between SUA and the TG/HDL-C ratio.

SUA levels were positively associated with the TG/HDL-C ratio (r = 0.232, p < 0.001). RCS analysis revealed a significant nonlinear relationship between SUA and the TG/HDL-C ratio (p for nonlinear = 0.019). When SUA exceeded 4.40 mg/dL, the positive relationship between SUA and the TG/HDL-C ratio became stronger compared to levels below this threshold. Moreover, children with SUA levels >4.40 mg/dL showed a significantly higher proportion of BMI z-scores >2.0 and a greater prevalence of dyslipidemia than those with lower SUA levels. The relationship between SUA and the TG/HDL-C ratio in males and females was consistent with that observed in the general population.

Our study identified a nonlinear relationship between SUA levels and the TG/HDL-C ratio in school-age children with adenoid or tonsillar hypertrophy. This nonlinear pattern persisted in sex-stratified analyses, with males exhibiting a higher SUA inflection point compared to females. These findings suggest that SUA could serve as a practical marker for early metabolic risk assessment.