Association Between Uric Acid to HDL-C Ratio and Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Xiangyun Zhu,1,2,* Han Yin,1,2,* Jing Han,1,2,* Xiaoyan Zhang,1,2 Qing Han,1,2 Weixia Sun,1,2 Yijun Liu,1,2 Wenxuan Tao,1,2 Xinliang Liu,3 Guofeng Wang,4 Ling Li1,2 1Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People’s Republic of China; 2Pancreatic Research Institute, Southeast University, Nanjing, Jiangsu, 210009, People’s Republic of China; 3Department of Endocrinology, Lianyungang Affiliated Hospital of Nanjing Medical University, Lianyungang, 222000, People’s Republic of China; 4Department of Endocrinology, Xuyi People’s Hospital of Clinical College of Yangzhou University, Huai’an, Jiangsu, 211700, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ling Li, Email [email protected]; Guofeng Wang, Email [email protected]: Patients with type 2 diabetes mellitus (T2DM) exhibit an elevated risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD). The uric acid to high-density lipoprotein cholesterol ratio (UHR) has emerged as a novel metabolic biomarker implicated in MASLD pathogenesis. This study aimed to evaluate the association between UHR and MASLD in a T2DM population.Methods: In this cross-sectional study, we analyzed clinical data from 1081 T2DM patients (464 without MASLD, 617 with MASLD). Physiological and biochemical parameters were collected and analyzed. UHR was calculated as [uric acid (mg/dL)/HDL-C (mg/dL)] × 100%. Univariate and multivariate logistic regression analyses were performed to examine the association between UHR and MASLD.Results: T2DM patients with MASLD had significantly higher UHR levels than those without MASLD (12.12[9.06– 16.83] vs 10.36[7.65– 14.08], p< 0.001). UHR showed a strong positive correlation with TG/HDL (r =0.673, p < 0.001), moderate correlations with TG (r = 0.516, p < 0.001) and TC/HDL (r =0.548, p < 0.001), weak but significant associations with BMI (r = 0.330), WHR (r = 0.289), HOMA-IR (r = 0.121), ALT (r = 0.123), and GGT (r = 0.267) (all p < 0.05). Multivariate logistic regression showed that elevated UHR levels were significantly associated with increased MASLD risk (adjusted OR = 1.057, 95% CI: 1.016– 1.100, p = 0.006), after adjusting for age, diabetes duration, BMI, blood pressure, and biochemical confounders.Conclusion: Elevated UHR is independently associated with MASLD in T2DM patients, suggesting its clinical relevance in MASLD screening among this high-risk population.Keywords: type 2 diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, uric acid to high-density lipoprotein ratio, metabolic syndrome