Uric acid to high-density lipoprotein cholesterol ratio (UHR) as a potential biomarker for visceral fat accumulation and heterogeneous skeletal muscle remodeling

The global prevalence of metabolic syndrome (MetS) is rising rapidly and has become a critical risk factor for cardiovascular disease. Although traditional anthropometric indicators (e.g., BMI, waist circumference) and basic biochemical tests are widely used for MetS screening and risk stratification, they capture only overall metabolic status. They cannot accurately detect early structural tissue abnormalities, such as abnormal visceral fat accumulation and skeletal muscle dysfunction. This study aimed to investigate associations between novel composite metabolic indicators and multidimensional body composition using quantitative computed tomography (QCT) and to identify potential biomarkers closely correlated with visceral fat accumulation and heterogeneous skeletal muscle remodeling. This single-center retrospective study included 423 consecutive adult patients who underwent non-contrast chest and abdominal CT examinations from December 2025 to February 2026. Multi-dimensional body composition parameters were quantified using QCT, and novel composite metabolic indicators, including the uric acid-to-high-density lipoprotein cholesterol ratio (UHR), were derived from routine blood tests. Correlation analysis, multiple linear regression, restricted cubic spline (RCS) analysis, and exploratory mediation analysis were conducted to examine associations between these indicators and abnormal body composition remodeling. Among all tested composite metabolic indicators, UHR showed the strongest positive correlation with visceral fat area (VFA) (unadjusted Spearman r = 0.64, P < 0.001; adjusted partial r = 0.54, P < 0.001). After adjusting for age, sex, and history of underlying metabolic diseases, UHR remained independently positively associated with VFA, skeletal muscle area (SMA), and intermuscular fat area (IMFA), and independently negatively associated with paraspinal muscle attenuation (PMA) and the SMA/VFA ratio, indicating a heterogeneous skeletal muscle remodeling pattern of “increased quantity but decreased quality”. RCS analysis revealed nonlinear dose-response associations, characterized by an inverted L-shaped curve for IMFA and an L-shaped curve for the SMA/VFA ratio, indicating a critical metabolic stress threshold. Sex significantly modified the associations between UHR and body composition. Mediation analysis suggested that the inflammatory indicator Neutrophil-γ-glutamyltransferase-to-lymphocyte ratio (NγLR) partially mediated the association between UHR and VFA, with a mediation effect of 6.91%. UHR is a potential and practical biomarker for identifying visceral fat accumulation and the “increased quantity but decreased quality” heterogeneous remodeling of skeletal muscle. UHR can be easily calculated from routine blood tests, making it a valuable tool for early identification of abnormal body composition remodeling and for improved metabolic risk stratification in clinical practice.