Association of the uric acid-to-HDL cholesterol ratio with a study-defined dysmetabolic phenotype in adults with obesity: a cross-sectional study

The uric acid-to-HDL cholesterol ratio (UHR) has been proposed as a composite marker of metabolic dysregulation. This study aimed to evaluate the association between UHR and a study-defined dysmetabolic phenotype in adults with obesity, with particular consideration of the shared contribution of HDL-C to both UHR and the phenotype definition. This retrospective cross-sectional study included 2,453 adults with a body mass index (BMI) ≥ 30 kg/m² who presented to Kayseri City Hospital between March 2025 and March 2026. The study-defined dysmetabolic phenotype (Group 2) comprised participants with central obesity and reduced HDL-C accompanied by elevated triglycerides and/or impaired glucose metabolism/diabetes; all remaining participants were classified as Group (1) Importantly, reduced HDL-C alone was insufficient for classification as Group (2) UHR was calculated as (uric acid [mg/dL] / HDL-C [mg/dL]) × 100. Discriminatory performance was assessed by receiver operating characteristic (ROC) analysis, and adjusted associations were examined by multivariable logistic regression. Of 2,453 patients (81.5% female), 878 (35.8%) met the criteria for the study-defined dysmetabolic phenotype. UHR was significantly higher in this group [13.95 (IQR: 11.40–17.75) vs. 10.19 (IQR: 7.82–13.09), p < 0.001]. Reduced HDL-C was also present in 39.4% of Group 1, indicating that reduced HDL-C alone did not determine phenotype classification. ROC analysis demonstrated moderate discriminatory performance for UHR (AUC = 0.745; optimal cut-off ≥ 11.70; sensitivity 70.8%; specificity 66.8%), with significantly higher discrimination than uric acid alone (AUC = 0.580) and lower discrimination than HDL-C (AUC = 0.825; both DeLong p < 0.001). In the adjusted logistic regression model, UHR was associated with the study-defined dysmetabolic phenotype (OR = 1.356; 95% CI: 1.316–1.397; p < 0.001), although a significant quadratic term indicated a nonlinear association ( p < 0.001). Adding UHR to an HDL-C-containing clinical model produced only a small further improvement in discrimination (AUC 0.871 to 0.873). UHR was associated with a study-defined dysmetabolic phenotype characterized by reduced HDL-C accompanied by triglyceride and/or glycemic abnormalities in adults with obesity. However, its incremental discrimination beyond HDL-C was small. These findings support UHR as a complementary biochemical index rather than a replacement for HDL-C or direct assessment of metabolic abnormalities. Not applicable.