Uric acid to high density lipoprotein-cholesterol ratio as a potential biomarker of comorbidities in youth with obesity

Background and aim: The uric acid to high-density lipoprotein-cholesterol ratio (UHR) has been associated with type 2 diabetes or hepatic steatosis in adults, while pediatric evidence is poor. We aimed to evaluate the association between UHR and several obesity-related comorbidities in youths with overweight or obesity (OW/OB). Methods and results: 1215 youths of the CARITALY study were enrolled. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were assessed by standard methods. The homeostasis model assessment of insulin resistance (HOMA-IR) and the whole-body insulin sensitivity index (WBISI) were calculated. A continuous cardiometabolic risk score (cCMR) was calculated. Metabolic-associated steatotic liver disease (MASLD) was defined by a standard method. Mild reduced-estimated glomerular filtration rate (MReGFR) was defined by eGFR value > 60 < 90 ml/min/1.73 m(2) White blood cell count (WBCc) was obtained. UHR was stratified into quartiles. Youths in the top UHR quartile showed a higher odds ratio (OR)(95%CI) of MReGFR: 2.03 (1.31-3.13) and cCMR: 2915 (1.60-4.24) vs the first quartile. Youths in the third UHR quartile showed significantly higher ORs of IFG 2.00 (1.01-3.94), IGT: 2.64 (1.37-5.10), HOMA-IR: 1.64 (1.17-2.29), and high WBCc: 2.49 (1.64-3.77), whereas youths yet in the second quartile showed significantly higher OR of low WBISI: 1.60 (1.04-2.50) and MASLD: 1.61 (1.13-2.28) vs the first quartile. Conclusions: UHR was associated with disrupted glucose homeostasis, high cardiometabolic risk, MASLD, reduced glomerular filtration, and low-grade inflammation in youths with OW/OB. UHR is a promising biomarker for detecting obesity-related comorbidities in this population.