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. 2025 Jun 4:16:1619003.
doi: 10.3389/fendo.2025.1619003. eCollection 2025.

The serum uric acid to apolipoprotein A1 ratio is independently correlated with metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus: findings from a single national metabolic management center cohort

Xiu Li Guo  1 , Mei Tu  1 , Xiu Ping Qiu  1 , Wei Wang  1
Affiliations

The serum uric acid to apolipoprotein A1 ratio is independently correlated with metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus: findings from a single national metabolic management center cohort

Xiu Li Guo et al. Front Endocrinol (Lausanne). .

Abstract

Background: Recent evidence suggests that the serum uric acid to apolipoprotein A1 ratio (UAR) may be a novel biomarker for metabolic dysfunction-associated steatotic liver disease (MASLD). This study aims to investigate the relationship between UAR and MASLD, and compare the diagnostic ability of UAR with other insulin resistance-related markers for MASLD in individuals with type 2 diabetes mellitus (T2DM).

Method: A cohort of 1,019 individuals with T2DM was recruited from the National Metabolic Management Center of our hospital. Unenhanced abdominal CT scans were performed to evaluate liver steatosis for diagnosing MASLD. The association between UAR and the risk of MASLD was analyzed using weighted binomial logistic regression, restricted cubic splines (RCS), and subgroup analysis. Receiver operating characteristic (ROC) curve analysis was conducted to compare the diagnostic performance of UAR with other insulin resistance-related markers, including the serum uric acid to high-density lipoprotein cholesterol ratio (UHR), triglyceride to high-density lipoprotein cholesterol ratio (THR), and triglyceride to apolipoprotein A1 ratio (TAR).

Results: Participants in the MASLD group exhibited elevated UAR levels. After full adjustments for potential confounders, UAR remained independently associated with MASLD (OR: 1.65, 95% CI: 1.45-1.89, P < 0.001). Subgroup analyses revealed that this association was consistent across various subgroups, including sex, drinking status, hypertension, lipid-lowering therapy, and body mass index (P < 0.05). RCS analysis demonstrated a linear increase in the risk of MASLD with higher UAR levels (P for nonlinear = 0.319). ROC curve analysis indicated that UAR provided good diagnostic performance for MASLD (AUC:0.777, 95% CI: 0.749- 0.805), comparable to TAR (AUC difference: -0.003, 95% CI: -0.033-0.026, P = 0.818) and superior to UHR (AUC difference: 0.043, 95% CI: 0.019-0.067, P < 0.001) and THR (AUC difference: 0.035, 95% CI: 0.019-0.067, P = 0.047).

Conclusion: UAR was independently associated with MASLD and demonstrated significant diagnostic value, indicating that UAR could be a cost-effective biomarker to help identify high-risk individuals for MASLD.

Keywords: apolipoprotein A1; insulin resistance; metabolic dysfunction-associated steatotic liver disease; serum uric acid to apolipoprotein A1 ratio; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Prevalence of MASLD (A) and distribution of CTL-S (B) based on quartiles of UAR. MASLD, metabolic dysfunction-associated steatotic liver disease; CTL-S, CT hepato-spleen attenuation measurements; UAR, serum uric acid to apolipoprotein A1 ratio.
Figure 2
Figure 2
The variation in the variable coefficients (A) and the process of selecting the optimal value for the parameter λ in the Lasso regression model using the cross-validation method (B).
Figure 3
Figure 3
Subgroup analysis for the association between UAR and the risk of MASLD across sex, drinking, hypertension, lipid-lowering therapy, and BMI. Notes: Model adjusted age, waist circumference, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, creatinine, alanine aminotransferase, and aspartate aminotransferase. MASLD, metabolic dysfunction-associated steatotic liver disease; UAR, serum uric acid to apolipoprotein A1 ratio. BMI, body mass index.
Figure 4
Figure 4
A linear association between UAR and the risk of MASLD as analyzed by restricted cubic splines analysis. Notes: Model adjusted for age, waist circumference, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, creatinine, alanine aminotransferase, and aspartate aminotransferase. MASLD, metabolic dysfunction-associated steatotic liver disease; UAR, serum uric acid to apolipoprotein A1 ratio.
Figure 5
Figure 5
Comparison of diagnostic ability for MASLD between UAR, UHR, THR, and TAR. UAR, serum uric acid to apolipoprotein A1 ratio; UHR, serum uric acid to high-density lipoprotein cholesterol ratio; TAR, triglyceride to apolipoprotein A1 ratio; THR, triglyceride to high-density lipoprotein cholesterol ratio.
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