Uric acid-to-albumin ratio is associated with metabolic syndrome in a large adult cohort

Serum uric acid has been linked to metabolic syndrome (MetS), although the relationship has been inconsistent. The uric acid-to-albumin ratio (UAR) has emerged as a novel composite biomarker that indicates the balance between systemic prooxidant burden and antioxidant capacity. This study aimed to evaluate the independent association between UAR and MetS in a large, real-world adult cohort. This cross-sectional study utilized retrospectively collected data from 4,596 adults (mean age: 38.78 ± 9.78 years; 64.6% female). MetS was defined according to the modified National Cholesterol Education Program– Adult Treatment Panel III (NCEP-ATP III) framework, excluding waist circumference due to significant missing data. Consequently, MetS classification was based on the remaining four criteria: triglycerides, HDL cholesterol, blood pressure, and fasting plasma glucose. UAR was calculated as uric acid (mg/dL) divided by albumin (g/L) and was dichotomized by the cohort median (low vs. high UAR). The prevalence of MetS was 7.0% (n = 320). Participants diagnosed with MetS were older and predominantly male compared to those without the condition (45.23 ± 9.93 vs. 38.29 ± 9.60 years; 61.2% vs. 33.4%, respectively; both P0.001). High UAR was more prevalent in the MetS group (70.9% vs. 44.6%, P0.001). Multivariable analysis revealed that age (OR 1.06, 95% CI 1.05–1.07), sex (female vs. male OR 0.43, 95% CI 0.33–0.56), and UAR group (OR 1.89, 95% CI 1.43–2.49) were independently associated with MetS (all P0.001). These findings indicate that UAR is significantly associated with MetS and adverse metabolic features, suggesting a relationship with cardiometabolic risk and reflecting an underlying metabolic imbalance.