Association between uric acid to high-density lipoprotein ratio and mental health symptoms in people with type 2 diabetes

doi:10.4239/wjd.v16.i10.110211

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Oct 15, 2025; 16(10): 110211
Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.110211

Association between uric acid to high-density lipoprotein ratio and mental health symptoms in people with type 2 diabetes

Hui Xu, Dong-Juan He, Cheng Luo, Xian-Mei Yu, Cheng-Zheng Duan, Da Sun, De-Jun Wu, Xiao-Qiang Mao, Wei-Feng Jiang

Hui Xu, Department of Hospital Management, Quzhou Hospital of Traditional Chinese Medicine, Quzhou 324000, Zhejiang Province, China

Dong-Juan He, Xian-Mei Yu, Department of Endocrinology, The Second People’s Hospital of Quzhou, Quzhou 324002, Zhejiang Province, China

Cheng Luo, Cheng-Zheng Duan, Department of Endocrinology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China

Da Sun, Institute of Life Sciences & Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325000, Zhejiang Province, China

De-Jun Wu, Xiao-Qiang Mao, Wei-Feng Jiang, Department of Gerontology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China

Co-first authors: Hui Xu and Dong-Juan He.

Author contributions: Xu H and He DJ contributed to writing - original draft and contributed equally as co-first authors; He DJ, Sun D, and Jiang WF contributed to writing - review & editing; Xu H, Luo C, Duan CZ, and Mao XQ contributed to investigation, methodology, software; Xu H, Duan CZ, Wu DJ, and Mao XQ contributed to data curation; Xu H, Luo C, Sun D, and Jiang WF contributed to formal analysis; Luo C, Yu XM, Duan CZ, and Mao XQ contributed to validation; Xu H, Yu XM, Duan CZ, and Sun D contributed to visualization; He DJ and Jiang WF contributed to funding acquisition, project administration, resources, supervision; All authors contributed to conceptualization.

Supported by Science and Technology Program of Quzhou, China, No. 2022K67; Zhejiang Medical Association Clinical Research Fund Project, No. 2024ZYC-A526; and the Research Project of Quzhou People’s Hospital, No. KYQD2024-006.

Institutional review board statement: This study was approved by the Ethics Committee of the Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital (Approval No. 2022-133). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments.

Informed consent statement: Written informed consent was obtained from all participants after they were fully informed of the study objectives, procedures, potential risks, and benefits. Participation was entirely voluntary.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this study.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised accordingly.

Data sharing statement: The raw data supporting the conclusions of this study will be made available by the corresponding author upon reasonable request, without undue reservation.

Open Access: This article is an open-access article that was selected by an in-house editor and was fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Wei-Feng Jiang, MD, Associate Chief Physician, Department of Gerontology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, No. 100 Minjiang Avenue, Kecheng District, Quzhou 324000, Zhejiang Province, China. weifengjiang@wmu.edu.cn

Received: June 3, 2025
Revised: July 2, 2025
Accepted: August 18, 2025
Published online: October 15, 2025
Processing time: 136 Days and 22.4 Hours

Abstract

BACKGROUND

The association between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and mental health among individuals with type 2 diabetes mellitus (T2DM) has not been thoroughly investigated.

AIM

To examine the link between UHR and symptoms of depression and anxiety in patients with T2DM.

METHODS

A cross-sectional analysis was carried out from March 2023 to April 2024, involving participants diagnosed with T2DM. Data on sociodemographic characteristics, clinical parameters, and UHR values were systematically gathered. The Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were utilized to evaluate depressive and anxiety symptoms, respectively. To assess the relationships between UHR and SDS/SAS scores, linear regression models were employed, incorporating adjustments for potential confounding variables. Additionally, smooth curve fitting and threshold effect analyses were conducted to explore potential nonlinear relationships.

RESULTS

A total of 285 patients with T2DM were included. Initial univariate analysis demonstrated a significant positive correlation between elevated UHR levels and higher SDS and SAS scores. Multivariate regression analysis revealed that a one-unit rise in UHR was associated with a 1.13-point increase in SDS scores (95%CI: 0.69-1.58) and a 0.57-point increase in SAS scores (95%CI: 0.20-0.93). After controlling for confounders, UHR remained positively correlated with SDS (β = 1.55, 95%CI: 0.57-2.53) and SAS (β = 0.72, 95%CI: 0.35-1.09). Nonlinear analysis identified critical thresholds at UHR values of 5.02 for SDS and 4.00 for SAS, beyond which the relationships between UHR and psychological symptom scores became markedly stronger (P < 0.05).

CONCLUSION

Higher UHR levels are significantly linked to exacerbated depressive and anxiety symptoms in patients with T2DM. These results indicate that UHR may function as a promising biomarker to identify individuals at greater risk of mental health complications within this population.

Keywords: Anxiety; Depression; Type 2 diabetes mellitus; Uric acid; High-density lipoprotein cholesterol; Uric acid-to-high-density lipoprotein cholesterol ratio

Core Tip: This study highlights the significant association between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and symptoms of depression and anxiety in individuals with type 2 diabetes mellitus (T2DM). Using multivariate and nonlinear analyses, the study identifies threshold effects, suggesting that elevated UHR levels may serve as a cost-effective biomarker for psychological distress in T2DM. These findings underscore the importance of integrating metabolic and mental health assessments in diabetic care, particularly in high-risk subgroups.