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

Table 1 Characteristics of study participants divided by uric acid-to-high-density lipoprotein cholesterol ratio tertile, n (%)

Variables	Total, n = 285	Tertiles of UHR			P value
		T1, n= 94	T2, n = 96	T3, n = 95
Age (year)	58.79 ± 15.00	61.22 ± 12.22	57.60 ± 14.96	57.57 ± 17.24	0.157
Male	182 (63.86)	39 (41.49)	67 (69.79)	76 (80.00)	< 0.001
BMI (kg/m2)	25.12 ± 4.02	24.86 ± 3.32	26.02 ± 4.35	0.023	0.006
Education					0.842
Illiterate	34 (11.93)	13 (13.83)	10 (10.42)	11 (11.58)
Primary school	72 (25.26)	27 (28.72)	24 (25.00)	21 (22.11)
Junior high school	95 (33.33)	29 (30.85)	33 (34.38)	33 (34.74)
Senior high school	40 (14.04)	12 (12.77)	11 (11.46)	17 (17.89)
College or above	44 (15.44)	13 (13.83)	18 (18.75)	13 (13.68)
DM duration (years)					0.815
< 1	45 (16.01)	17 (18.48)	17 (17.89)	11 (11.70)
< 10	139 (49.47)	44 (47.83)	43 (45.26)	52 (55.32)
< 20	62 (22.06)	20 (21.74)	22 (23.16)	20 (21.28)
≥ 20	35 (12.46)	11 (11.96)	13 (13.68)	11 (11.70)
Smoking	126 (44.21)	30 (31.91)	44 (45.83)	52 (54.74)	0.006
Drinking	104 (36.49)	26 (27.66)	38 (39.58)	40 (42.11)	0.088
HbA1c (%)	8.93 ± 2.40	8.65 ± 2.28	9.40 ± 2.36	8.74 ± 2.51	0.062
FPG (mmol/L)	7.87 ± 2.50	7.69 ± 2.05	8.17 ± 2.97	7.74 ± 2.38	0.348
AST (U/L)	23.64 ± 16.75	23.12 ± 19.90	22.58 ± 11.74	25.23 ± 17.67	0.514
ALT (U/L)	27.11 ± 21.84	24.20 ± 19.84	26.60 ± 18.68	30.53 ± 26.04	0.132
TG (mmol/L)	2.35 ± 2.28	2.04 ± 2.46	2.16 ± 1.55	2.84 ± 2.64	0.033
TC (mmol/L)	4.54 ± 1.33	4.83 ± 1.30	4.58 ± 1.37	4.21 ± 1.27	0.005
LDL-C (mmol/L)	2.69 ± 1.19	2.86 ± 1.26	2.78 ± 1.25	2.44 ± 1.00	0.036
HDL-C (mmol/L)	1.11 ± 0.29	1.34 ± 0.28	1.09 ± 0.19	0.91 ± 0.19	< 0.001
UA (mg/dL)	5.48 ± 1.71	3.97 ± 1.19	5.36 ± 0.91	7.09 ± 1.29	< 0.001
UHR	5.33 ± 2.38	3.01 ± 0.83	4.95 ± 0.54	8.01 ± 1.82	< 0.001
SDS	46.16 ± 10.67	44.92 ± 9.73	44.00 ± 11.14	49.57 ± 10.34	< 0.001
SAS	42.75 ± 7.89	42.03 ± 7.35	42.36 ± 8.88	43.86 ± 7.30	0.238

Uric acid to high-density lipoprotein cholesterol ratio (UHR) tertiles were defined as follows: T1, UHR < 4.05; T2, 4.05 ≤ UHR < 6.01; T3, UHR ≥ 6.01. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; DM: Diabetes mellitus; FPG: Fasting plasma glucose; HbA1c: Glycated hemoglobin; LDL-C: Low-density lipoprotein cholesterol; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; TC: Total cholesterol; TG: Triglycerides; UHR: Uric acid to high-density lipoprotein cholesterol ratio; HDL-C: High-density lipoprotein cholesterol; UA: Urine acid.

Table 2 The results of univariate analysis, n (%)

Variables	SDS, β (95%CI)	P value	SAS, β (95%CI)	P value
Gender
Female	Reference		Reference
Male	-2.69 (-5.19 to -0.19)	0.0351	-2.71 (-4.57 to -0.84)	0.0045
Age (years)	0.13 (0.05-0.21)	0.0010	0.11 (0.06-0.16)	< 0.0001
Education
Illiterate	Reference		Reference
Primary school	-3.14 (-7.38 to 1.10)	0.1471	-3.51 (-6.46 to -0.57)	0.0193
Junior high school	-2.83 (-6.91 to 1.24)	0.1731	-7.49 (-10.26 to -4.71)	< 0.0001
Senior high school	-4.28 (-8.96 to 0.39)	0.0724	-8.08 (-11.22 to -4.93)	< 0.0001
College or above	-7.12 (-11.81 to -2.44)	0.0029	-6.28 (-9.29 to -3.26)	< 0.0001
DM duration (years)
< 1	Reference		Reference
< 10	3.29 (-0.25, 6.83)	0.0689	3.74 (1.29, 6.20)	0.0028
< 20	2.17 (-1.90, 6.23)	0.2963	3.80 (1.02, 6.58)	0.0073
≥ 20	3.75 (-0.74, 8.24)	0.1019	3.38 (-0.09, 6.85)	0.0561
Smoking
No	0		0
Yes	-1.61 (-4.11, 0.89)	0.2058	-2.21 (-4.05, -0.37)	0.0188
Drinking
No	Reference		Reference
Yes	-0.42 (-3.02, 2.17)	0.7496	-2.04 (-3.93, -0.15)	0.0346
BMI (kg/m2)	0.12 (-0.15, 0.39)	0.3859	0.14 (-0.09, 0.37)	0.2269
HbA1c (%)	-0.39 (-0.90, 0.13)	0.1449	-0.12 (-0.46, 0.22)	0.4891
FPG (mmol/L)	-0.01 (-0.46, 0.44)	0.9518	0.01 (-0.29, 0.31)	0.9645
AST (U/L)	0.05 (-0.02, 0.12)	0.1908	0.02 (-0.04, 0.08)	0.4797
ALT (U/L)	0.00 (-0.05, 0.06)	0.9513	-0.01 (-0.05, 0.03)	0.7473
TG (mmol/L)	-0.01 (-0.59, 0.56)	0.9670	-0.24 (-0.66, 0.18)	0.2606
TC (mmol/L)	-1.26 (-2.18, -0.33)	0.0078	-0.71 (-1.39, -0.03)	0.0400
LDL-C (mmol/L)	-1.59 (-2.52, -0.66)	0.0008	-0.97 (-1.71, -0.24)	0.0095
HDL-C (mmol/L)	-5.58 (-9.92, -1.23)	0.0119	-1.29 (-4.41, 1.82)	0.4154
UA (mg/dL)	1.25 (0.61, 1.88)	0.0001	0.75 (0.27, 1.24)	0.0022
UHR	1.13 (0.69, 1.58)	< 0.0001	0.57 (0.20, 0.93)	0.0026

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; DM: Diabetes mellitus; FPG: Fasting plasma glucose; HbA1c: Glycated hemoglobin; LDL-C: Low-density lipoprotein cholesterol; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; TC: Total cholesterol; TG: Triglycerides; UHR: Uric acid to high-density lipoprotein cholesterol ratio; HDL-C: High-density lipoprotein cholesterol; UA: Urine acid.

Table 3 Subgroup analysis of the correlation of uric acid to high-density lipoprotein cholesterol ratio with depression/anxiety

Subgroup	n	SDS, β (95%CI)	P value	SAS, β (95%CI)	P value
Gender
Female	103	1.86 (1.17-2.54)	< 0.0001	0.77 (0.15-1.38)	0.0144
Male	182	1.22 (0.70-1.73)	< 0.0001	0.79 (0.34-1.24)	0.0006
Age (years)
< 60	144	1.32 (0.69-1.96)	< 0.0001	0.49 (-0.10-1.08)	0.1030
≥ 60	141	0.94 (0.34-1.55)	0.0023	0.64 (0.21-1.06)	0.0037
Education (n, %)
Illiterate	34	2.03 (1.12-2.94)	< 0.0001	0.63 (0.01-1.24)	0.0454
Primary school	72	1.17 (0.37-1.98)	0.0042	0.56 (-0.12 to 1.23)	0.1060
Junior high school	95	1.18 (0.45-1.91)	0.0014	0.65 (0.02-1.27)	0.0415
Senior high school	40	-0.33 (-1.41 to 0.75)	0.5472	0.26 (-0.53 to 1.05)	0.5230
College or above	44	1.12 (-0.19 to 2.43)	0.0932	0.63 (-0.29 to 1.54)	0.1778
DM duration (years)
< 1	45	0.04 (-1.28 to 1.37)	0.9493	-0.44 (-1.52 to 0.64)	0.4234
< 10	139	0.97 (0.38-1.56)	0.0013	0.89 (0.48-1.29)	< 0.0001
< 20	62	2.11 (1.10-3.11)	< 0.0001	-0.16 (-1.11 to 0.79)	0.7387
≥ 20	35	0.88 (-0.27 to 2.03)	0.1328	0.27 (-0.75 to 1.30)	0.5995
Smoking
No	159	1.30 (0.72-1.89)	< 0.0001	0.67 (0.24-1.09)	0.0023
Yes	126	1.09 (0.42-1.76)	0.0014	0.63 (0.03-1.23)	0.0400
Drinking
No	181	1.06 (0.50-1.61)	0.0002	0.57 (0.12-1.02)	0.0124
Yes	104	1.31 (0.57-2.05)	0.0005	0.65 (0.03-1.27)	0.0391
BMI (kg/m2)
< 24	122	0.80 (-0.03 to 1.62)	0.0581	0.35 (-0.26 to 0.96)	0.2626
≥ 24	163	1.36 (0.82-1.90)	< 0.0001	0.70 (0.23-1.17)	0.0034
HBA1C (%)
< 7.0	70	0.96 (0.22-1.69)	0.0105	0.67 (0.19-1.16)	0.0067
≥ 7.0	215	1.22 (0.68-1.77)	< 0.0001	0.52 (0.04-1.01)	0.0336

BMI: Body mass index; DM: Diabetes mellitus; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; HbA1c: Glycated hemoglobin.

Table 4 Multivariate regression analysis of uric acid-to-high-density lipoprotein cholesterol ratio and depression/anxiety

Outcome	Crude model	P value	Model I	P value	Model II	P value
SDS, β (95%CI)	1.13 (0.69-1.58)	< 0.0001	1.35 (0.91-1.78)	< 0.0001	1.27 (0.80-1.74)	< 0.0001
SAS, β (95%CI)	0.57 (0.20-0.93)	0.0026	0.67 (0.33-1.00)	0.0001	0.72 (0.35-1.09)	0.0001

Crude model: No adjustment. Model I: Adjusted for gender, age, education level, diabetes mellitus (DM) duration, smoking, drinking, body mass index (BMI). Model II: Adjusted for gender, age, education level, DM duration, smoking, drinking, BMI, glycated hemoglobin, fasting plasma glucose, aspartate aminotransferase, alanine aminotransferase; triglycerides, total cholesterol, and low-density lipoprotein cholesterol. SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 5 Threshold effect analysis of uric acid-to-high-density lipoprotein cholesterol ratio on depression and anxiety

Outcome	SDS, β (95%CI)	P value	SAS, β (95%CI)	P value
Model 1
Standard linear model	1.27 (0.80-1.74)	< 0.0001	0.72 (0.35-1.09)	0.0001
Model II
Inflection point (K)	5.02		4.00
< K	0.07 (-1.00 to 1.14)	0.8918	-0.22 (-1.35 to 0.91)	0.7061
> K	1.83 (1.13-2.53)	< 0.0001	0.91 (0.43-1.40)	0.0002

Adjusted for gender, age, education level, diabetes mellitus duration, smoking status, drinking status, body mass index, glycated hemoglobin, fasting plasma glucose, aspartate aminotransferase, alanine aminotransferase, triglycerides, total cholesterol, and low-density lipoprotein cholesterol. K: Inflection point; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.