Cholesterol Ratio Linked to Prediabetes in 113,795-Person Qatar Study

A ratio between uric acid and HDL cholesterol, two routine blood measurements, is independently associated with prediabetes in a large multinational primary care population in Qatar, according to a retrospective cross-sectional study published in BMC Endocrine Disorders. Among 113,795 adults aged 18 to 60 years drawn from anonymized electronic medical records of Primary Health Care Corporation between July 2021 and June 2025, 30,125 participants, or 26.5 percent, had prediabetes, defined using American Diabetes Association glycaemic thresholds based on available fasting plasma glucose or HbA1c.

The study found that the median uric acid-to-HDL cholesterol ratio, abbreviated UHR, was higher in participants with prediabetes than in controls, at 0.120 versus 0.100, a difference that was statistically significant. In multivariable logistic regression adjusted for age, sex, BMI, and nationality-derived geographic sub-region, each 0.01-unit higher UHR was associated with higher adjusted odds of prediabetes, with an adjusted odds ratio of 1.057 and a 95 percent confidence interval of 1.053 to 1.062. The association followed a graded pattern across quartiles of the ratio: participants in the highest quartile had an adjusted odds ratio of 2.300, with a 95 percent confidence interval of 2.167 to 2.440, compared with those in the lowest quartile.

The researchers also compared UHR with its individual components and examined whether the association varied across subgroups. The relationship remained similar in sensitivity analyses that accounted for missing BMI data, and it was stronger in women, with an interaction P value below 0.001. There was no evidence of effect modification by geographic sub-region, with an interaction P value of 0.125, suggesting the association was consistent across the nationality-derived groups within this multinational population.

Despite the statistically robust association, the marker’s practical value appears limited. UHR showed modest discrimination for prediabetes, with a receiver operating characteristic area under the curve of 0.618, and the authors identified an exploratory threshold of approximately 0.106. The study’s conclusion states that this threshold requires external prospective validation before any clinical implementation, meaning the ratio cannot yet be recommended as a screening or diagnostic tool.

As a cross-sectional analysis of medical records, the study establishes an association at a single point in time and cannot determine whether a higher UHR precedes the development of prediabetes or contributes to its progression. The authors note that prediabetes is frequently underdiagnosed and carries significant cardiometabolic risk, and that UHR has emerged as a marker of metabolic dysfunction, but its association with prediabetes in large multinational primary care populations had remained poorly characterized. The findings add to evidence linking combined uric acid and lipid measures to dysglycaemia, while the modest discriminatory performance and the observational design temper any immediate clinical application.

Subject of Research: Association between the uric acid-to-HDL cholesterol ratio and prediabetes in a multinational primary care population in Qatar

Article Title: Uric acid-to-HDL cholesterol ratio is independently associated with prediabetes in a large multinational primary care population in Qatar: a cross-sectional study

Article References: Almallah, S., Hamed, E., AlFehaidi, A. S., & Joshi, M. C. (2026). Uric acid-to-HDL cholesterol ratio is independently associated with prediabetes in a large multinational primary care population in Qatar: a cross-sectional study. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02662-8

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02662-8

Keywords: prediabetes, uric acid, HDL cholesterol, UHR ratio, cross-sectional study, Qatar, primary care, metabolic dysfunction, logistic regression, cardiometabolic risk, Uric, acid-to-HDL