MHR Was Associated with Hyperuricemia Risk in Patients with Type 2 Diabetes Mellitus: The Mediating Effect of Body Mass Index

The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) reflects systemic inflammation, combining the pro-inflammatory role of monocytes with the anti-atherogenic and anti-inflammatory properties of HDL-cholesterol. Prior studies have established MHR as an independent predictor of hyperuricemia (HUA) prevalence. Emerging evidence further identifies MHR as a potential biomarker for early type 2 diabetes mellitus (T2DM) screening, likely mediated through its association with insulin resistance. Therefore, our study specifically investigates the relationship between MHR and HUA in a T2DM population. This cross-sectional study enrolled 1,261 T2DM patients. Logistic regression assessed associations between MHR and HUA. Mediation analysis evaluated body mass index (BMI) as a mediator. Restricted cubic spline (RCS) analysis examined nonlinear relationships. Receiver operating characteristic (ROC) curves compared predictive performance. Elevated MHR (adjusted OR = 2.040, 95% CI: 1.023 to 4.071, p < 0.05) was independently associated with HUA risk. BMI mediated 18.59% of the associations for MHR, respectively. RCS analysis revealed nonlinear patterns, with HUA risk increasing notably when MHR > 0.47. In ROC analysis, MHR demonstrated significant predictive ability for HUA, with an area under the curve (AUC) of 0.62. Higher MHR was significantly associated with HUA risk in T2DM patients, with BMI serving as a key mediator. These markers may aid in early identification of patients at risk and underscore the importance of weight and inflammation control in HUA prevention.