Background Hepatic steatosis affects ∼25% of the global population, yet practical, noninvasive biomarkers for early detection and risk stratification are lacking. The uric‐acid‐to‐HDL‐cholesterol ratio (UHR)—a simple, inexpensive composite of oxidative stress and lipid protection—has not been examined for hepatic steatosis. Methods We analysed 3783 adults aged ≥ 18 years from the 2017‐2018 NHANES cycle. Hepatic steatosis was defined by FibroScan controlled attenuation parameter > 285 dB/m. The UHR was calculated as serum uric acid (mg/dL) ÷ HDL cholesterol (mg/dL). Complex‐survey logistic regression (three sequential models) and restricted cubic splines were used to quantify associations; Cox models assessed mortality. Results Across UHR quartiles (Q1 0.52–2.94 ⟶ Q4 5.49–17.87), hepatic steatosis prevalence rose stepwise from 17.6% to 60.4% ( P < 0.001). Each 1‐unit increase in UHR conferred 2.06‐fold higher hepatic steatosis odds (95% CI 1.79–2.36), the largest effect among 18 variables. After full adjustment (Model 3), the hepatic steatosis ORs for Q2–Q4 versus Q1 were 2.18 (1.74–2.73), 3.74 (2.98–4.69) and 8.47 (6.66–10.78), respectively ( P ‐trend < 0.001). A threshold at UHR 6.98 separated two linear segments; below the inflection point every 1‐unit increment raised odds by 63% (OR 1.63, 95% CI 1.54–1.73). During follow‐up, each UHR quartile increment shortened survival (Kaplan–Meier P < 0.001); per‐unit rise increased all‐cause mortality by 22% (HR 1.22, 95% CI 1.03–1.44). Conclusion UHR is a readily available, inexpensive marker strongly associated with both the presence of hepatic steatosis and a poorer long‐term prognosis. It may serve as an easily scalable screening tool and warrants prospective validation.
Chu et al. (Thu,) studied this question.