Introduction: Hyperuricemia is increasingly recognized as a metabolic disorder linked to dyslipidemia, insulin resistance, and vascular complications. In Saudi Arabia, the prevalence of hyperuricemia is rising with obesity and diabetes, yet its relationship with lipid-derived cardiometabolic indices remained understudied. This study aimed to examine the associations between uricemia status and lipid-derived cardiometabolic indices in a large adult cohort. Methods: This retrospective cross-sectional study analyzed data from 7652 adults, including 5385 normouricemic (NU) and 2267 hyperuricemic (HU). Key cardiometabolic indices, including the triglyceride-glucose index (TyG), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), atherogenic index of plasma (AIP), and Castelli risk indices I and II (CRI-I, CRI-II), were calculated. Associations were evaluated treating HU as the exposure and the lipid-derived cardiometabolic indices as the outcomes. Multivariable regression analyses, receiver operating characteristic (ROC) curves, and prevalence-based association estimates were used to assess these relationships. Results: HU individuals exhibited significantly higher TG along with lowered HDL-C. Median TyG (4.61), AIP (0.38), non-HDL-C (147 mg/dL), RC (18 mg/dL), CRI-I (4.30), and CRI-II (2.85) were higher in the HU group compared to NU group, with non-HDL-C and CRI-I falling within the abnormal range, AIP in the high-risk range, and TyG and CRI-II at borderline levels. Across the separately adjusted models, hyperuricemia showed consistent positive associations with RC, AIP, CRI-I, and CRI-II, whereas associations with TyG and non-HDL-C diminished after adjustment for renal or liver markers. ROC analysis demonstrated modest discriminatory ability of uric acid for elevated indices, with AIP (AUC = 0.641) and CRI-I (AUC = 0.640) exhibiting the highest performance. The prevalence of elevated indices was substantially higher in HU, particularly for CRI-II (44.0% vs. 25.9%) and CRI-I (28.2% vs. 13.7%). Conclusions: These findings highlight associations between HU and lipid-derived cardiometabolic indices, but further longitudinal research is required to determine whether HU has a clinical predictive value in cardiovascular risk assessment.

Background: Obesity is a heterogeneous condition encompassing metabolically healthy and metabolically unhealthy phenotypes. Routine liver enzymes may reflect metabolic heterogeneity among individuals with obesity, yet their metabolic relevance in non-diabetic obesity remains incompletely characterized, particularly in Arab populations. This study examined the associations of routine liver enzymes with obesity severity and metabolic abnormalities in Saudi adults with non-diabetic obesity. Methods: This cross-sectional study included 168 non-diabetic adults with obesity. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) were evaluated in relation to obesity severity, prediabetes, hypercholesterolemia, hypertriglyceridemia and metabolic syndrome (MetS). Correlation, multivariable linear regression, and receiver operating characteristic (ROC) analyses were performed to examine associations with obesity severity, prediabetes, hypercholesterolemia, and hypertriglyceridemia. Results: ALT, AST, and GGT generally increased with obesity severity, with ALT and GGT significantly higher in Class III than Class I obesity. GGT showed the most consistent differences across metabolic abnormalities, with higher concentrations in participants with prediabetes (20.0 vs. 16.0 U/L), hypercholesterolemia (21.0 vs. 16.0 U/L), and hypertriglyceridemia (22.0 vs. 17.0 U/L). GGT was also higher in participants with MetS (20.0 vs. 16.0 U/L). After multivariable adjustment, GGT remained positively associated with HbA1c (β = 0.031) and triglycerides (β = 0.188), while ALT was associated with BMI (β = 0.04). ROC analyses showed modest, outcome-specific discrimination, with GGT showing the highest discrimination for hypertriglyceridemia (AUC = 0.68). Conclusions: Liver enzyme profiles, particularly GGT and ALT, are associated with distinct dimensions of metabolic dysfunction in non-diabetic adults with obesity. GGT demonstrated the most consistent metabolic relationships with glycemic and lipid abnormalities, although the modest discriminatory performance supports its potential role as a complementary rather than standalone metabolic indicator.