Association between alpha-1-acid glycoprotein and serum uric acid in young and middle-aged US women: A cross-sectional study on the mediating role of the triglyceride-glucose index.

Evidence on the association between alpha-1-acid glycoprotein (AGP), a systemic inflammatory marker, and serum uric acid (SUA) remains limited, particularly among young and middle-aged women. Using cross-sectional data from 614 US women aged 20 to 49 years from the 2015 to 2018 National Health and Nutrition Examination Survey, we assessed the AGP-SUA relationship and the mediating role of the triglyceride-glucose index using multiple linear regression, smooth curve fitting, and mediation analysis. After full adjustment, each 1 g/L increase in AGP was associated with a 0.68 mg/dL increase in SUA (β = 0.68, 95% confidence interval: 0.28-1.09, P = .001). A significant dose-response trend was observed across AGP tertiles (P for trend = .003). The triglyceride-glucose index mediated 24.52% of this association. Among several inflammatory markers, AGP showed the strongest correlation with SUA (ρ = 0.27) and the highest predictive value for hyperuricemia, although the discriminative ability was modest (AUC = 0.641). Elevated AGP is independently linked to higher SUA levels, partly through insulin resistance, highlighting AGP as a relevant inflammatory marker and the interplay between inflammation and metabolism in female hyperuricemia.