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This study examined the associations between MHO and other metabolic-obesity phenotypes with MASLD and hyperuricemia, and explored the mediating roles of metabolic indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 11,712 and 13,846 participants from a health examination cohort at the First Affiliated Hospital of Ningbo University for MASLD and hyperuricemia analyses, respectively. Participants were classified into four metabolic-obesity phenotypes, with MHO defined as obesity without metabolic syndrome components. Cox regression and mediation analyses were performed to examine the associations and the proportions explained by metabolic indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a 7-year follow-up period, 3,756 MASLD and 3,294 hyperuricemia cases were identified. Compared with the metabolically healthy non-obese group, individuals with MHO exhibited significantly higher risks of MASLD (hazard ratio [HR]\u2009=\u20093.54, 95% confidence interval [CI]: 3.09\u20134.05) and hyperuricemia (HR\u2009=\u20091.92, 95% CI: 1.65\u20132.23). Mediation analysis illustrated that the triglyceride glucose index accounted for 16.2% and 13.8% of the total effects, while other indicators also contributed to the associations to varying degrees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MHO is associated with an increased risk of MASLD and hyperuricemia, partly explained by metabolic indicators. Greater attention to these indicators may facilitate earlier risk identification and more effective prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>NCT07001865; Registration date: May 25, 2025; ClinicalTrials.gov.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-025-02106-9","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T15:46:09Z","timestamp":1764258369000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolically healthy obesity increases the risks of MASLD and hyperuricemia: a cohort study with mediation analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Yiyun","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianchen","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyang","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoliang","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarong","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"issue":"4","key":"2106_CR1","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/hep.0000000000000004","volume":"77","author":"ZM Younossi","year":"2023","unstructured":"Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, et al. 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