Background: Previous studies have found a significant positive association between obesity, visceral fat accumulation and hyperuricemia. The purpose of the study was to explore the association between the ratio of visceral fat area to leg muscle mass(VFA-to-LMM) and hyperuricemia, and verify the role of sex differences in the association.Methods:In this cross-sectional study, a total of 3393 (43.3% for men) participants from Tianjin Union Medical Center-Health Management Center were recruited. Body composition were measured by multielectrode bioelectrical impedance analyzer. The VFA-to-LMM ratio was used as independent variable. Hyperuricemia, defined as a serum uric acid level ≥ 416 μmol/L in men and menopausal women, and ≥ 357 μmol/L in premenopausal women, was used as the dependent variable. Multiple logistic regression analysis was used to estimate the odds ratio and 95% confidence interval between VFA-to-LMM ratio and hyperuricemia.Results:The overall prevalence of hyperuricemia was 14.8%, and the prevalence of hyperuricemia in women (8.9%) was significantly lower than that in men (22.5%). After adjustment for age, smoking status (for males), menopause status (for females), drinking status, exercise frequency, blood pressure, alanine aminotransferase, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, creatinine, and history of diseases, a strong positive association was observed between VFA-to-LMM ratio and hyperuricemiain bothmen (4th vs. 1st quartile 1.60, 95%CI: 1.03-2.49) and women (4th vs. 1st quartile 5.22, 95%CI: 2.44-12.56).After additionally adjustment for BMI, there was still a significant positive association in women (4th vs. 1st quartile 2.57, 95%CI: 1.06-6.77), while the association disappeared in men(4th vs. 1st quartile 0.97, 95%CI: 0.55-1.70).Conclusions:The VFA-to-LMM ratio was positively associated with the risk of hyperuricemia in women after adjustments for confounders. In addition, the highest risk of hyperuricemia was observed when both VFA and LMM were at the highest quartile. However, well-controlled prospective studies are needed to further confirm the causality between VFA-to-LMM ratio and hyperuricemia.