Previous studies have suggested that leptin works as a key regulator in the pathogenesis of osteoarthritis (OA), and genetic factors modulate OA. This study assessed the contribution of leptin gene (LEP) polymorphism(s) to knee OA among Han Chinese. Three tag single-nucleotide polymorphisms (SNPs) covering all those LEP SNPs of which the minor allele frequencies were over 10% were selected. Study subjects (697 patients and 699 controls) were divided into four groups (underweight, normal weight, overweight and obese) by body mass index (BMI). Allele and genotype frequencies in the three tag SNPs were significantly different in the normal weight and overweight groups. In the normal weight, overweight and obese groups, BMI (P¼4.3Â10 À5 , 0.012 and 0.009, respectively) and gender (P¼3.5Â10 À22 , 5.1Â10 À23 and 2.1Â10 À8 , respectively) were effective factors. Age was an independent effective factor in the overweight group (P¼0.009). Haplotypes were associated with OA in the normal weight group (CAT, P¼0.015) and the overweight group (AGC, P¼0.015). Our results suggest an association between LEP and knee OA in the normal weight and overweight groups among Han Chinese. Keywords: case-control association study; leptin; osteoarthritis; tag SNPs INTRODUCTION Knee osteoarthritis (OA) usually causes considerable pain and frequent instability, consequently resulting in physical disability. 1 Among Chinese of over 60 years of age, prevalence of symptomatic knee OA is 19.4%. 2 For knee OA, obesity is a major risk factor, and genetic factors modulate obesity and OA. 3 Classic twin studies have shown that the genetic influence is between 39 and 65% in radiographic OA of the hand and knee in women. 4 Previous studies found associations of knee OA with ASPN, GDF5 and DVWA, and metaanalysis showed global association in GDF5, whereas ASPN and DVWA have ethnic differences. [5][6][7] Leptin is a 16-kDa non-glycosylated peptide hormone, mainly produced by adipocytes. 8 Leptin protein level is much higher in OA cartilage than in normal cartilage. 9 It participated in the pathogenesis of OA by affecting chondrocyte metabolism. 10,11 A high level of leptin expression increases nitric oxide, matrix metaloprotease-9 and matrix metaloprotease-13 expression, affects chondrocyte function and finally results in OA. 11,12 However, so far, few studies have been conducted on the possible existence of association between leptin gene (LEP) polymorphisms and OA susceptibility.