Sex-Specific Differences in the Association of Metabolically Healthy Obesity With Hyperuricemia and a Network Perspective in Analyzing Factors Related to Hyperuricemia

Abstract

Background Although obesity is a well-known risk factor for hyperuricemia, it remains unclear whether obese subjects with metabolically healthy status have a decreased the risk of hyperuricemia and whether sex modifies the association of metabolically healthy obesity (MHO) with hyperuricemia risk. We aimed to investigate the sex-specific association between MHO and other obesity phenotypes and hyperuricemia, and to use Bayesian networks to determine and visualize the interactions among hyperuricemia and its related factors. Methods This study was conducted using data from the China Health and Nutrition Survey 2009. Hyperuricemia was defined as serum uric acid ≥ 420 μmol/L in men and ≥ 360 μmol/L in women according to the guidelines. Body mass index (BMI) was used to define normal weight, overweight, and obese status in subjects, and metabolic health state was defined by the Adult Treatment Panel (ATP)-III and Visceral Adiposity Index (VAI) criteria, respectively. Subjects were categorized into six phenotypes according to their metabolic health and BMI level status. Results Of the 7,364 Chinese adult individuals included, the prevalence of hyperuricemia among MHO women was only 8.5% (95% CI 4.8 to 14.3%), but increased to 30.7% among MUO women, whereas the highest prevalence among men was found in the MUOW phenotype (39.4%, 95% CI 35.4 to 43.6%), compared to 15.4% for male subjects with MHO. After adjusting for confounders, the MHO phenotype was significantly associated with an increased risk of hyperuricemia compared with their MHNW counterparts in women (OR: 1.95, 95% CI: 1.02–3.74) whereas a significant association was not found in men (OR: 1.46, 95% CI: 0.8–2.68). A complex network structure was established by BNs and then used to find connections between hyperuricemia and its related factors, as well as their interrelationships. By using BN reasoning, the probability of having hyperuricemia was 0.076 among MHO men, while it reached 0.124 in MHO women. Conclusions In conclusion, our results demonstrated that the MHO phenotype was significantly associated with the risk of hyperuricemia only in women, not in men. This sex-specific differences in the association may suggest a favorable condition of MHO for Chinese men with respect to hyperuricemia risk, meanwhile more attention should be paid to the increased risk of hyperuricemia among MHO women.

Adipose Tissue Insulin Resistance Is Positively Associated With Serum Uric Acid Levels and Hyperuricemia in Northern Chinese Adults

“…Consistent with our results, L.-K. Chen et al claimed a positive association between serum UA and HOMA-IR in older women but not in men among a Taiwan population (46). Another study revealed a sex-difference association between metabolically healthy obese status and hyperuricemia (47). Further studies are warranted to explore the sex-related roles of IR in hyperuricemia.…”

The Association Between Hyperuricemia and Obesity Metabolic Phenotypes in Chinese General Population: A Retrospective Analysis

“…Previous studies have shown that obesity and its phenotypes are significantly associated with the risk of hyperuricemia, and the relationship are sex-specific and age-specific differences ( 29 – 31 ). In the Chinese population, Tian et al suggested that the MHOO phenotype was significantly associated with the risk of hyperuricemia only in women and not in men from the China Health and Nutrition Survey ( 30 ). Yu et al found that MUOO, in comparison with MHOO, was significantly associated with hyperuricemia in Chinese adults ( 29 ).…”

Association between hyperuricemia and metabolic syndrome: A cross-sectional study in Tibetan adults on the Tibetan plateau

“…The present study further showed that hyperuricemia was signifficantly associated with MetS-related variables such as elevated blood pressure, abdominal obesity, and elevated TG but not elevated fasting glucose and reduced HDL-C, which is slightly different from other studies. Many studies have demonstrated a strong association between SUA and various MetS-related components, but the association could be differed by study objects (25,34,35). Kim et al discovered that hyperuricemia was positively connected with the remaining MetS components except for hyperglycemia in male patients, and hyperuricemia was favorably correlated with all MetS components in female patients (25).…”