The Mediation Effect of Body Composition on the Association Between Menopause and Hyperuricemia: Evidence From China National Health Survey

Abstract

Reproductive factors have been demonstrated to be associated with hyperuricemia. Body composition is an essential determinant influencing serum uric acid (SUA), but it is largely unknown whether increased SUA was influenced by changed body composition during the menopausal transition. As a secondary analysis of China National Health Survey from 2012-to 2017, this study included 18,997 women aged 20 to 80. Menarche age and menopause information were collected by questionnaire interview. Body mass index (BMI), body fat percentage (BFP), fat mass index (FMI), and fat-free mass index (FFMI) were used as body composition indexes. Hyperuricemia was defined as SUA higher than 360μmol/L (approximately 6 mg/dl). Mediation analysis was performed to explore the direct and indirect effects of menopause on hyperuricemia. A 1:2 age-matched case-control data set (n=6202) was designed to control age-related confounders and was used in multivariable analyses. After adjustment of covariates, postmenopausal women had 14.08 (10.89-17.27) μmol/L higher SUA than their premenopausal counterparts. Overweight/obesity and higher levels of BFP, FMI, and FFMI were all found to be positively associated with hyperuricemia. The mediation analysis showed that the total effect of menopause on hyperuricemia was positive, but was substantially mediated by body composition indexes. Forty-five percent of the total effect can be attributed to the indirect effect mediated by BMI (OR for the natural indirect effect (NIE): 1.09, 95%CI: 1.04-1.13), and over 80% mediated by BFP (OR for NIE: 1.23, 95%CI: 1.16-1.29). However, FFMI did not present the mediated role in the association (OR for NIE: 0.99, 95%CI: 0.96-1.02). The findings revealed that body composition, especially the fat mass indexes, significantly mediated the association between menopause and hyperuricemia. The role of body composition as mediator constitutes clinical and public health significance that should be recognized and considered in healthcare for women experiencing their menopause transition.

Hyperuricemia and hypertension in working-age people: results of a population study

“…Распространенность ГУ и подагры значительно возрастала у женщин старше 50 лет, в результате частота данных нарушений у них не отличалась от таковой у мужчин. Показано, что более высокий уровень МК отмечался у женщин в постменопаузе как в европейской, так и в азиатской популяциях [21,22]. В настоящем исследовании частота ГУ в возрастной группе 45-54 лет у мужчин составила 22,4%, у женщин -15%, тогда как в группе 55-64 лет распространенность данного нарушения у мужчин и женщин была равна 21,4% и 20,3, соответственно.…”

Prevalence of hyperuricemia and the population attributable fraction of modifiable risk factors: Evidence from a general population cohort in China

“…Menopause has been suggested as a female-specific cardiovascular risk factor by the American Heart Association ( 30 ). Higher level of SUA has been observed in post-menopausal women in both European and Asian populations ( 31 – 33 ). Higher prevalence of hyperuricemia with aging in female requires more attention on aged women, especially post-menopausal individuals.…”

Fat-to-Muscle Ratio Is Independently Associated with Hyperuricemia and a Reduced Estimated Glomerular Filtration Rate in Chinese Adults: The China National Health Survey

“…Given the associations between the FMR, HUA and reduced eGFR, we performed a mediation analysis to further explore whether there was an indirect effect of HUA on the association between the FMR and reduced eGFR. The methodology and hypothesis were described in detail in our previous study [ 24 ]. In the mediation analysis, the FMR was categorized into two groups based on its sex-specific cutoff values by calculating the Youden Index (the maximum value of sensitivity + specificity − 1), yielded by the covariates’ adjusted receiver operator characteristic (ROC) curves.…”