The association between the uric acid to high-density lipoprotein cholesterol ratio (UHR) index and obesity in postmenopausal women: a cross-sectional analysis based on the NHANES.

Publisher: BioMed Central Country of Publication: England NLM ID: 101147696 Publication Model: Electronic Cited Medium: Internet ISSN: 1476-511X (Electronic) Linking ISSN: 1476511X NLM ISO Abbreviation: Lipids Health Dis Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2002-

Postmenopause*/blood ; Obesity*/blood ; Obesity*/epidemiology ; Uric Acid*/blood ; Cholesterol, HDL*/blood; Biomarkers/blood ; Metabolic Syndrome/blood ; Metabolic Syndrome/epidemiology ; Humans ; Female ; Middle Aged ; Cross-Sectional Studies ; Body Mass Index ; Nutrition Surveys ; Aged ; Prevalence ; Risk Factors ; ROC Curve

Background: Obesity has emerged as a critical global public health challenge. Postmenopausal women experience significantly elevated risks of metabolic disorders and a marked increase in obesity prevalence due to declining estrogen levels. The uric acid to high-density lipoprotein cholesterol ratio (UHR), an emerging biomarker for metabolic syndrome, is gaining clinical recognition. This study systematically investigates the association between the UHR index and obesity in postmenopausal women and evaluates its predictive value.
Methods: We conducted a cross-sectional analysis of 7,811 postmenopausal women from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariable logistic regression models, adjusted for sociodemographic characteristics, behavioral patterns, and clinical covariates, were employed to examine the UHR index's association with three obesity indices: body mass index (BMI), waist-to-height ratio (WHtR), and weight-adjusted waist index (WWI). Robustness was assessed through stratified subgroup analyses, interaction tests, restricted cubic spline (RCS) modeling, receiver operating characteristic (ROC) curves, and sensitivity analyses to evaluate nonlinear relationships and predictive performance.
Results: The weighted obesity prevalence was 44.05%. After full adjustment, the highest UHR quartile (Q4) showed significantly elevated obesity risks versus the lowest quartile (Q1): BMI-defined obesity (adjusted OR = 8.08, 95% CI: 6.49-10.09), WHtR-defined obesity (adjusted OR = 29.95, 95% CI: 17.08-52.51), and WWI-defined obesity (adjusted OR = 4.58, 95% CI: 3.70-5.67). Subgroup analyses revealed significant effect modifications by diabetes, cardiovascular disease, and chronic kidney disease status (P for interaction < 0.05 for all three obesity indices). The RCS analysis demonstrated a nonlinear dose-response relationship. ROC analysis indicated superior predictive performance for WHtR-defined abdominal obesity (AUC = 0.795, 95% CI: 0.778-0.813), with sensitivity analyses corroborating the primary findings.
Conclusion: The UHR index exhibits a strong, dose-dependent association with obesity risk in postmenopausal women, persisting after comprehensive covariate adjustment. As a metabolic indicator, the UHR index provides clinically meaningful supplementation to conventional obesity assessments, particularly in capturing metabolically driven obesity risk.
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: The NCHS Research Ethics Review Committee and the NHANES both examined and approved the research that involved human subjects. To take part in this study, the patients/participants gave their written informed consent. This study utilized de-identified, publicly available NHANES secondary data. All personally identifiable information (including names, identification numbers, and other direct identifiers) was removed through standardized de-identification procedures in compliance with ethical requirements for human subject data protection. In accordance with prevailing research ethics guidelines, secondary analysis of such pre-approved, de-identified public datasets qualifies for exemption from additional institutional review, a standard this study rigorously followed. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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Keywords: Cross-sectional study; NHANES database; Obesity; Postmenopausal women; Uric acid to high-density lipoprotein cholesterol ratio (UHR)

268B43MJ25 (Uric Acid)
0 (Cholesterol, HDL)
0 (Biomarkers)

Date Created: 20250905 Date Completed: 20250905 Latest Revision: 20250909

20260130

PMC12412247

10.1186/s12944-025-02715-2

40913235