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.

Keywords: excess adiposity; mediation analysis; menopause; serum uric acid; women health.