Metabolically unhealthy overweight/obesity increases the risk of incident hyperuricemia in middle-aged and elderly adults: a retrospective study based on the Lanzhou health examination cohort

Both obesity and metabolic abnormalities are important risk factors for hyperuricemia(HUA), but the impacts of their combined phenotypes and dynamic changes on HUA remains unclear. This study aims to investigate the correlation between different obesity-metabolic phenotypes and their dynamic changes with new-onset HUA in a middle-aged and elderly population undergoing health checkups in Lanzhou, providing evidence for the identification of high-risk populations and early intervention.

A retrospective cohort study design was adopted. Based on the health examination cohort at the Health Management Center of Lanzhou University Second Hospital from January 2019 to January 2024, a total of 5307 participants aged ≥45 years without HUA at baseline were enrolled. Demographic data, physical examination results, and laboratory test data were collected. According to baseline body mass index(BMI) and metabolic status, the participants were divided into 4 groups: metabolically healthy normal weight(MHNW), metabolically healthy overweight/obesity(MHOO), metabolically unhealthy normal weight(MUNW), and metabolically unhealthy overweight/obesity(MUOO). Logistic regression analysis was used to examine the association of obesity-metabolic phenotypes and their dynamic changes with HUA, and subgroup analyses were performed. Restricted cubic spline(RCS) was employed to analyze the dose-response relationships of BMI, waist circumference, and metabolic components with the risk of incident HUA.

During the follow-up, 536 new-onset HUA cases occurred. The incidence rates of HUA in the MHNW, MHOO, MUNW, and MUOO groups were 6.85%, 9.24%, 11.39%, and 14.47%, respectively. After adjusting for confounding factors, compared with the MHNW group, the risk of HUA occurrence was increased in the MHOO, MUNW, and MUOO groups, with odds ratios(ORs) of 1.53(95%CI: 1.15 to 2.03, P=0.003), 1.37(95%CI: 1.03 to 1.81, P=0.028), and 1.79(95%CI: 1.36 to 2.34, P<0.001), respectively. Subgroup analyses further confirmed these results. The risk of HUA occurrence showed a non-linear positive correlation with baseline BMI and triglyceride(TG), a non-linear negative correlation with high-density lipoprotein cholesterol(HDL-C), and a nonlinear J-shaped association with waist circumference(P<0.05). Dynamic changes in obesity-metabolic phenotypes significantly increased the risk of HUA occurrence(P<0.05).

In the middle-aged and elderly adults in Lanzhou, obesity-metabolic phenotypes and their dynamic changes are associated with an increased risk of HUA occurrence, with the MUOO phenotype showing the highest risk. Weight gain or deterioration of metabolic status can further elevate the risk.

Relevant authorities should establish a stratified screening model centered on obesity-metabolic phenotypes, with emphasis on identifying individuals with abnormal phenotypes such as MUOO, metabolic deterioration, and weight gain. Comprehensive measures including lifestyle guidance, weight management, and pharmacological treatment should be strengthened, with regular monitoring and dynamic follow-up implemented to achieve early warning and precision intervention for high-risk populations, thereby reducing the burden of disease.