The Effect of Body Adiposity and Alcohol Consumption on Serum Uric Acid: A Quantile Regression Analysis Based on the China National Health Survey

Abstract

Adiposity and alcohol consumption are reported to be associated with a higher level of serum uric acid (SUA), but whether their effect differs on SUA percentile distribution is still unclear. In this study, we aimed to investigate how alcohol intake and body fat percentage (%BF) integrated with body mass index (BMI) influence the distribution of SUA in Chinese adults. Data from the China National Health Survey (CNHS) which included adults from 10 provinces of China were used (n = 31,746, aged 20-80 years, 40% male). %BF and BMI were integrated into eight expanded body composition groups to understand how excess body adiposity affects the distribution of SUA in the populational level. Self-report alcohol intake information was collected by face-to-face questionnaire interview. Quantile regression (QR) was used to analyze the data. We found that adiposity and alcohol consumption were associated with SUA, especially at the upper percentile in both sexes. In obese men, the QR coefficients at the 75th and 95th percentiles were 74.0 (63.1-84.9) and 80.9 (52.5-109.3) μmol/L, respectively. The highest quartile of %BF in men had a 92.6 (79.3-105.9) μmol/L higher SUA levels at its 95th percentile than the 5th quartile (p < 0.001). Compared with normal or underweight with the lowest %BF group (NWBF1), the obesity-highest %BF group (OBBF4) had the strongest positive effect on SUA, especially at the higher percentile of SUA. In BMI-defined normal or underweight participants, a higher quartile of %BF had greater effect size in all SUA percentiles. In men, current alcohol drinking had the strongest effect at the 95th percentile of SUA (QR coefficient: 31.8, with 95% CI: 22.6-41.0) comparing with 14.5, 95% CI of 8.4 to 20.6 in the 5th SUA percentile. High risk of alcohol consumption had a greater effect on SUA, especially in the higher SUA percentile. The observation of stronger association at the higher percentile of SUA suggests that decreasing body adiposity and alcohol intake at the populational level may shift the upper tails of the SUA distributions to lower values, thereby reducing the incidence of hyperuricemia.

Keywords: alcohol consumption; body fat percentage; body mass index; quantile regression; uric acid.

Figure 1

Associations between body adiposity and SUA among men using quantile regression models. The under or normal weight group with the lowest %BF quartile is the reference group. The models are adjusted for age, study sites, residential areas, educational attainment, and alcohol consumption. The x-axis is the quantile level of SUA, and the y-axis is the difference of SUA level between the current group and the reference group. The solid lines represent the estimated effect of the associations, and the shadows are their 95% confidence intervals. SUA, serum uric acid; %BF, body fat percentage; NWBF 2, under/normal weight with the second quartile of %BF; NWBF3, under/normal weight with the third quartile of %BF; NWBF4, under/normal weight with the fourth quartile of %BF; OWBF2, overweight with the second quartile of %BF; OWBF3, overweight with the third quartile of %BF; OWBF4, overweight with the fourth quartile of %BF; OBBF4, obesity with the fourth quartile of %BF.

Figure 2

Body adiposity associations with SUA among women using quantile regression models. The under/normal weight group with the lowest %BF quartile is the reference group. The models are adjusted for age, study sites, residential areas, educational attainment, and alcohol consumption. The x-axis is the quantile level of SUA, and the y-axis is the difference of SUA level between the current group and the reference group. The solid lines represent the estimated effect of the associations, and the shadows are their 95% confidence intervals. SUA, serum uric acid; %BF, body fat percentage; NWBF2, under/normal weight with the second quartile of %BF; NWBF3, under/normal weight with the third quartile of %BF; NWBF4, under/normal weight with the fourth quartile of %BF; OWBF2, overweight with the second quartile of %BF; OWBF3, overweight with the third quartile of %BF; OWBF4, overweight with the fourth quartile of %BF; OBBF4, obesity with the fourth quartile of %BF.

Figure 3

Alcohol consumption associations with SUA among men using QRs. The never drink group was the reference group. The models focusing on alcohol risk levels are adjusted for age, study sites, residential areas, educational attainment, and body adiposity categories. The BMI-alcohol consumption combined models are adjusted for covariates similarly except for body adiposity. The x-axis is the quantile level of SUA, and the y-axis is the difference of SUA level between the current group and the reference group The solid lines represent the estimated effect of the associations, and the shadows are their 95% confidence intervals.