Association between normal-weight central obesity and asymptomatic hyperuricemia in Korean adults: a cross-sectional study

BMC Public Health Shim et al. BMC Public Health (2025) 25:3807 https://doi.org/10.1186/s12889-025-24756-z Open Access RESEARCH Association between normal-weight central obesity and asymptomatic hyperuricemia in Korean adults: a cross-sectional study Minok Shim1 , Hyun Joe2* , Jung-Eun Oh3 , Yong-Jin Cho3 and Hwang-Sik Shin3 Abstract Background Obesity increases the risk of hyperuricemia. Recent studies have shown that normal-weight central obesity increases the risk of cardiometabolic disease. In this study, we examined the relationship between normalweight central obesity and asymptomatic hyperuricemia in Korean adults aged > 20 years. Methods This cross-sectional study included 14,501 adults who visited the health checkup center at a university hospital in 2021. The participants were classified based on sex, and were divided into four groups according to their body mass index and waist-to-height ratio as follows: normal weight, normal-weight central obesity, obesity, and obesity central obesity groups. The odds ratios and 95% confidence intervals for asymptomatic hyperuricemia were analyzed separately using logistic regression models. Results Regardless of sex, the prevalence of asymptomatic hyperuricemia was higher in the central obesity groups than in the normal weight group. The odds ratios for asymptomatic hyperuricemia were higher in the normal-weight central obesity group than in the normal weight group, even after adjusting for confounding factors (p < 0.05). Conclusions In Korean adults aged over 20 years, normal-weight central obesity was significantly associated with asymptomatic hyperuricemia. Therefore, screening tests and proper management of asymptomatic hyperuricemia in normal-weight central obesity individuals are necessary. Keywords Asymptomatic hyperuricemia, Normal-weight central obesity, Obesity, Central obesity *Correspondence: Hyun Joe 1 Department of Family Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea 2 Department of Family Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea 3 Department of Family Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea Background Asymptomatic hyperuricemia is characterized by elevated serum uric acid levels without the clinical manifestations or symptoms of gout [1]. Serum uric acid levels are regulated by a balance between uric acid production and excretion [2]. Hyperuricemia occurs when uric acid production increases, or its excretion becomes impaired. Hyperuricemia has been recognized and managed as a precursor to gout and nephrolithiasis due to urate crystal deposition. However, recent studies have revealed its association with an increased risk of chronic metabolic disorders, such as hypertension, diabetes mellitus, and metabolic syndrome [3–5]. Therefore, the identification © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Shim et al. BMC Public Health (2025) 25:3807 and management of asymptomatic hyperuricemia have emerged as significant societal challenges in chronic disease management. Obesity, defined as excessive fat accumulation that negatively impacts health, is on the rise both globally as well as in South Korea. It is associated with several conditions, including type 2 diabetes, hypertension, coronary artery disease, obstructive sleep apnea, and metabolic syndrome, which can collectively increase socioeconomic burdens [6]. Many other epidemiological studies have demonstrated that obesity increases the risk of asymptomatic hyperuricemia [7–9]. The body mass index (BMI) is commonly used to define obesity. However, BMI use has limitations, as it is influenced by several factors such as age, sex, and ethnicity, making it an imprecise measure of body fat distribution [10]. Central obesity, often indicative of visceral fat accumulation, has been established as a risk factor for metabolic syndrome, type 2 diabetes mellitus, hypertension, cardiovascular diseases, and cerebrovascular diseases [11–14]. Additionally, central obesity indicators such as waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) have shown stronger associations with cardiovascular metabolic risks compared to BMI, in previous research [15, 16]. Therefore, assessing central obesity is essential when evaluating its health impacts. There is a growing interest in conducting research on individuals classified as having normal weight but exhibiting central obesity (normal-weight central obesity) [17]. Although previous domestic studies have investigated the relationship between normalweight central obesity and cardiovascular risk factors [18, 19], no research has examined its association with asymptomatic hyperuricemia. Among the various indicators of central obesity, WHtR is particularly notable for its ease of calculation using standard anthropometric data and its strong correlation with cardiovascular metabolic diseases [15]. We investigated the association between asymptomatic hyperuricemia and normal-weight central obesity using BMI and WHtR among participants undergoing health checkups at a university hospital’s health checkup center. Methods Study population This study included 16,666 adults aged 20 years or older who underwent health check-ups at a university hospital’s health checkup center between January 2021 and December 2021. Subsequently, we excluded 1,361 individuals with missing data on medical history and Lifestyle questionnaires, 364 individuals with missing serum uric acid or glycated hemoglobin (HbA1c) levels, 352 individuals with a BMI < 18.5, and 88 individuals diagnosed with gout or currently taking urate-lowering medications. A total of Page 2 of 9 14,501 participants were ultimately included. Approval from the hospital’s Institutional Review Board (IRB) (IRB No. 2023-05-002) was received. Variables and mea (...truncated)