Association of the uric acid-to-high-density lipoprotein cholesterol ratio with vitamin D deficiency in postmenopausal women: evidence from NHANES 2005–2016

Huang et al. Lipids in Health and Disease (2025) 24:360 https://doi.org/10.1186/s12944-025-02783-4 Lipids in Health and Disease Open Access RESEARCH Association of the uric acid-to-high-density lipoprotein cholesterol ratio with vitamin D deficiency in postmenopausal women: evidence from NHANES 2005–2016 Xueping Huang1*†, Xiukui He2†, Jianhong Xia1† and Limei Li1* Abstract Background The relationship between vitamin D deficiency and the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) in postmenopausal women remains unclear. This study aims to investigate the association between these variables and to evaluate the potential interaction between UHR and waist circumference (WC). Methods Data from 5,155 postmenopausal women who participated in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2016 were included in this crosssectional investigation. Weighted regression analysis served as the primary methodology employed to examine the association between UHR and vitamin D deficiency. Furthermore, interaction analysis, sensitivity analysis, and restricted cubic splines (RCS) were also conducted. Results According to multivariate adjusted analysis, vitamin D deficiency was positively correlated with UHR (OR = 1.05, 95% CI 1.02–1.07). The risk of vitamin D deficiency in the highest quartile population of UHR was significantly higher than that in the lowest quartile population (OR = 1.75, 95% CI: 1.36–2.27). Serum 25-hydroxyvitamin D was negatively correlated with UHR (β= -0.74, 95% CI: -1- -0.47). Vitamin D deficiency has a linear dose-response relationship with UHR. In addition, the study also discovered the interaction between UHR and WC. Conclusions The UHR level in postmenopausal women is positively associated with vitamin D deficiency. Managing WC may contribute to reducing the risk of vitamin D deficiency in individuals with elevated UHR. Keywords Vitamin d deficiency, UHR, Uric acid, High-density lipoprotein cholesterol, Waist circumference, Postmenopausal † Xueping Huang, Xiukui He and Jianhong Xia contributed equally to this work and share first authorship. *Correspondence: Xueping Huang Limei Li 1 Department of Women’s Health Care, Guangdong Women and Children Hospital, Guangzhou 511442, China 2 Department of Gynecology, Guangdong Women and Children Hospital, Guangzhou 511442, China © 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/. Huang et al. Lipids in Health and Disease (2025) 24:360 Introduction Vitamin D, an essential micronutrient for human health, plays a critical role in maintaining bone integrity and regulating calcium and phosphorus homeostasis [1]. Recent research has demonstrated that vitamin D exerts multiple physiological functions, including modulation of immune responses, suppression of pro-inflammatory mediators, improvement of vascular endothelial function, reduction of insulin resistance, and protection of reproductive health [2–6]. Vitamin D deficiency is typically characterized by a serum level of 25-hydroxyvitamin D (25(OH)D) that falls below 20 ng/mL (50 nmol/L) [7]. Epidemiological studies indicate that approximately 47.9% of the global population is deficient in vitamin D, with the prevalence in the United States being 32.1% [8, 9]. Postmenopausal women are more prone to vitamin D deficiency [10], which increases the prevalence of osteoporosis [11]. Furthermore, these women demonstrate a greater susceptibility to metabolic disorders such as insulin resistance, central obesity, and diabetes; the absence of adequate vitamin D exacerbates this condition [10, 12, 13]. Cognitive decline and mood disturbances are two additional symptoms commonly associated with both menopause and vitamin D insufficiency [14, 15]. Consequently, the effective supplementation of vitamin D holds significant importance for enhancing the quality of life in postmenopausal women. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has attracted increasing attention as a potential biomarker. This innovative metric effectively integrates two important markers: high-density lipoprotein cholesterol (HDL-C) and uric acid (UA) [16]. This comprehensive indicator effectively reflects systemic oxidative stress and inflammatory response, and serves as a sensitive marker for dyslipidemia and cardiovascular risks [17]. In addition to its strong association with cardiovascular and all-cause mortality [18], elevated UHR levels are also linked to insulin resistance (IR), abdominal obesity [19], non-alcoholic fatty liver disease [20], and female infertility [21]. Waist circumference (WC) serves as the primary clinical indicator of central obesity, which is characterized by pathological accumulation of visceral fat. In postmenopausal women, the accumulation of abdominal fat may disrupt metabolic homeostasis of vitamin D through an oxidative-inflammatory response [22, 23]. Given that this mechanism aligns closely with the pathological process associated with elevated UHR, we hypothesize that elevated UHR and central obesity may interact synergistically collectively contribute to vitamin D deficiency. In addition to investigating the relationship between UHR and vitamin D deficiency, this study also aims to analyze the potential interaction between UHR and WC. Page 2 of 10 Materials & methods Study population The National Health and Nutrition Examination Survey (NHANES) is a nationwide research project of the American population that adheres to strict standards and collects data through questionnaires, interviews, laboratory tests, and physical examinations, providing an important basis for health and epidemiological research. All participants have given their informed permission, and the study procedure has been approved by ethics. This study is based on the data of a total of 60,936 participants in the NHANES cycle from 2005 to 2016. The screening steps for the research subjects are as follows: Firstly, male participants (n = 30,152) and non (...truncated)