Abstract: Background　The prevention and treatment of chronic diseases〔including hyperuricemia（HUA）〕in communities are a kind of comprehensive management for such diseases.Many factors，such as obesity，metabolic disorders，cardiovascular disease，cerebrovascular disease，and chronic kidney disease are associated with the risk of increased HUA.However，previous studies linking obesity to HUA have shown different results.Objective　To assess the association between diverse measures of obesity〔body mass index（BMI），waist circumference（WC） and neck circumference（NC）〕and HUA in the elderly in Puxing Community.Methods　Elderly（65-99 years old） people（n=4 364） were recruited from the Puxing Community，Pudong New District，Shanghai.All of them participated in the free physical examination delivered by the Puxing Community Health Center during April to June，2015.A cross-sectional survey was used to collected the data concerning BMI，WC and NC，and other factors associated with HUA〔history of smoking and drinking，hypertension，diabetes，levels of uric acid（UA）fasting plasma glucose（FPG），total cholesterol（TC），triacylglycerol（TG），urea，creatinine（Cr），total bilirubin，ALT and estimated glomerular filtration rate （eGFR）〕．They were divided into high sUA group（n=610） and normal UA group（n=3 754） according to the level of UA （UA>420 μmol/L in men and postmenopausal women was defined as the diagnostic criterion for HUA）．And personal characteristics of both groups were compared.By BMI，the participants were stratified into underweight，normal weight，overweight，and obesity.On the basis of the quartile of WC，they were assigned to A1（WC<82.2 cm for men，<78.0 cm for women），A2（82.2 cm≤WC<88.5 cm for men，78.0 cm≤WC<85.0 cm for women），A3（88.5 cm≤WC<94.0 cm for men，85.0 cm≤WC<92.0 cm for women），A4（WC≥94.0 cm for men，≥92.0 cm for women）．They were also divided into 4 groups according to the quartile of NC，B1（NC<35.0 cm for men，<31.0 cm for women），B2（35.0 cm≤NC<37.0 cm for men，31.0 cm≤NC<33.0 cm for women），B3（37.0 cm≤NC<38.0 cm for men，33.0 cm≤NC<35.0 cm for women），B4（NC≥38.0 cm for men，≥35.0 cm for women）．The relationships of HUA prevalence with BMI，WC and NC were analyzed by sex.Multivariable Logistic regression analyses were also performed to investigate the relationships of HUA prevalence with BMI，WC and NC.Results　The average age，history of hypertension，BMI，WC，NC，systolic and diastolic blood pressure，UA，TG，urea，SCr，total bilirubin，ALT and eGFR，prevalence of overweight and obesity，abdominal obesity，increased NC，hypertension，and decreased eGFR were significant different between high UA group and normal UA group （all P<0.05）．The prevalence of HUA significantly increased with the growth of age，BMI，WC，and NC in both men and women（P<0.05）.After adjusting for sex，age，smoking，drinking，TC，TG，total bilirubin，ALT，hypertension，and diabetes，multivariate Logistic regression analyses of the models established with the BMI，WC and NC data showed that BMI，WC and NC were all associated with HUA（P<0.001）．The prevalence of HUA increased by 42%，38%，29%，respectively，with every 1-standard deviation（3.4 kg/m2） increase in BMI，every 1-standard deviation（9.5 cm） increase in WC，and every 1-standard deviation（3.3 cm） increase in NC.After further adjusting for WC and NC，multivariable Logistic regression analyses found that BMI was associated with HUA（P<0.05）．In addition，male，TG，decreased eGFR，hypertension and diabetes were associated with HUA（P<0.05）．Conclusion　BMI，WC and NC were all associated with HUA.But after adjusting for the latter two，BMI was found to be associated with HUA.Compared with WC and NC，BMI might have a stronger association with HUA.

Key words: Hyperuricemia, Body mass index, Waist circumference, Neck circumference, Obesity, Shanghai, Pudong New District

摘要： 背景　社区慢性病防治是一种综合管理，包括高尿酸血症（HUA）的防治。HUA相关危险因素较多，如肥胖、代谢异常性疾病、心脑血管疾病以及慢性肾脏病等。然而，以往肥胖与HUA的相关性研究显示的结果不同。目的　探讨浦兴社区老年人体质指数（BMI）、腰围、颈围与HUA的关系。方法　选取2015年4—6月于上海市浦东新区浦兴社区卫生服务中心参加老年人免费体检的65~99岁的老年人4 364例，调查BMI、腰围、颈围以及HUA其他相关因素〔吸烟、饮酒、高血压史、糖尿病史、尿酸、空腹血糖、总胆固醇、三酰甘油、尿素、肌酐、总胆红素、丙氨酸氨基转移酶（ALT）、估算肾小球滤过率（eGFR）〕。男性及绝经后女性血清尿酸>420 μmol/L定义为HUA诊断标准。根据HUA检出情况分为高尿酸组（n=610）与尿酸正常组（n=3 754），比较两组的一般情况。根据BMI将研究对象分为低体质量、正常体质量、超重与肥胖，根据腰围四分位数分为A1（男<82.2 cm，女<78.0 cm）、A2（男82.2 ~<88.5 cm，女78.0~<85.0 cm）、A3（男88.5~<94.0 cm，女85.0~<92.0 cm）、A4（男≥94.0 cm，女≥92.0 cm）；根据颈围四分位数分为B1（男<35.0 cm，女<31.0 cm）、B2（男35.0~<37.0 cm，女31.0~<33.0 cm）、B3（男37.0~<38.0 cm，女33.0~<35.0 cm）、B4（男≥38.0 cm，女≥35.0 cm）；分析不同性别HUA检出率与年龄、BMI、腰围、颈围的关系。采用多因素Logistic回归分析BMI、腰围、颈围与HUA的相关性。结果　高尿酸组年龄、高血压史、BMI、腰围、颈围、收缩压、舒张压、尿酸、三酰甘油、尿素、肌酐、总胆红素、ALT、eGFR、超重和肥胖发生率、腹型肥胖发生率、颈围超标发生率、高血压发生率、eGFR下降发生率与尿酸正常组比较，差异有统计学意义（P<0.05）。男、女性HUA检出率均随年龄增长逐渐升高（P<0.05）；男、女性HUA检出率均随着BMI、腰围、颈围升高而升高（P值均<0.05）。BMI、腰围、颈围分别建模，调整性别、年龄、吸烟情况、饮酒情况、总胆固醇、三酰甘油、总胆红素、ALT、高血压发生情况、糖尿病发生情况后，进行多因素Logistic回归分析，结果显示，BMI、腰围、颈围与HUA均有相关性（P值均<0.05）。BMI每增加1个标准差（3.4 kg/m2），HUA检出风险升高42%；腰围每增加1个标准差（9.5 cm），HUA检出风险升高38%；颈围每增加1个标准差（3.3 cm），HUA检出风险升高29%。进一步相互调整3项肥胖指标后，进行多因素Logistic回归分析，结果显示，BMI与HUA有相关性（P<0.05）。此外，男性、三酰甘油、eGFR下降、高血压、糖尿病与HUA有相关性（P<0.05）。结论　BMI、腰围、颈围与HUA均有相关性，但调整相关因素后，仅BMI与HUA有相关性，因此与腰围或颈围相比，BMI可能与老年人HUA的关系更密切。

关键词: 高尿酸血症, 人体质量指数, 腰围, 颈围, 肥胖症, 上海, 浦东新区