The association between serum uric acid and homocysteine is mediated by metabolic risk factors.

Previous studies have revealed a link between serum uric acid (SUA) and homocysteine (Hcy) levels, but it is unclear whether such relationship can be mediated by metabolic risk factors. This study evaluated the relationship between SUA and Hcy levels through a mediation analysis, examining the extent to which metabolic risk factors mediate this association. A total of 16,870 participants aged 20-60 years was consecutively enrolled at the Third Xiangya Hospital, Central South University. Data on health behaviours and medical history were collected through self-reported health questionnaires. Laboratory examinations were conducted by trained personnel via standardized methods. Logistic regression models were used to evaluate the associations between SUA and Hcy levels. Mediation analysis was conducted to explore the possible impact of metabolic risk factors on the SUA-Hcy relationship. There was a significant dose‒response relationship between higher SUA quartiles and increased hyperhomocysteinemia (HHcy) risk (P for trend < 0.01). Mediation analysis indicated that the relationship between SUA and HHcy was partially mediated by triglyceride (TG, 10.78%), diastolic blood pressure (DBP, 10.12%), systolic blood pressure (SBP, 7.63%), body mass index (BMI, 6.02%), and total cholesterol (TC, 0.56%); high-density lipoprotein cholesterol (HDL-C) negatively mediated this association, accounting for 13.03% of the effect. SUA is positively associated with HHcy risk and potentially mediated by metabolic factors such as HDL-C, TG, DBP, SBP, and BMI.