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Published in: Italian Journal of Pediatrics 1/2017

Open Access 01-12-2017 | Research

Percentiles of serum uric acid and cardiometabolic abnormalities in obese Italian children and adolescents

Authors: Rosa Luciano, Blegina Shashaj, MariaRita Spreghini, Andrea Del Fattore, Carmela Rustico, Rita Wietrzykowska Sforza, Giuseppe Stefano Morino, Bruno Dallapiccola, Melania Manco

Published in: Italian Journal of Pediatrics | Issue 1/2017

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Abstract

Background

To investigate the association of serum uric acid (SUA) with cardiometabolic abnormalities in Caucasian overweight/obese children (<10 years of age) versus adolescents (≥10 years of age) by drawing age and gender specific percentiles of uric acid.

Methods

Cross-sectional evaluation of 1364 Caucasian overweight/obese patients (age 4.1–17.9 years; 726 males, 53%; 560 children, 41%).

Results

SUA levels were significantly lower in children than in adolescents (4.74 ± 1.05 vs. 5.52 ± 1.49 mg/dl, p < 0.001) and peaked in 12–14 years-old boys and 10–12 years-old girls.
In children with levels of SUA in the highest quartile (N = 75, 13%), OR for high triglycerides was 4.145, 95% CI 1.506–11.407 (p = 0.009). In adolescents with SUA in the highest quartile (N = 274, 34%), ORs for insulin resistance was 2.399 (95%CI 1.4–4.113; p < 0.001); for impaired fasting glucose 2.184 (95% CI 0.877–5.441; p = 0.07); for impaired glucose tolerance 2.390 (95% CI 1.405–4.063; p = 0.001); and for high triglycerides 1.8, (95%CI 0.950–3.420; p = 0.05). Multivariable random-effect linear regression models demonstrated that waist circumference and age (p < 0.0001 for both) are the variables most significantly predicting SUA levels, followed by triglycerides (p = 0.005) and 2 h glucose (p = 0.03) while HOMA-IR and BMI z-score did not predict SUA.

Conclusions

High uric acid is associated with metabolic abnormalities and particularly with waist circumference very early in childhood.
Literature
1.
go back to reference Gagliardi AC, Miname MH, Santos RD. Uric acid: A marker of increased cardiovascular risk. Atherosclerosis. 2009;202:11–7.CrossRefPubMed Gagliardi AC, Miname MH, Santos RD. Uric acid: A marker of increased cardiovascular risk. Atherosclerosis. 2009;202:11–7.CrossRefPubMed
2.
go back to reference Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99:759–66.CrossRefPubMed Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99:759–66.CrossRefPubMed
3.
go back to reference Kivity S, Kopel E, Maor E, Abu-Bachar F, Segev S, Sidi Y, et al. Association of serum uric acid and cardiovascular disease in healthy adults. Am J Cardiol. 2013;111:1146–51.CrossRefPubMed Kivity S, Kopel E, Maor E, Abu-Bachar F, Segev S, Sidi Y, et al. Association of serum uric acid and cardiovascular disease in healthy adults. Am J Cardiol. 2013;111:1146–51.CrossRefPubMed
4.
go back to reference Rodrigues TC, Maahs DM, Johnson RJ, Jalal DI, Kinney GL, Rivard C, et al. Serum uric acid predicts progression of subclinical coronary atherosclerosis in individuals without renal disease. Diabetes Care. 2010;33:2471–3.CrossRefPubMedPubMedCentral Rodrigues TC, Maahs DM, Johnson RJ, Jalal DI, Kinney GL, Rivard C, et al. Serum uric acid predicts progression of subclinical coronary atherosclerosis in individuals without renal disease. Diabetes Care. 2010;33:2471–3.CrossRefPubMedPubMedCentral
5.
go back to reference Harlan WR, Cornoni-Huntley J, Leaverton PE. Physiologic determinants of serum urate levels in adolescence. Pediatrics. 1979;63:569–75.PubMed Harlan WR, Cornoni-Huntley J, Leaverton PE. Physiologic determinants of serum urate levels in adolescence. Pediatrics. 1979;63:569–75.PubMed
6.
go back to reference Agamah ES, Srinivasan SR, Webber LS, Berenson GS. Serum uric acid and its relation to cardiovascular disease risk factors in children and young adults from a biracial community: the Bogalusa Heart Study. J Lab Clin Med. 1991;118:241–9.PubMed Agamah ES, Srinivasan SR, Webber LS, Berenson GS. Serum uric acid and its relation to cardiovascular disease risk factors in children and young adults from a biracial community: the Bogalusa Heart Study. J Lab Clin Med. 1991;118:241–9.PubMed
7.
go back to reference Tang L, Kubota M, Nagai A, Mamemoto K, Tokuda M. Hyperuricemia in obese children and adolescents: the relationship with metabolic syndrome. Pediatr Rep. 2010;2:e12.PubMedPubMedCentral Tang L, Kubota M, Nagai A, Mamemoto K, Tokuda M. Hyperuricemia in obese children and adolescents: the relationship with metabolic syndrome. Pediatr Rep. 2010;2:e12.PubMedPubMedCentral
8.
go back to reference Tsunoda S, Kamide K, Minami J, Kawano Y. Decreases in serum uric acid by amelioration of insulin resistance in overweight hypertensive patients: effect of a low-energy diet and an insulin-sensitizing agent. Am J Hypertens. 2002;15:697–701.CrossRefPubMed Tsunoda S, Kamide K, Minami J, Kawano Y. Decreases in serum uric acid by amelioration of insulin resistance in overweight hypertensive patients: effect of a low-energy diet and an insulin-sensitizing agent. Am J Hypertens. 2002;15:697–701.CrossRefPubMed
9.
go back to reference Civantos Modino S, Guijarro de Armas MG, Monereo Mejias S, Montano Martinez JM, Iglesias Bolanos P, Merino Viveros M, et al. Hyperuricemia and metabolic syndrome in children with overweight and obesity. Endocrinol Nutr. 2012;59:533–8.CrossRefPubMed Civantos Modino S, Guijarro de Armas MG, Monereo Mejias S, Montano Martinez JM, Iglesias Bolanos P, Merino Viveros M, et al. Hyperuricemia and metabolic syndrome in children with overweight and obesity. Endocrinol Nutr. 2012;59:533–8.CrossRefPubMed
10.
go back to reference Ford ES, Li C, Cook S, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation. 2007;115:2526–32.CrossRefPubMed Ford ES, Li C, Cook S, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation. 2007;115:2526–32.CrossRefPubMed
11.
go back to reference Loeffler LF, Navas-Acien A, Brady TM, Miller 3rd ER, Fadrowski JJ. Uric acid level and elevated blood pressure in US adolescents: National Health and Nutrition Examination Survey, 1999–2006. Hypertension. 2012;59:811–7.CrossRefPubMedPubMedCentral Loeffler LF, Navas-Acien A, Brady TM, Miller 3rd ER, Fadrowski JJ. Uric acid level and elevated blood pressure in US adolescents: National Health and Nutrition Examination Survey, 1999–2006. Hypertension. 2012;59:811–7.CrossRefPubMedPubMedCentral
12.
go back to reference Pacifico L, Cantisani V, Anania C, Bonaiuto E, Martino F, Pascone R, et al. Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children. Eur J Endocrinol. 2009;160:45–52.CrossRefPubMed Pacifico L, Cantisani V, Anania C, Bonaiuto E, Martino F, Pascone R, et al. Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children. Eur J Endocrinol. 2009;160:45–52.CrossRefPubMed
13.
go back to reference Ishiro M, Takaya R, Mori Y, Takitani K, Kono Y, Okasora K, et al. Association of uric acid with obesity and endothelial dysfunction in children and early adolescents. Ann Nutr Metab. 2013;62:169–76.CrossRefPubMed Ishiro M, Takaya R, Mori Y, Takitani K, Kono Y, Okasora K, et al. Association of uric acid with obesity and endothelial dysfunction in children and early adolescents. Ann Nutr Metab. 2013;62:169–76.CrossRefPubMed
14.
go back to reference Bassols J, Martínez-Calcerrada JM, Prats-Puig A, Carreras-Badosa G, Díaz-Roldán F, Osiniri I, Riera-Pérez E, de Zegher F, Ibáñez L, López-Bermejo A. Uric acid, carotid intima-media thickness and body composition in prepubertal children. Pediatr Obes. 2016;11(5):375–82.CrossRefPubMed Bassols J, Martínez-Calcerrada JM, Prats-Puig A, Carreras-Badosa G, Díaz-Roldán F, Osiniri I, Riera-Pérez E, de Zegher F, Ibáñez L, López-Bermejo A. Uric acid, carotid intima-media thickness and body composition in prepubertal children. Pediatr Obes. 2016;11(5):375–82.CrossRefPubMed
15.
go back to reference Sun HL, Pei D, Lue KH, Chen YL. Uric Acid Levels Can Predict Metabolic Syndrome and Hypertension in Adolescents: A 10-Year Longitudinal Study. PLoS One. 2015;10(11):e0143786.CrossRefPubMedPubMedCentral Sun HL, Pei D, Lue KH, Chen YL. Uric Acid Levels Can Predict Metabolic Syndrome and Hypertension in Adolescents: A 10-Year Longitudinal Study. PLoS One. 2015;10(11):e0143786.CrossRefPubMedPubMedCentral
16.
go back to reference Luciano R, Barraco GM, Muraca M, Ottino S, Spreghini MR, Sforza RW, et al. Biomarkers of Alzheimer disease, insulin resistance, and obesity in childhood. Pediatrics. 2015;135:1074–81.CrossRefPubMed Luciano R, Barraco GM, Muraca M, Ottino S, Spreghini MR, Sforza RW, et al. Biomarkers of Alzheimer disease, insulin resistance, and obesity in childhood. Pediatrics. 2015;135:1074–81.CrossRefPubMed
17.
go back to reference Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio N, Tonini G, Cicognani A. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest. 2006;29(7):581–93.CrossRefPubMed Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio N, Tonini G, Cicognani A. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest. 2006;29(7):581–93.CrossRefPubMed
18.
go back to reference National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(Suppl 4th Report):555–76.CrossRef National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(Suppl 4th Report):555–76.CrossRef
19.
go back to reference Manco M, Grugni G, Di Pietro M, Balsamo A, Di Candia S, Morino GS, et al. Triglycerides-to-HDL cholesterol ratio as screening tool for impaired glucose tolerance in obese children and adolescents. Acta Diabetol. 2016;53:493–8.CrossRefPubMed Manco M, Grugni G, Di Pietro M, Balsamo A, Di Candia S, Morino GS, et al. Triglycerides-to-HDL cholesterol ratio as screening tool for impaired glucose tolerance in obese children and adolescents. Acta Diabetol. 2016;53:493–8.CrossRefPubMed
20.
go back to reference Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, et al. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis. 2015;25:489–94.CrossRefPubMed Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, et al. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis. 2015;25:489–94.CrossRefPubMed
21.
go back to reference Shashaj B, Luciano R, Contoli B, Morino GS, Spreghini MR, Rustico C, et al. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians. Acta Diabetol. 2016;53:251–60.CrossRefPubMed Shashaj B, Luciano R, Contoli B, Morino GS, Spreghini MR, Rustico C, et al. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians. Acta Diabetol. 2016;53:251–60.CrossRefPubMed
22.
go back to reference Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92:911–4.CrossRefPubMed Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92:911–4.CrossRefPubMed
23.
go back to reference Denzer C, Muche R, Mayer H, Heinze E, Debatin KM, Wabitsch M. Serum uric acid levels in obese children and adolescents: linkage to testosterone levels and pre-metabolic syndrome. J Pediatr Endocrinol Metab. 2003;16:1225–32.CrossRefPubMed Denzer C, Muche R, Mayer H, Heinze E, Debatin KM, Wabitsch M. Serum uric acid levels in obese children and adolescents: linkage to testosterone levels and pre-metabolic syndrome. J Pediatr Endocrinol Metab. 2003;16:1225–32.CrossRefPubMed
24.
25.
go back to reference Alper Jr AB, Chen W, Yau L, Srinivasan SR, Berenson GS, Hamm LL. Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension. 2005;45:34–8.CrossRefPubMed Alper Jr AB, Chen W, Yau L, Srinivasan SR, Berenson GS, Hamm LL. Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension. 2005;45:34–8.CrossRefPubMed
26.
go back to reference Muntner P, Srinivasan S, Menke A, Patel DA, Chen W, Berenson G. Impact of childhood metabolic syndrome components on the risk of elevated uric acid in adulthood: the Bogalusa Heart Study. Am J Med Sci. 2008;335:332–7.CrossRefPubMed Muntner P, Srinivasan S, Menke A, Patel DA, Chen W, Berenson G. Impact of childhood metabolic syndrome components on the risk of elevated uric acid in adulthood: the Bogalusa Heart Study. Am J Med Sci. 2008;335:332–7.CrossRefPubMed
27.
go back to reference Facchini F, Chen YD, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA. 1991;266:3008–11.CrossRefPubMed Facchini F, Chen YD, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA. 1991;266:3008–11.CrossRefPubMed
28.
go back to reference Muscelli E, Natali A, Bianchi S, Bigazzi R, Galvan AQ, Sironi AM, et al. Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am J Hypertens. 1996;9:746–52.CrossRefPubMed Muscelli E, Natali A, Bianchi S, Bigazzi R, Galvan AQ, Sironi AM, et al. Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am J Hypertens. 1996;9:746–52.CrossRefPubMed
29.
go back to reference Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature. 2002;417:447–52.PubMed Enomoto A, Kimura H, Chairoungdua A, Shigeta Y, Jutabha P, Cha SH, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature. 2002;417:447–52.PubMed
30.
go back to reference Lin WT, Chan TF, Huang HL, Lee CY, Tsai S, Wu PW, et al. Fructose-Rich Beverage Intake and Central Adiposity, Uric Acid, and Pediatric Insulin Resistance. J Pediatr. 2016;171:90–6.e1.CrossRefPubMed Lin WT, Chan TF, Huang HL, Lee CY, Tsai S, Wu PW, et al. Fructose-Rich Beverage Intake and Central Adiposity, Uric Acid, and Pediatric Insulin Resistance. J Pediatr. 2016;171:90–6.e1.CrossRefPubMed
31.
go back to reference Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119:1322–34.CrossRefPubMedPubMedCentral Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119:1322–34.CrossRefPubMedPubMedCentral
32.
go back to reference Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, et al. Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism. 1998;47:929–33.CrossRefPubMed Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, et al. Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism. 1998;47:929–33.CrossRefPubMed
33.
go back to reference Shashaj B, Bedogni G, Graziani MP, Tozzi AE, DiCorpo ML, Morano D, et al. Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity. JAMA Pediatr. 2014;168:917–24.CrossRefPubMed Shashaj B, Bedogni G, Graziani MP, Tozzi AE, DiCorpo ML, Morano D, et al. Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity. JAMA Pediatr. 2014;168:917–24.CrossRefPubMed
Metadata
Title
Percentiles of serum uric acid and cardiometabolic abnormalities in obese Italian children and adolescents
Authors
Rosa Luciano
Blegina Shashaj
MariaRita Spreghini
Andrea Del Fattore
Carmela Rustico
Rita Wietrzykowska Sforza
Giuseppe Stefano Morino
Bruno Dallapiccola
Melania Manco
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2017
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/s13052-016-0321-0

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