Background: Hyperuricemia in adults is known to be associated with hypertension, the metabolic syndrome and cardiovascular disease. The purpose of this study was to elucidate the factors associated with hyperuricemia in obese children and early adolescents and to investigate the threshold serum level of uric acid (UA) for the metabolic syndrome in children. Methods: We assessed anthropometric measurements, blood pressure, body composition and biochemical data in 1,559 obese children. To assess endothelial dysfunction, flow-mediated dilatation (FMD) was measured in 92 children. The correlations between serum UA levels and various parameters were examined. The threshold serum UA level for the metabolic syndrome was calculated by receiver-operating characteristic (ROC) curve analysis. Results: Serum UA levels were positively correlated with lipids in both boys and girls, and they were inversely correlated with FMD in the boys but not the girls. The threshold serum UA level for the metabolic syndrome was 5.25 mg/dl in boys and 5.05 mg/dl in girls. However, the specificity and sensitivity of ROC curve analysis are not so striking. Conclusion: The correlation between UA and FMD showed gender differences and might be affected by the hormonal status. The cutoff level of serum UA as a marker of the metabolic syndrome in obese children was affected by both age and gender.

Keywords:
Children, Hyperuricemia, Metabolic syndrome, Obesity, Uric acid
1.
Dietz WH: Pediatric obesity; in Eckel RH (ed): Obesity, Mechanisms and Clinical Management. Philadelphia, Lippincott Willams & Wilkins, 2003, pp 91-102.
2.
Baker JL, Olsen LW, Søren TI: Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007;357:2329-2337.
3.
Eckel RH, Grundy SM, Zimmet PZ: The metabolic syndrome. Lancet 2005;365:1415-1428.
4.
Ford ES, Li C: Defining the metabolic syndrome in children and adolescents: will the real definition please stand up? J Pediatr 2008;152:160-164.
5.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al: Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-2374.
6.
Boney CM, Verma A, Tucker R, Vohr BR: Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005;115:e290-e296.
7.
Wilcox WD: Abnormal serum uric acid levels in children. J Pediatr 1996;128:731-741.
8.
Feig DI, Kang DH, Johnson RJ: Uric acid and cardiovascular risk. N Engl J Med 2008;359:1811-1821.
9.
Ford ES, Li C, Cook S, Choi HK: Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 2007;115:2526-2532.
10.
Deanfield JE, Halcox JP, Rabelink TJ: Endothelial function and dysfunction: testing and clinical relevance. Circulation 2007;115:1285-1295.
11.
Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al: Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992;340:1111-1115.
12.
Charakida M, Deanfield JE, Halcox JP: Childhood origins of arterial disease. Curr Opin Pediatr 2007;19:538-545.
13.
Asayama K, Dobashi K, Hayashibe H, Kodera K, Uchida N, Nakane T, et al: Threshold values of visceral fat measures and their anthropometric alternatives for metabolic derangement in Japanese obese boys. Int J Obes Relat Metab Disord 2002;26:208-213.
14.
Mori Y: Flow-mediated dilatation in obese children. Clin Pediatr Endocrinol 2003;12:43-48.
15.
Corretti MC, Anderson TJ, Benjamin EJ, Ce-lermajer D, Charbonneau F, Creager MA, et al: Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002;39:257-265.
16.
Ohzeki T, Nakagawa Y: Abdominal adiposity in obese children and adolescents; in Ashizawa K, Cameron N (eds): Human Growth in a Changing Lifestyle. London, Smith-Gordon, 2009, pp 121-125.
17.
Gagliardi AC, Miname MH, Santos RD: Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202:11-17.
18.
Ford ES, Li C, Cook S, Choi HK: Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 2007;115:2526-2532.
19.
Takahashi S, Yamamoto T, Tsutsumi Z, Moriwaki Y, Yamakita J, Higashino K: Close correlation between visceral fat accumulation and uric acid metabolism in healthy men. -Metabolism 1997;46:1162-1165.
20.
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;47:929-933.
21.
McCrindle BW: Hyperlipidemia in children. Thromb Res 2006;118:49-58.
22.
Giacomello A, Di Sciascio N, Quaratino CP: Relation between serum triglyceride level, serum urate concentration, and fractional urate excretion. Metabolism 1997;46:1085-1089.
23.
Matsubara K, Matsuzawa Y, Jiao S, Takama T, Kubo M, Tarui S: Relationship between hypertriglyceridemia and uric acid production in primary gout. Metabolism 1989;38:698-701.
24.
Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al: Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001;358:1400-1404.
25.
Watts K, Beye P, Siafarikas A, O'Driscoll G, Jones TW, Davis EA, et al: Effects of exercise training on vascular function in obese children. J Pediatr 2004;144:620-625.
26.
Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, et al: Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation 2004;109:1981-1986.
27.
Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE: Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol 1994;24:471-476.
28.
Kapuku GK, Treiber FA, Hartley B, Ludwig DA: Gender influences endothelial-dependent arterial dilatation via arterial size in youth. Am J Med Sci 2004;327:305-309.
29.
Erdogan D, Gullu H, Caliskan M, Yildirim E, Bilgi M, Ulus T, et al: Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults. Int J Clin Pract 2005;59:1276-1282.
30.
Mercuro G, Vitale C, Cerquetani E, Zoncu S, Deidda M, Fini M, et al: Effect of hyperuricemia upon endothelial function in patients at increased cardiovascular risk. Am J Cardiol 2004;94:932-935.
31.
Tang Z, Cheng LT, Li HY, Wang T: Serum uric acid and endothelial dysfunction in continuous ambulatory peritoneal dialysis patients. Am J Nephrol 2009;29:368-373.
32.
Reinehr T, de Sousa G, Toschke AM, Andler W: Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child 2007;92:1067-1072.
33.
Mikkelsen WM, Dodge HJ, Valkenburg H: The distribution of serum uric acid values in a population unselected as to gout or hyeruricemia. Tecumseh, Michigan 1959-1960. Am J Med 1965;39:242-251.
34.
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;118:241-249.
35.
Igarashi T: Normal serum uric acid concentrations for age and sex and incidence of renal hypouricaemia in Japanese school children. Pediatr Nephrol 1993;7:239-240.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.