Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents: analysis based on the 2016-2017 Korea National Health and Nutrition Examination Survey

  • Lee, Jung Hyun (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • Received : 2019.05.09
  • Accepted : 2019.06.17
  • Published : 2019.08.15
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Abstract

Purpose: Investigating the prevalence of hyperuricemia and its association with metabolic syndrome (MetS) and cardiometabolic risk factors (CMRFs) in Korean children and adolescents. Methods: This cross-sectional survey used data from the 7th Korea National Health and Nutrition Examination Survey (2016-2017); 1,256 males and females aged 10-18 years were included. Hyperuricemia was defined as serum uric acid levels were >6.6 mg/dL at 10-11 years of age (both sexes), >7.7 mg/dL for males at 12-18 years of age and >5.7 mg/dL for females at 12-18 years of age. MetS was defined by the International Diabetes Federation criteria. Logistic regression analysis was used to analyze hyperuricemia-associated risk factors. Results: The prevalence of hyperuricemia was 9.4% (male, 8.4%; female, 10.5%) (P<0.281). After adjusting for sociodemographic factors and health behaviors in multivariate analysis (model 1), the odds ratio (OR) for hyperuricemia of MetS was 3.05 (95% confidence interval [CI], 1.17-7.92; P=0.022). After adjusting for the same variables in model 1 plus obesity and all MetS components (model 2), only abdominal obesity was significant, and the OR for hyperuricemia was 3.38 (95% CI, 1.72-6.63; P<0.001) After adjusting for the same variables in model 1 plus body mass index (BMI) z scores and all MetS components except abdominal obesity (model 3), only BMI z scores was significant, and the OR for hyperuricemia was 1.59 (95% CI, 1.34-1.89; P<0.001). Conclusion: MetS, abdominal obesity, and BMI z scores were CMRFs significantly associated with hyperuricemia in Korean children and adolescents. Therefore, attention should be paid to hyperuricemia in patients with obesity or MetS.

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References

  1. Alshehri AM. Metabolic syndrome and cardiovascular risk. J Family Community Med 2010;17:73-8. https://doi.org/10.4103/1319-1683.71987
  2. Morrison JA, Friedman LA, Wang P, Glueck CJ. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr 2008;152:201-6. https://doi.org/10.1016/j.jpeds.2007.09.010
  3. Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med 2007;120:442-7. https://doi.org/10.1016/j.amjmed.2006.06.040
  4. 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. https://doi.org/10.1161/CIRCULATIONAHA.106.657627
  5. Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O. Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. Eur J Endocrinol 1998;138:63-9. https://doi.org/10.1530/eje.0.1380063
  6. Rho YH, Zhu Y, Choi HK. The epidemiology of uric acid and fructose. Semin Nephrol 2011;31:410-9. https://doi.org/10.1016/j.semnephrol.2011.08.004
  7. Reis LN, Reuter CP, Pollo Renner JD, Burgos LT, Rech Franke SI, Burgos MS. High urate concentration is associated with elevated blood pressure in schoolchildren. J Pediatr Endocrinol Metab 2018; 31:1207-12. https://doi.org/10.1515/jpem-2018-0227
  8. Oyama C, Takahashi T, Oyamada M, Oyamada T, Ohno T, Miyashita M, et al. Serum uric acid as an obesity-related indicator in early adolescence. Tohoku J Exp Med 2006;209:257-62. https://doi.org/10.1620/tjem.209.257
  9. Ko YC, Wang TN, Tsai LY, Chang FT, Chang SJ. High prevalence of hyperuricemia in adolescent Taiwan aborigines. J Rheumatol 2002; 29:837-42.
  10. Loeffler LF, Navas-Acien A, Brady TM, Miller ER 3rd, 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. https://doi.org/10.1161/HYPERTENSIONAHA.111.183244
  11. 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.
  12. Luciano R, Shashaj B, Spreghini M, Del Fattore A, Rustico C, Wietrzykowska Sforza R, et al. Percentiles of serum uric acid and cardiometabolic abnormalities in obese Italian children and adolescents. Ital J Pediatr 2017;43:3. https://doi.org/10.1186/s13052-016-0321-0
  13. Li N, Zhang S, Li W, Wang L, Liu H, Li W, et al. Prevalence of hyperuricemia and its related risk factors among preschool children from China. Sci Rep 2017;7:9448. https://doi.org/10.1038/s41598-017-10120-8
  14. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61: 135-49. https://doi.org/10.3345/kjp.2018.61.5.135
  15. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502. https://doi.org/10.1093/clinchem/18.6.499
  16. Michael AP. Reference ranges for laboratory tests and procedures. In: Kliegman RM, Behrman RA, Jenson HB, Stanton BF, editor. Nelson textbook of pediatrics. 18th ed. Philadelphia (PA): Elsevier Saunders, 2007:2949.
  17. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299-306. https://doi.org/10.1111/j.1399-5448.2007.00271.x
  18. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25. https://doi.org/10.3345/kjp.2008.51.1.1
  19. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med 2008;359:1811-21. https://doi.org/10.1056/NEJMra0800885
  20. Kim Y, Kang J, Kim GT. Prevalence of hyperuricemia and its associated factors in the general Korean population: an analysis of a population-based nationally representative sample. Clin Rheumatol 2018;37:2529-38. https://doi.org/10.1007/s10067-018-4130-2
  21. Shatat IF, Abdallah RT, Sas DJ, Hailpern SM. Serum uric acid in U.S. adolescents: distribution and relationship to demographic characteristics and cardiovascular risk factors. Pediatr Res 2012;72:95-100. https://doi.org/10.1038/pr.2012.47
  22. Wilcox WD. Abnormal serum uric acid levels in children. J Pediatr 1996;128:731-41. https://doi.org/10.1016/S0022-3476(96)70322-0
  23. Harlan WR, Cornoni-Huntley J, Leaverton PE. Physiologic determinants of serum urate levels in adolescence. Pediatrics 1979;63:569-75.
  24. Nicholls A, Snaith ML, Scott JT. Effect of oestrogen therapy on plasma and urinary levels of uric acid. Br Med J 1973;1:449-51. https://doi.org/10.1136/bmj.1.5851.449
  25. Choi TI, Rhee HJ, Ko KM, Yoo SM, Kim KN, Lee SY, et al. The prevalence of obesity and obesity-related metabolic complications in Korean Adolescents. J Korean Acad Fam Med 2006;27:175-81.
  26. Lee MS, Wahlqvist ML, Yu HL, Pan WH. Hyperuricemia and metabolic syndrome in Taiwanese children. Asia Pac J Clin Nutr 2007;16 Suppl 2:594-600.
  27. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28. https://doi.org/10.1016/S0140-6736(05)66378-7
  28. Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009;119:628-47. https://doi.org/10.1161/CIRCULATIONAHA.108.191394
  29. Quinones Galvan A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D, et al. Effect of insulin on uric acid excretion in humans. Am J Physiol 1995;268(1 Pt 1):E1-5.
  30. Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, et al. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol 2006;290:F625-31. https://doi.org/10.1152/ajprenal.00140.2005
  31. Wun YT, Chan CS, Lui CS. Hyperuricaemia in Type 2 diabetes mellitus. Diabetes Nutr Metab 1999;12:286-91.
  32. Yoo TW, Sung KC, Shin HS, Kim BJ, Kim BS, Kang JH, et al. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circ J 2005;69:928-33. https://doi.org/10.1253/circj.69.928
  33. Ryu S, Chang Y, Zhang Y, Kim SG, Cho J, Son HJ, et al. A cohort study of hyperuricemia in middle-aged South Korean men. Am J Epidemiol 2012;175:133-43. https://doi.org/10.1093/aje/kwr291
  34. Alper AB Jr, 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. https://doi.org/10.1161/01.HYP.0000150783.79172.bb
  35. Feig DI, Nakagawa T, Karumanchi SA, Oliver WJ, Kang DH, Finch J, et al. Hypothesis: uric acid, nephron number, and the pathogenesis of essential hypertension. Kidney Int 2004;66:281-7. https://doi.org/10.1111/j.1523-1755.2004.00729.x

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