SERUM URIC ACID AS A RISK FACTOR FOR CARDIOMETABOLIC DISEASE IN CHILDREN: A SYSTEMATIC REVIEW

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5996

Keywords:

Uric Acid, Children, Cardiometabolic Risk, Metabolic Syndrome, Obesity, Hypertension, Atherosclerosis, Biomarkers

Abstract

Background: Cardiometabolic diseases (CMD), including obesity, hypertension, and metabolic syndrome (MS), are increasingly prevalent in pediatric populations. Early identification of biomarkers associated with cardiometabolic risk is essential for effective prevention. Serum uric acid (UA), traditionally linked to gout and renal disease, has recently emerged as a potential marker and mediator of metabolic dysfunction.

Aim: This systematic review aimed to evaluate the relationship between serum UA levels and cardiometabolic risk factors in children and adolescents and to determine whether UA functions as an independent risk factor or a biomarker of CMD.

Methods: A systematic literature search was conducted using PubMed, ScienceDirect, and Google Scholar for studies published up to 2025. Keywords included “uric acid,” “children,” “adolescents,” “cardiometabolic risk,” “metabolic syndrome,” “obesity,” “insulin resistance,” and “hypertension.” Eligible studies included original research and reviews involving individuals aged 0–18 years. A qualitative analisys was performed focusing on associations between UA and specific cardiometabolic conditions.

Results: Elevated UA levels were consistently associated with obesity, MS, hypertension, and early markers of atherosclerosis in children. UA showed strong correlations with body mass index and waist circumference and may help distinguish between metabolically healthy and unhealthy obesity phenotypes. Higher UA levels were also linked to primary hypertension and appeared to precede its development. Additionally, UA was associated with increased carotid intima–media thickness, suggesting a role in early vascular changes. However, the strength of these associations was sometimes reduced after adjusting for confounding factors such as adiposity and insulin resistance.

Conclusions: Serum UA is closely associated with multiple cardiometabolic risk factors in pediatric populations and may serve both as a biomarker and a potential contributor to early disease processes. Although its causal role remains uncertain, UA represents a promising, accessible marker for early risk stratification. Further longitudinal and interventional studies are needed to clarify its clinical utility and determine whether reducing UA levels can improve cardiometabolic outcomes in children.

References

Viazzi, F., Antolini, L., Giussani, M., Brambilla, P., Galbiati, S., Mastriani, S., Stella, A., Pontremoli, R., Valsecchi, M. G., & Genovesi, S. (2013). Serum uric acid and blood pressure in children at cardiovascular risk. Pediatrics, 132(1), e93-99. https://doi.org/10.1542/peds.2013-0047

Özalp Kızılay, D., Şen, S., & Ersoy, B. (2019). Associations Between Serum Uric Acid Concentrations and Cardiometabolic Risk and Renal Injury in Obese and Overweight Children. Journal of Clinical Research in Pediatric Endocrinology, 11(3), 262–269. https://doi.org/10.4274/jcrpe.galenos.2018.2019.0241

Pacifico, L., Cantisani, V., Anania, C., Bonaiuto, E., Martino, F., Pascone, R., & Chiesa, C. (2009). Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children. European Journal of Endocrinology, 160(1), 45–52. https://doi.org/10.1530/EJE-08-0618

Feig, D. I., & Johnson, R. J. (2003). Hyperuricemia in Childhood Primary Hypertension. Hypertension, 42(3), 247–252. https://doi.org/10.1161/01.HYP.0000085858.66548.59

Glantzounis, G. K., Tsimoyiannis, E. C., Kappas, A. M., & Galaris, D. A. (2005). Uric acid and oxidative stress. Current Pharmaceutical Design, 11(32), 4145–4151. https://doi.org/10.2174/138161205774913255

Johnson, R. J., Segal, M. S., Sautin, Y., Nakagawa, T., Feig, D. I., Kang, D.-H., Gersch, M. S., Benner, S., & Sánchez-Lozada, L. G. (2007). Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. The American Journal of Clinical Nutrition, 86(4), 899–906. https://doi.org/10.1093/ajcn/86.4.899

Bussler, S., Penke, M., Flemming, G., Elhassan, Y. S., Kratzsch, J., Sergeyev, E., Lipek, T., Vogel, M., Spielau, U., Körner, A., de Giorgis, T., & Kiess, W. (2017). Novel Insights in the Metabolic Syndrome in Childhood and Adolescence. Hormone Research in Paediatrics, 88(3–4), 181–193. https://doi.org/10.1159/000479510

Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E. C., Biryukov, S., Abbafati, C., Abera, S. F., Abraham, J. P., Abu-Rmeileh, N. M. E., Achoki, T., AlBuhairan, F. S., Alemu, Z. A., Alfonso, R., Ali, M. K., Ali, R., Guzman, N. A., … Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9945), 766–781. https://doi.org/10.1016/S0140-6736(14)60460-8

Blüher, M. (2010). The distinction of metabolically „healthy” from „unhealthy” obese individuals. Current Opinion in Lipidology, 21(1), 38–43. https://doi.org/10.1097/MOL.0b013e3283346ccc

Blüher, M. (2014). Are metabolically healthy obese individuals really healthy? European Journal of Endocrinology, 171(6), R209-219. https://doi.org/10.1530/EJE-14-0540

Rey-López, J. P., de Rezende, L. F., Pastor-Valero, M., & Tess, B. H. (2014). The prevalence of metabolically healthy obesity: A systematic review and critical evaluation of the definitions used. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 15(10), 781–790. https://doi.org/10.1111/obr.12198

Rocha, E. P. A. A., Vogel, M., Stanik, J., Pietzner, D., Willenberg, A., Körner, A., & Kiess, W. (2018). Serum Uric Acid Levels as an Indicator for Metabolically Unhealthy Obesity in Children and Adolescents. Hormone Research in Paediatrics, 90(1), 19–27. https://doi.org/10.1159/000490113

Lurbe, E., Torro, M. I., Alvarez-Pitti, J., Redon, J., Borghi, C., & Redon, P. (2018). Uric acid is linked to cardiometabolic risk factors in overweight and obese youths. Journal of Hypertension, 36(9), 1840–1846. https://doi.org/10.1097/HJH.0000000000001814

Gustafsson, D., & Unwin, R. (2013). The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality. BMC Nephrology, 14, 164. https://doi.org/10.1186/1471-2369-14-164

Coresh, J., Wei, G. L., McQuillan, G., Brancati, F. L., Levey, A. S., Jones, C., & Klag, M. J. (2001). Prevalence of high blood pressure and elevated serum creatinine level in the United States: Findings from the third National Health and Nutrition Examination Survey (1988-1994). Archives of Internal Medicine, 161(9), 1207–1216. https://doi.org/10.1001/archinte.161.9.1207

Cannon, P. J., Stason, W. B., Demartini, F. E., Sommers, S. C., & Laragh, J. H. (1966). Hyperuricemia in primary and renal hypertension. The New England Journal of Medicine, 275(9), 457–464. https://doi.org/10.1056/NEJM196609012750902

Mazzali, M., Hughes, J., Kim, Y. G., Jefferson, J. A., Kang, D. H., Gordon, K. L., Lan, H. Y., Kivlighn, S., & Johnson, R. J. (2001). Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension, 38(5), 1101–1106. https://doi.org/10.1161/hy1101.092839

Watanabe, S., Kang, D.-H., Feng, L., Nakagawa, T., Kanellis, J., Lan, H., Mazzali, M., & Johnson, R. J. (2002). Uric acid, hominoid evolution, and the pathogenesis of salt-sensitivity. Hypertension, 40(3), 355–360. https://doi.org/10.1161/01.hyp.0000028589.66335.aa

Burke, G. L., Arcilla, R. A., Culpepper, W. S., Webber, L. S., Chiang, Y. K., & Berenson, G. S. (1987). Blood pressure and echocardiographic measures in children: The Bogalusa Heart Study. Circulation, 75(1), 106–114. https://doi.org/10.1161/01.cir.75.1.106

Pontremoli, R., Nicolella, C., Viazzi, F., Ravera, M., Sofia, A., Berruti, V., Bezante, G. P., Del Sette, M., Martinoli, C., Sacchi, G., & Deferrari, G. (1998). Microalbuminuria is an early marker of target organ damage in essential hypertension. American Journal of Hypertension, 11(4 Pt 1), 430–438. https://doi.org/10.1016/s0895-7061(97)00498-6

Wang, J. G., Staessen, J. A., Fagard, R. H., Birkenhäger, W. H., Gong, L., & Liu, L. (2001). Prognostic significance of serum creatinine and uric acid in older Chinese patients with isolated systolic hypertension. Hypertension, 37(4), 1069–1074. https://doi.org/10.1161/01.hyp.37.4.1069

Obrycki, Ł., Skoczyński, K., Sikorski, M., Koziej, J., Mitoraj, K., Pilip, J., Pac, M., Feber, J., & Litwin, M. (2025). Current etiology of hypertension in European children—Factors associated with primary hypertension. Pediatric Nephrology (Berlin, Germany), 40(10), 3233–3244. https://doi.org/10.1007/s00467-025-06761-x

Raitakari, O. T., Juonala, M., Kähönen, M., Taittonen, L., Laitinen, T., Mäki-Torkko, N., Järvisalo, M. J., Uhari, M., Jokinen, E., Rönnemaa, T., Akerblom, H. K., & Viikari, J. S. A. (2003). Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: The Cardiovascular Risk in Young Finns Study. JAMA, 290(17), 2277–2283. https://doi.org/10.1001/jama.290.17.2277

Nagahama, K., Iseki, K., Inoue, T., Touma, T., Ikemiya, Y., & Takishita, S. (2004). Hyperuricemia and cardiovascular risk factor clustering in a screened cohort in Okinawa, Japan. Hypertension Research: Official Journal of the Japanese Society of Hypertension, 27(4), 227–233. https://doi.org/10.1291/hypres.27.227

Kanellis, J., & Kang, D.-H. (2005). Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Seminars in Nephrology, 25(1), 39–42. https://doi.org/10.1016/j.semnephrol.2004.09.007

Li, S., Chen, W., Srinivasan, S. R., Bond, M. G., Tang, R., Urbina, E. M., & Berenson, G. S. (2003). Childhood cardiovascular risk factors and carotid vascular changes in adulthood: The Bogalusa Heart Study. JAMA, 290(17), 2271–2276. https://doi.org/10.1001/jama.290.17.2271

Codazzi, V., Frontino, G., Galimberti, L., Giustina, A., & Petrelli, A. (2024). Mechanisms and risk factors of metabolic syndrome in children and adolescents. Endocrine, 84(1), 16–28. https://doi.org/10.1007/s12020-023-03642-x

Martino, F., Pannarale, G., Puddu, P. E., Colantoni, C., Zanoni, C., Martino, E., Torromeo, C., Paravati, V., Perla, F. M., & Barillà, F. (2015). Is it possible a new definition of metabolic syndrome in childhood? European Review for Medical and Pharmacological Sciences, 19(22), 4324–4331.

Obrycki, Ł., Sikorski, M., Skoczyński, K., Koziej, J., Mitoraj, K., Pilip, J., Pac, M., Feber, J., & Litwin, M. (2026). Metabolic syndrome and serum uric acid level in children and adolescents with hypertension. Journal of Hypertension, 44(5), 847–857. https://doi.org/10.1097/HJH.0000000000004275

Villasis-Keever, M. A., Zurita-Cruz, J. N., Alcaraz-Hurtado, I. A., Klünder-Klünder, M., Vilchis-Gil, J., Romero-Guerra, A. L., López-Beltran, A. L., & Delgadillo-Ruano, M. A. (2025). Association of Serum Uric Acid Levels with Cardiometabolic Factors in Adolescents with Obesity: A Cross-Sectional Study. Metabolites, 15(4), 237. https://doi.org/10.3390/metabo15040237

Downloads

Published

2026-09-24

How to Cite

Tora, A., Petelicki, K., Biełanowicz, E., Szulim, J., Pondo, W., & Barszcz, A. (2026). SERUM URIC ACID AS A RISK FACTOR FOR CARDIOMETABOLIC DISEASE IN CHILDREN: A SYSTEMATIC REVIEW. International Journal of Innovative Technologies in Social Science, 4(3(51). https://doi.org/10.31435/ijitss.3(51).2026.5996