Hyperuricemia in Obese Children: Diagnostic Challenges, Pathophysiological Mechanisms, and Therapeutic Approaches - systematic review of current literature
DOI:
https://doi.org/10.12775/QS.2025.41.60115Keywords
hyperuricemia, obesity, child obesity, uric acid, hypertension, type 2 diabetesAbstract
Hyperuricemia in children with obesity is an increasingly common health issue, strongly associated with the development of various metabolic and cardiovascular diseases. It serves as a significant risk factor for conditions such as hypertension, type 2 diabetes, and chronic kidney disease. This study aimed to conduct a comprehensive review of the existing literature on the relationship between hyperuricemia and childhood obesity, adhering to the PRISMA guidelines for systematic reviews.
The primary mechanisms leading to hyperuricemia in this context include insulin resistance, lipid disorders, and impaired renal function. This article discusses several risk factors contributing to elevated uric acid levels in obese children, including a diet high in purines, excessive fructose intake, and a lack of physical activity. Additionally, it presents available diagnostic methods, such as measuring serum uric acid concentration and supporting tests like lipid profiles and renal function assessments. The article also explores preventive interventions, which encompass dietary and lifestyle modifications, as well as the early implementation of pharmacological treatments, such as allopurinol or metformin. Furthermore, it emphasizes the necessity for ongoing clinical research to develop more effective strategies for the treatment and prevention of hyperuricemia in obese children.
References
1. Skoczyńska M, Chowaniec M, Szymczak A, Langner-Hetmańczuk A, Maciążek-Chyra B, Wiland P. Pathophysiology of hyperuricemia and its clinical significance - a narrative review. Reumatologia. 2020;58(5):312–23.
2. Zhang S, Wang Y, Cheng J, Ning H, Zhao R, Xu Z, et al. Hyperuricemia and Cardiovascular Disease. Curr Pharm Des. 2016;25 6(1):700–9.
3. Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014 Mar;26(2):186–91.
4. Lima WG, Martins-Santos MES, Chaves VE. Uric acid as a modulator of glucose and lipid metabolism. Biochimie. 2015 Jul 4;116:17–23.
5. Copur S, Demiray A, Kanbay M. Uric acid in metabolic syndrome: Does uric acid have a definitive role? Eur J Intern Med. 2022 Sep 1;103:4–12.
6. Dolepski K, Duszyńska K, Góral A, Żuk K, Czachajda M. Childhood Obesity - Risk Factors and Consequences of the Disease. Quality in Sport [Internet]. 2025 Mar 17 [cited 2025 Apr 6];39:59095. Available from: https://apcz.umk.pl/QS/article/view/59095
7. Caprio S, Santoro N, Weiss R. Childhood obesity and the associated rise in cardiometabolic complications. Nat Metab. 2020 Mar 1;2(3):223–32.
8. Di Cesare M, Sorić M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA, et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med. 2019 Nov 25;17(1).
9. Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017 Feb 1;92(2):251–65.
10. Hussein HA, Ali H, Dulaimy JA‐, Zabin W, Al-Dulaimy S. Hyperuricemia And Its Relation With Obesity Among Children In Anbar Province. Int J Med Sci Clin Invent. 2024 Jan 15;11(01):6993–9.
11. Stiburkova B, Lukesova M, Zeman J. Pediatrics hyperuricemia in clinical practice: a retrospective analysis in 1,753 children and adolescents with hyperuricemia. Joint Bone Spine. 2025 Jan 1;92(1).
12. Spychalski J, Musiał M, Spychalska M, Dylik A, Gryczyńska W, Grochowska W, et al. The Impact of Childhood Obesity on Mental Health: A Comprehensive Review. Quality in Sport [Internet]. 2024 Dec 20 [cited 2025 Apr 6];36:56639. Available from: https://apcz.umk.pl/QS/article/view/56639
13. AlAteeq MA, Almaneea A, Althaqeb EK, Aljarallah MF, Alsaleh AE, Alrasheed MA. Uric Acid Levels in Overweight and Obese Children, and Their Correlation With Metabolic Risk Factors. Cureus. 2024 Sep 25;16.
14. Bae J, Park KY, Son S, Huh Y, Nam GE. Associations between obesity parameters and hyperuricemia by sex, age, and diabetes mellitus: A nationwide study in Korea. Obes Res Clin Pract. 2023 Sep 1;17(5):405–10.
15. Feng X, Yang Y, Xie H, Zhuang S, Fang Y, Dai Y, et al. The Association Between Hyperuricemia and Obesity Metabolic Phenotypes in Chinese General Population: A Retrospective Analysis. Front Nutr. 2022 Apr 18;9.
16. Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92 6(6):911–4.
17. Baldree LA, Stapleton FB. Uric acid metabolism in children. Pediatr Clin North Am. 1990;37 2(2):391–418.
18. Kolz M, Johnson T, Sanna S, Teumer A, Vitart V, Perola M, et al. Meta-Analysis of 28,141 Individuals Identifies Common Variants within Five New Loci That Influence Uric Acid Concentrations. PLoS Genet. 2009 Jun;5(6).
19. Allegrini S, Garcia-Gil M, Pesi R, Camici M, Tozzi MG. The Good, the Bad and the New about Uric Acid in Cancer. Cancers (Basel). 2022 Oct 1;14(19).
20. Marcicka J, Mądry W, Mazurkiewicz A, Kołodziej M, Męczyńska J, Saiuk N, et al. Probiotics - should pediatricians and neonatologists use them? A literature review. Quality in Sport [Internet]. 2024 Jul 8 [cited 2025 Apr 6];15:52273. Available from: https://apcz.umk.pl/QS/article/view/52273
21. Zhdan VM, Tkachenko MV, Babanina MYu, Volchenko HV, Kitura YeM. ADVANCEMENTS IN UNDERSTANDING THE MOLECULAR MECHANISMS REGULATING URIC ACID METABOLISM IN THE INTESTINE. Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії. 2024 May 20;24(2):293–7.
22. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008 Oct 23;359(17):1811–21.
23. Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318–28.
24. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007 Oct 1;86(4):899–906.
25. Bobulescu IA, Moe OW. Renal transport of uric acid: evolving concepts and uncertainties. Adv Chronic Kidney Dis. 2012 Nov;19(6):358–71.
26. Ichida K, Matsuo H, Takada T, Nakayama A, Murakami K, Shimizu T, et al. Decreased extra-renal urate excretion is a common cause of hyperuricemia. Nat Commun. 2012;3.
27. Bjornstad P, Lanaspa MA, Ishimoto T, Kosugi T, Kume S, Jalal D, et al. Fructose and uric acid in diabetic nephropathy. Diabetologia. 2015 Sep 7;58(9):1993–2002.
28. SZYMAŃSKA A, DOBROWOLSKA B, PILEWSKA-KOZAK AB, PAWŁOWSKA-MUC AK. Wybrane elementy stylu życia rodziny a problem nadwagi i otyłości u dzieci w wieku wczesnoszkolnym. Doniesienie z badań = Selected elements of family lifestyle and the problem of overweight and obesity among young school children. Journal of Education, Health and Sport [Internet]. 2015 Dec 23 [cited 2025 Apr 6];5(12):137–48. Available from: https://apcz.umk.pl/JEHS/article/view/23041
29. Rapicka D, Fabian-Danielewska A. Hyperuricemia and hypertension. Journal of Education, Health and Sport [Internet]. 2019 Jul 5 [cited 2025 Apr 6];9(7):233–9. Available from: https://apcz.umk.pl/JEHS/article/view/26205
30. Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016 Jun 15;213:8–14.
31. Facchini F, Ida 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 Dec 4;266(21):3008–11.
32. Katsiki N, Papanas N, Fonseca V, Maltezos E, Mikhailidis D. Uric acid and diabetes: Is there a link? Curr Pharm Des. 2013 Jun 26;19(27):4930–7.
33. Sztandera P, Szczepanowska-Wołowiec B, Kotela I. Evaluation of nutritional status among children aged 7-10. Journal of Education, Health and Sport [Internet]. 2017 May 13 [cited 2025 Apr 6];7(5):197–208. Available from: https://apcz.umk.pl/JEHS/article/view/24089
34. Ahmed B, Sultana R, Greene MW. Adipose tissue and insulin resistance in obese. Biomed Pharmacother. 2021 May 1;137.
35. Anderson PM, Butcher KF, Schanzenbach DW. Understanding recent trends in childhood obesity in the United States. Econ Hum Biol. 2019 Aug 1;34:16–25.
36. Tsoi MF, Li HL, Feng Q, Cheung CL, Cheung TT, Cheung BMY. Prevalence of Childhood Obesity in the United States in 1999–2018: A 20-Year Analysis. Obes Facts. 2022 Aug 31;15(4):560–9.
37. Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev. 2012 Feb 1;33 1(1):48–70.
38. Liu M, Cao B, Luo Q, Song Y, Shi Y, Cheng M, et al. A Gender-, Age-, and Weight Status-Specific Analysis of the High Prevalence of Hyperuricemia Among Chinese Children and Adolescents with Obesity. Diabetes, Metabolic Syndrome and Obesity. 2024;17:381–91.
39. Kiełczewska A, Szcześniak G, Kiełczewska A. Primary and Secondary Prevention of Obesity. Journal of Education, Health and Sport [Internet]. 2025 Jan 8 [cited 2025 Apr 6];77:56843. Available from: https://apcz.umk.pl/JEHS/article/view/56843
40. Kulynych RL, Soloviuk OA, Soloviuk OO. Pathophysiological association of expression hormone of adipose tissue omentin-1 and the degree of vascular remodeling of brachyocephalic vessels in persons with obesity and disorders of carbohydrate metabolism. Journal of Education, Health and Sport [Internet]. 2020 Oct 30 [cited 2025 Apr 6];10(10):127–43. Available from: https://apcz.umk.pl/JEHS/article/view/31846
41. Shangguan J, Zhang W, Zhu X, Zheng Y, Xue R, Xiao L, et al. Allele C of rs6068816 in the CYP24A1 Gene is Associated with Increased Risk of Hyperuricemia in the Chinese Population: A Case-Control Study. Discov Med. 2024;36 190(190):2224–30.
42. Alegría-Torres JA, Vargas-Morales JM, Guevara-Cruz M, Aradillas-García C, G. Noriega L, Tovar A. Polymorphisms of the genes ABCG2, SLC22A12 and XDH and their relation with hyperuricemia and hypercholesterolemia in Mexican young adults. F1000Res. 2021;10.
43. Krzystek-Korpacka M, Patryn E, Kustrzeba-Wojcicka I, Chrzanowska J, Gamian A, Noczynska A. The effect of a one-year weight reduction program on serum uric acid in overweight/obese children and adolescents. Clin Chem Lab Med [Internet]. 2011 May 1 [cited 2025 Apr 2];49(5):915–21. Available from: https://pubmed.ncbi.nlm.nih.gov/21288171/
44. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008 Feb 9;336(7639):309–12.
45. Johnson RJ, Sanchez-Lozada LG, Nakagawa T. The effect of fructose on renal biology and disease. J Am Soc Nephrol. 2010;21(12):2036–9.
46. Honda M, Horiuchi H, Torii T, Nakajima A, Iijima T, Murano H, et al. Urate-lowering therapy for gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database. BMC Pediatr [Internet]. 2021 Dec 1 [cited 2025 Apr 2];21(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34922491/
47. Kahan LG, Mehrzad R. Environmental factors related to the obesity epidemic. Obesity: Global Impact and Epidemiology. 2020 Jan 1;117–39.
48. Zhang T, Gu Y, Meng G, Zhang Q, Liu L, Wu H, et al. Genetic Risk, Adherence to a Healthy Lifestyle, and Hyperuricemia: the TCLSIH cohort study. Am J Med. 2023 May 1;136(5):476-483.e5.
49. Amagasa S, Fukushima N, Kikuchi H, Takamiya T, Oka K, Inoue S. Light and sporadic physical activity overlooked by current guidelines makes older women more active than older men. Int J Behav Nutr Phys Act. 2017 May 2;14(1).
50. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, Shafiu M, Sundaram S, Le M, et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013 Oct;62(10):3307–15.
51. Kanwal K, Khan M, Zahid K, Noor M, Abid N, Naz W, et al. Ultrasound Comparison of Renal Changes in Diabatic and Non-Diabatic Adult in Swabi. Journal of Health and Rehabilitation Research. 2024 Jun 15;4(2):1429–33.
52. Yu W, Cheng JD. Uric Acid and Cardiovascular Disease: An Update From Molecular Mechanism to Clinical Perspective. Front Pharmacol. 2020 Nov 16;11.
53. Wei X, Zhang M, Huang S, Lan X, Zheng J, Luo H, et al. Hyperuricemia: A key contributor to endothelial dysfunction in cardiovascular diseases. The FASEB Journal. 2023 Jul 1;37(7).
54. Zhao J, Chen H, Liu N, Chen J, Gu Y, Chen J, et al. Role of Hyperhomocysteinemia and Hyperuricemia in Pathogenesis of Atherosclerosis. J Stroke Cerebrovasc Dis. 2017 Dec 1;26 12(12):2695–9.
55. Zhao H, Lu J, He F, Wang M, Yan Y, Chen B, et al. Hyperuricemia contributes to glucose intolerance of hepatic inflammatory macrophages and impairs the insulin signaling pathway via IRS2-proteasome degradation. Front Immunol. 2022 Sep 13;13.
56. Rodenbach KE, Schneider MF, Furth SL, Moxey-Mims MM, Mitsnefes MM, Weaver DJ, et al. Hyperuricemia and Progression of CKD in Children and Adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis. 2015 Dec 1;66 6(6):984–92.
57. Noone DG, Marks SD. Hyperuricemia is associated with hypertension, obesity, and albuminuria in children with chronic kidney disease. J Pediatr. 2013 Jan;162(1):128–32.
58. 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(1):38–41.
59. Weihrauch-Blüher S, Wiegand S, Weihe P, Prinz N, Weghuber D, Leipold G, et al. Uric acid and gamma-glutamyl-transferase in children and adolescents with obesity: Association to anthropometric measures and cardiometabolic risk markers depending on pubertal stage, sex, degree of weight loss and type of patient care: Evaluation of the adiposity patient follow-up registry. Pediatr Obes. 2023 Mar 1;18(3).
60. Genovesi S, Vania A, Caroli M, Orlando A, Lieti G, Parati G, et al. Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity. Nutrients. 2024 Aug 1;16(15).
61. Giussani M, Orlando A, Tassistro E, Lieti G, Patti I, Antolini L, et al. Impact of Lifestyle Modifications on Alterations in Lipid and Glycemic Profiles and Uric Acid Values in a Pediatric Population. Nutrients. 2022 Mar 1;14(5).
62. Mosca A, Nobili V, De Vito R, Crudele A, Scorletti E, Villani A, et al. Serum uric acid concentrations and fructose consumption are independently associated with NASH in children and adolescents. J Hepatol. 2017 May 1;66(5):1031–6.
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