Elevated uric acid levels link to a higher cardiometabolic risk profile in adolescents.

BACKGROUND

Serum uric acid (sUA) plays a complex role in cardiovascular disease (CVD). However, its utility as an early cardiometabolic risk marker in adolescents remains underexplored.

PURPOSE: To examine the relationship between sUA levels and CVD risk factors, and to assess its potential in identifying metabolically unhealthy adolescents across different weight categories.

METHODS

This is a cross-sectional analysis with 4,390 adolescents aged 12 to 17 years from four Brazilian cities. sUA was categorized into quartiles. Linear regression, adjusted for confounders, assessed associations between sUA quartiles and cardiometabolic variables. Adjusted Poisson regression with robust variance estimated prevalence ratios (PR) of metabolic syndrome components across sUA quartiles, as well as the PR of a metabolically unhealthy profile, stratified by weight categories.

RESULTS

The sample was predominantly female (61.5%). The mean (SD) age was 14.8 (1.5) years, and median (IQR) sUA was 4.5 (3.8, 5.4) mg/dL. Higher sUA quartiles were associated with increased waist circumference, BMI Z-score, elevated blood pressure, higher triglycerides, and higher total and LDL cholesterol. There was also a negative association with HDL cholesterol and adiponectin. An inverse sUA-fasting plasma glucose association was also observed. Adolescents in the highest sUA quartile showed substantially higher PR for metabolic syndrome and its components (high waist circumference, high blood pressure, low HDL cholesterol, high triglycerides). The PR of metabolically unhealthy profile progressively increased across sUA quartiles, in both normal-weight individuals (PR 1.29, 95% CI 1.14-1.45, in the fourth sUA quartile) and, even more substantially, in those with overweight/obesity (PR 1.87, 95% CI 1.67-2.08, in the fourth sUA quartile).

CONCLUSION

Higher sUA levels were strongly associated with a worse cardiometabolic profile and an increased prevalence of metabolic unhealthiness, thereby reinforcing the role of sUA as an early risk marker in adolescence.