Can Uric Acid Be A Marker For Metabolically Unhealthy Obesity in Children and Adolescents?

Yıl 2021, Cilt: 15 Sayı: 3, 226 - 233, 25.05.2021

Erdal Kurnaz , Ayberk Türkyılmaz Atilla Çayır

https://doi.org/10.12956/tchd.874768

Öz

Aim: In this study it was investigated whether there is a difference between metabolically healthy (MHO) and unhealthy (MUO) obese children regarding laboratory results, especially serum uric acid levels.
Patients and Methods: Data of 220 individuals diagnosed with obesity were collected from medical records. Obese individuals without cardiovascular risk factors (fasting serum lipids, blood pressure, and glucose) were classified as MHO (n=124). Individuals meeting one or more criteria of cardiovascular risk factors were classified as MUO (n=96). The control group was composed of 111 healthy individuals.
Results: The mean age of the participants was 12.14±3.28 years, including 44.4% (n=147) were males. While there was statistical significance regarding uric acid between obese and healthy individuals (308.11±71.97 umol/L (5.18±1.21 mg/dl), 251.6±70.78 umol/L (4.23±1.19 mg/dl), Z=6.670, p<0.001, respectively). No statistical significance was found between MHO and MUO groups (302.16±69 umol/L (5.08±1.16 mg/dl), 315.84±74.94 umol/L (5.31±1.26 mg/dl), Z=1.265, p=0.206, respectively). However, uric acid had a significant correlation with many variables, such as weight, height, body mass index, triglyceride, high-density lipoprotein and serum insulin levels, but the strongest being with weight (Spearman r=0.525, p<0.001). Moreover, there was no difference between these 3 groups concerning platelet count, mean platelet volume, and platelet distribution width (H; p, 3.620; 0.164, 1.624; 0.444, and 1.948; 0.378, respectively).
Conclusions: This study showed that uric acid level is higher in obese than healthy controls and the most significant correlation with weight. However, uric acid alone is not a good indicator between MHO and MUO groups.  

Anahtar Kelimeler

Adolescent, Metabolically Healthy Obesity, Metabolically Unhealthy Obesity, Children, Uric Acid

Ürik Asit Metabolik Sağlıksız Çocuk ve Adolesanlarda Ayırt Edici Bir Marker Olabilir mi?

Öz

Amaç: Bu çalışmada metabolik olarak sağlıklı ve sağlıksız obez çocuklar arasında laboratuvar değerlerinin, özellikle serum ürik asit düzeyleri açısından bir fark olup olmadığı araştırılmıştır.
Gereç ve Yöntemler: Obezite teşhisi konulan çocuk ve adolesan 220 kişinin verileri tıbbi kayıtlardan toplandı. Kardiyovasküler risk faktörleri (açlık serum lipidleri, kan basıncı ve açlık glukoz yüksekliği) olmayan obez bireyler sağlıklı obez (n = 124) olarak sınıflandırıldı. Bir veya daha fazla kardiyovasküler risk faktörü kriterini karşılayan kişiler sağlıksız obez (n = 96) olarak sınıflandırıldı. Kontrol grubu 111 sağlıklı bireyden oluşturuldu.
Bulgular: Çalışmaya alınan olguların yaş ortalaması 12.14 ± 3.28 yıl, %44.4'ü (n = 147) erkekti. Obez bireyler ile sağlıklı kontroller arasında ürik asit düzeyleri arasında istatistiksel anlamlı olarak fark saptandı (sırasıyla, 308.11±71.97 umol/L (5.18±1.21 mg/dl), 251.6±70.78 umol/L (4.23±1.19 mg/dl); Z=6.670, p<0.001), bu fark metabolik olarak sağlıklı ve sağlıksız obezlerde saptanmadı (sırasıyla, 302.16±69 umol/L (5.08±1.16 mg/dl), 315.84±74.94 umol/L (5.31±1.26 mg/dl); Z=1.265, p=0.206). Ancak kilo, boy, vücut kitle indeksi, trigliserid, yüksek yoğunluklu lipoprotein ve insülin serum seviyeleri gibi ürik asit düzeyi üzerine etkili birçok faktör saptandı, fakat en güçlü oranda korelasyon vücut ağırlığı ile ürik asit düzeyi arasında saptandı (Spearman r=0.525, p <0,001). Ayrıca trombosit sayısı, ortalama trombosit hacmi ve trombosit dağılım genişliği açısından bu 3 grup arasında fark yoktu (sırasıyla H; p, 3.620; 0.164, 1.624; 0.444 ve 1.948; 0.378).
Sonuç: Bu çalışma, obezlerde ürik asit düzeyinin sağlıklı kontrollere göre daha yüksek olduğunu, ürik asit düzeyleri ile en güçlü korelasyon gösteren parametrenin kilo olduğunu göstermektedir. Ancak ürik asit tek başına metabolik olarak sağlıklı ve sağlıksız obezlerde iyi bir gösterge değildir.  

Anahtar Kelimeler

Adolesan, Adolesan, Metabolik sağlıklı obezite, Çocuk, Ürik asit

Kaynakça

• 1. Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol. 2014 Sep;6(3):129-43.
• 2. Bussler S, Penke M, Flemming G, Elhassan YS, Kratzsch J, Sergeyev E, Lipek T, Vogel M, Spielau U, Körner A, de Giorgis T, Kiess W. Novel Insights in the Metabolic Syndrome in Childhood and Adolescence. Horm Res Paediatr. 2017;88(3-4):181-193.
• 3. Ortega FB, Lee DC, Katzmarzyk PT, Ruiz JR, Sui X, Church TS, Blair SN. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013 Feb;34(5):389-97.
• 4. Blüher M. The distinction of metabolically 'healthy' from 'unhealthy' obese individuals. Curr Opin Lipidol. 2010 Feb;21(1):38-43.
• 5. Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood - Does weight status alone matter? Metabolism. 2014 Sep;63(9):1084-92.
• 6. Rocha EPAA, Vogel M, Stanik J, Pietzner D, Willenberg A, Körner A, Kiess W. Serum Uric Acid Levels as an Indicator for Metabolically Unhealthy Obesity in Children and Adolescents. Horm Res Paediatr. 2018;90(1):19-27.
• 7. van Wijk DF, Boekholdt SM, Arsenault BJ, Ahmadi-Abhari S, Wareham NJ, Stroes ES, Khaw KT. C-Reactive Protein Identifies Low-Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer-Norfolk Prospective Population Study. J Am Heart Assoc. 2016 Jun 3;5(6):e002823.
• 8. Ferrara LA, Wang H, Umans JG, Franceschini N, Jolly S, Lee ET, Yeh J, Devereux RB, Howard BV, de Simone G. Serum uric acid does not predict incident metabolic syndrome in a population with high prevalence of obesity. Nutr Metab Cardiovasc Dis. 2014 Dec;24(12):1360-4.
• 9. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010 Jan;8(1):148-56.
• 10. Emeksiz HC. Mean Platelet Volume in Obese Prepubertal Children. [Obez Prepubertal Çocuklarda Ortalama Trombosit Hacmi]. Akd Tıp D / AkdMed J / 2018; 1.
• 11. Aypak C, Türedi O, Bircan MA, Yüce A. Could mean platelet volume among complete blood count parameters be a surrogate marker of metabolic syndrome in pre-pubertal children? Platelets. 2014;25(6):393-8.
• 12. E. Ozsu, andB. Yazicioglu, “Relationship between obesity and platelet indices in children,” Cukurova Med. J., vol.43, no. 1, pp. 30-35, 2018. 13. Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008 Jul; 122(1): 198–208.
• 14. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM; Subcommıttee On Screenıng And Management Of Hıgh Blood Pressure In Chıldren. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017 Sep;140(3):e20171904.
• 15. Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, Baş F. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 2015;7(4):280-93.
• 16. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty.
• 17. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-6.
• 18. 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 Jun;18(6):499-502.
• 19. Mangge H, Zelzer S, Puerstner P, Schnedl WJ, Reeves G, Postolache TT, Weghuber D. Uric acid best predicts metabolically unhealthy obesity with increased cardiovascular risk in youth and adults. Obesity (Silver Spring). 2013 Jan;21(1):E71-7.
• 20. Weghuber D, Zelzer S, Stelzer I, Paulmichl K, Kammerhofer D, Schnedl W, Molnar D, Mangge H. High risk vs. "metabolically healthy" phenotype in juvenile obesity - neck subcutaneous adipose tissue and serum uric acid are clinically relevant. Exp Clin Endocrinol Diabetes. 2013 Jul;121(7):384-90.
• 21. Ferrara LA, Wang H, Umans JG, Franceschini N, Jolly S, Lee ET, Yeh J, Devereux RB, Howard BV, de Simone G. Serum uric acid does not predict incident metabolic syndrome in a population with high prevalence of obesity. Nutr Metab Cardiovasc Dis. 2014 Dec;24(12):1360-4.
• 22. Turcot V, Lu Y, Highland HM, Schurmann C, Justice AE, Fine RS, et al. Protein-altering variants associated with body mass index implicate pathways that control energy intake and expenditure in obesity. Nat Genet. (2018) 50:26–41. 23. Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. . Genetic studies of body mass index yield new insights for obesity biology. Nature. (2015) 518:197–206.
• 24. Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A. 1981 Nov;78(11):6858-62.
• 25. Maciek Godycki-Cwirko M, Krol M, Krol B, Zwolinska A, Kolodziejczyk K, Kasielski M, et al. Uric Acid but not apple polyphenols is responsible for the rise of plasma antioxidant activity after apple juice consumption in healthy subjects. J Am Coll Nutr. 2010; 29:397–406.
• 26. Gustafsson, D.; Unwin, R. The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality. BMC Nephrol. 2013, 14, 164.
• 27. Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Physiol. 2007 Aug;293(2):C584-96.
• 28. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004 Dec;114(12):1752-61.
• 29. Oyama C, Takahashi T, Oyamada M, Oyamada T, Ohno T, Miyashita M, Saito S, Komatsu K, Takashina K, Takada G. Serum uric acid as an obesity-related indicator in early adolescence. Tohoku J Exp Med. 2006 Jul;209(3):257-62. 30. Christian Flemming GM, Bussler S, Körner A, Kiess W. Definition and early diagnosis of metabolic syndrome in children. J Pediatr Endocrinol Metab. 2020 Jul 28;33(7):821-833.
• 31. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996 Mar;7(2):157-61.
• 32. Coban E, Ozdogan M, Yazicioglu G, Akcit F. The mean platelet volume in patients with obesity. Int J Clin Pract. 2005 Aug;59(8):981-2.
• 33. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010 Jan;8(1):148-56.
• 34. Tavil Y, Sen N, Yazici HU, Hizal F, Abaci A, Cengel A. Mean platelet volume in patients with metabolic syndrome and its relationship with coronary artery disease. Thromb Res. 2007;120(2):245-50.
• 35. Aypak C, Türedi O, Bircan MA, Yüce A. Could mean platelet volume among complete blood count parameters be a surrogate marker of metabolic syndrome in pre-pubertal children? Platelets. 2014;25(6):393-8.