We comment on a recent study by Dehghan et al. (1), who identified high serum uric acid as an independent risk factor for type 2 diabetes in adults. We investigated serum levels of uric acid in a large cohort of obese adolescents (n = 355; mean ± SD age 13.1 ± 4.1 years and age range 10–22 years) and normal-weight control subjects (n = 200) of similar age and sex distribution (2). Uric acid levels were highly significantly increased in the obese adolescents (4.6 ± 1.1 vs. 5.6 ± 1.3 mg/dl, P < 0.0001). Male probands had significantly higher uric acid serum levels (P < 0.0001) in the obese and control groups. Interestingly, uric acid correlated highly significantly with systolic blood pressure (r = 0.37, P < 0.0001), increased intima-media thickness of common carotid arteries (r = 0.33, P < 0.0001), nuchal subcutaneous adipose tissue thickness (r = 0.46, P < 0.0001), measured by lipometry (3), and waist circumference (r = 0.57, P < 0.0001). A negative association was seen with the high molecular weight–to–total adiponectin ratio (r = −0.35, P = 0.01) (H. Mangge, G. Almer, H. Gruber, C. Mayer, M. Truschnig, N. Grandits, R. Möller, R. Horejsi, M. Borkenstein, S. Pilz, unpublished observations). In contrast to these strikingly significant correlations, identified as early as childhood, only weak correlations were seen between uric acid, homeostasis model assessment index (r = 0.2, P < 0.0001), and fasted insulin levels (r = 0.2, P < 0.0001). Fasted glucose levels and free fatty acids were not significantly associated with uric acid.
Thus, in the earliest phases of the metabolic syndrome, as detected in obese adolescents aged ∼13 years, uric acid indicates a high cardiovascular risk profile. However, in contrast to the observations in subjects in late adulthood by Dehghan et al., obese adolescents show a stronger association between uric acid, early vascular abnormalities, trunk-weighted obesity, and hypertension compared with markers of insulin resistance such as fasted insulin and homeostasis model assessment index.
