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High uric acid, reduced glomerular filtration rate and non-alcoholic fatty liver in young people with obesity

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Abstract

Objective

To evaluate the association between high uric acid (UA), reduced estimated glomerular filtration rate (eGFR), and non-alcoholic fatty liver disease (NAFLD) in outpatient children and adolescents with overweight (OW) or obesity (OB).

Methods

Anthropometric, biochemical, hepatic ultrasound and eGFR data were available from 2565 young people with OW/OB (age 5–18 years). eGFR was calculated using the Schwartz’s bedside formula and reduced eGFR (ReGFR+) was defined by a value < 90 mL/min/1.73 m2. High UA was defined as ≥ 75th percentile by sex in children and adolescents.

Results

The population was stratified in four categories: (1) normal eGFR and absence of NAFLD (ReGFR−/NAFLD−) (n = 1,236); (2) ReGFR+ and absence of NAFLD (ReGFR+/NAFLD− (n = 155); (3) normal eGFR and presence of NAFLD (ReGFR−/NAFLD+) (n = 1019); (4) presence of both conditions (ReGFR+/NAFLD+) (n = 155). Proportions of youth with high UA across the four categories were 17%, 30%, 33% and 46%, respectively (P < 0.0001). Young people with high levels of UA had odds ratio (95% CI) of 2.11 (1.43–3.11) for ReGFR+; 2.82 (2.26–3.45) for NAFLD+; and 5.04 (3.45–7.39) for both conditions (P < 0.0001 for all), independently of major confounders.

Conclusions

High levels of UA were independently associated with ReGFR, NAFLD and the combination of both conditions in young people with OW/OB. The strength of this association was the highest in cases presenting both reduced eGFR and NAFLD. UA may serve as marker to identify patients at risk for these conditions.

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Abbreviations

ALT:

Alanine aminotransferase

BMI:

Body mass index

CARITALY:

CARdiometabolic risk factors in overweight and obese children in ITALY

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

ISPED:

Italian Society of Pediatric Endocrinology and Diabetology

eGFR:

Estimated glomerular filtration rate

HOMA-IR:

Homeostasis model assessment of insulin resistance

NAFLD:

Non-alcoholic fatty liver disease

OW:

Overweight

OB:

Obesity

OR:

Odds ratio

SBP:

Systolic blood pressure

TG/HDL:

Triglycerides-to-HDL cholesterol ratio

UA:

Uric acid

WHtR:

Waist-to-height ratio

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Funding

G. Valerio was supported by Fondo di sostegno alla ricerca individuale di Ateneo, Anno 2017, University of Naples Parthenope.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, “S. Maria delle Grazie” Hospital, Pozzuoli, Italy

    P. Di Bonito

  2. Department of Movement Sciences and Wellbeing, University “Parthenope”, Naples, Italy

    G. Valerio

  3. Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    M. R. Licenziati & G. Campana

  4. Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    E. Miraglia del Giudice & A. Di Sessa

  5. Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy

    M. G. Baroni

  6. Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy

    A. Morandi & C. Maffeis

  7. Research Area for Multifactorial Disease, Children’s Hospital Bambino Gesù, Via Ferdinando Baldelli 38, 00146, Rome, Italy

    M. R. Spreghini, G. Morino, A. Crinò & M. Manco

  8. Institute of Translational Pharmacology, National Research Council, Rome, Italy

    C. Chiesa

  9. Policlinico Umberto I Hospital, “Sapienza” University of Rome, Rome, Italy

    L. Pacifico

Authors
  1. P. Di Bonito
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  2. G. Valerio
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  3. M. R. Licenziati
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  4. E. Miraglia del Giudice
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  10. A. Di Sessa
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  14. L. Pacifico
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  15. M. Manco
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Contributions

PB conceived and designed the study, analyzed data and interpreted, drafted and revised the manuscript for important intellectual content. GV interpreted data drafted and revised the manuscript for important intellectual content. MRL, EMG, MGB, AM, CM, GC, MRS, AS, GM, AC, CC, LP, acquired data and revised the draft for important intellectual content. MM conceived and designed the study, acquired and interpreted data, drafted the manuscript and revised it for important intellectual content. All the authors approved the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved.

Corresponding author

Correspondence to M. Manco.

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The authors have no conflicts of interest relevant to this manuscript to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All participating centers obtained informed consent from parents of subjects included in the study.

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Di Bonito, P., Valerio, G., Licenziati, M.R. et al. High uric acid, reduced glomerular filtration rate and non-alcoholic fatty liver in young people with obesity. J Endocrinol Invest 43, 461–468 (2020). https://doi.org/10.1007/s40618-019-01130-6

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  • DOI: https://doi.org/10.1007/s40618-019-01130-6

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