|Year : 2018 | Volume
| Issue : 2 | Page : 133-137
Obesity and serum uric acid in secondary school-age students of srinagarindra the princess mother school, Phayao, Thailand
Wanpen Suttikomin1, Preeya Leelahagul2, Suphawan Khamvang3, Chamnong Chaimongkol4, Nanticha Chaiwut4
1 Graduate Student in Doctor of Philosophy Program in Nutrition, Nutrition, Faculty of Medicine Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Bangkok, Thailand
2 Associate Professor of Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Bangkok, Thailand
3 Director, Srinagarindra The Princess Mother School, Phayao, Thailand
4 Instructor, Srinagarindra The Princess Mother School, Phayao, Thailand
|Date of Web Publication||14-Jun-2018|
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama Vi Road, Ratchathewi, Bangkok 10400
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Obesity and hyperuricemia are the precipitating factors of multiple disease processes. Studies on the relationship between obesity and hyperuricemia in Thai adolescents are limited. Objective: The objective is to investigate the gender differences in obesity and serum uric acid as well as the relationship between obesity and serum uric acid levels in secondary school-age students. Methods: A cross-sectional study conducted among 689 secondary school-age students; 313 boys and 376 girls. Body composition and fasting serum uric acid were assessed. This study defined hyperuricemia as serum uric acid >6 mg/dL in girls and >7 mg/dL in boys. Results: By body mass index (BMI) for age and percentage of body fat classification, the prevalences of obesity were 11.5% and 9.0%, respectively. Prevalence of obesity by BMI for age, 15.3% and percentage of body fat, 12.4% in boys were statistically significantly higher than those in girls, 8.2% and 6.1%, respectively. Boys in all age groups had statistically significantly higher serum uric acid levels than those in girls as well as serum uric acid levels at late adolescent period in both sexes were statistically significantly higher than those at early adolescent period. Conclusion: On multivariate analysis, the demographic factors studied showed that boys, late adolescence period, and excess body fat adolescents had higher prevalence of hyperuricemia in secondary school-age students who have their birthplace in 8 provinces of Northern Thailand. This indicated that early nutritional management and encourage obese adolescents to weight and serum uric acid reductions are important for the prevention of diet-related chronic diseases in their adult period.
Keywords: Adolescents, dietary habits, obesity, Srinagarindra the Princess Mother School, uric acid
|How to cite this article:|
Suttikomin W, Leelahagul P, Khamvang S, Chaimongkol C, Chaiwut N. Obesity and serum uric acid in secondary school-age students of srinagarindra the princess mother school, Phayao, Thailand. Indian J Public Health 2018;62:133-7
|How to cite this URL:|
Suttikomin W, Leelahagul P, Khamvang S, Chaimongkol C, Chaiwut N. Obesity and serum uric acid in secondary school-age students of srinagarindra the princess mother school, Phayao, Thailand. Indian J Public Health [serial online] 2018 [cited 2020 Sep 25];62:133-7. Available from: http://www.ijph.in/text.asp?2018/62/2/133/234493
| Introduction|| |
The World Health Organization reported that obesity is a problem in many countries including Thailand and it leads to many diet-related chronic diseases. More than 60% of overweight children have at least one additional risk factor for cardiovascular disease. More than 20% of obese children have two or more risk factors. Therefore, childhood obesity is a predictor of adult obesity and obesity-related disorders.
Uric acid is the end product of purine metabolism in humans due to the loss of uricase activity by various mutations of its gene, which led to humans having higher uric acid levels than other mammals.
Asayama et al. found that hyperuricemia was one of the metabolic derangements associated with obesity among Japanese obese children aged >5 years old. Oyama et al. studied the incidence of hyperuricemia in 1729 Japanese healthy early adolescents (9–15 years old). This study revealed the incidence of hyperuricemia was 8.8% in boys and 0.6% in girls; these data pointed out that hyperuricemia had positive correlation with degree of obesity. Ford et al. conducted a survey in 1370 US children and adolescents aged 12–17 years old. This cross-sectional study showed that the participants who had the levels of serum uric acid >5.7 mg/dL were 14.7 times (95% confidence interval CI 7.8–28.1) higher to develop the metabolic syndrome than those who had uric acid levels <4.9 mg/dL. In 2009–2013, many researchers.,, studied in secondary school-age students of the Northern region of Thailand found that the prevalence of obesity based on BMI for age in students was 6.7%–29.0%. Their range of serum uric acid levels was 3.8–11.7 mg/dL.
Therefore, the researcher is interested to study this relationship in Thai adolescents, starting the first study in the Northern region of Thailand. The specific objectives of the study were to find out the gender differences in obesity and serum uric acid as well as the relationship between obesity and serum uric acid levels in secondary school-age students.
| Materials and Methods|| |
Study design and subjects
The cross-sectional study conducted among Northern Thai adolescents who living in 8 Northern Thailand provinces, including Chiang Rai, Chiang Mai, Lampang, Lamphun, Phrae, Nan, Mae Hong Son, and Phayao. This study recruited those Northern Thai adolescents who were 689 students of a public secondary school in Royal Honour: Srinagarindra the Princess Mother School, Phayao (SW.PY.), aged 12–18 years during 2013 academic year.
All 12–18 years students of SW. PY. in 2013 academic year were included in the study.
Students who cannot participate throughout this study or who have some chronic diseases, e.g., liver disease, kidney disease, heart disease, thyroid disease, and thalassemia were also excluded from the study.
General and health information
General and health information including personal habits, food behaviors, and family history were collected with questionnaires.
Body composition assessment
Body composition parameters including height, body weight, body mass index (BMI), percentage of body fat, fat mass, and muscle mass were assessed by TANITA BC-420 MA Body Composition Analyzer, Tanita Corporation, Tokyo, Japan.
Fasting blood samples were collected from each student after an overnight fast (8 h) for serum uric acid level, which analyzed using the automated blood BS-400 Chemistry Analyzer, Mindray Bio-Medical Electronics Co. Ltd.
Body weight status
Body weight status was classified on the age- and sex-specific BMI percentiles provided in the WHO technical report: the use and interpretation of anthropometry: Underweight was defined as a BMI less than the 5th percentile, normal weight was defined as a BMI 5th percentile to less than the 85th percentile, overweight was defined as a BMI 85th to less than the 95th percentile, and obese was defined as a BMI 95th percentile or greater.
Body fat status
Body fat status was classified on the age- and sex-specific body fat provided in the child growth foundation for clinical monitoring of body fat: low body fat was defined as a percentage of body fat less than the 5th percentile, normal body fat was defined as a percentage of body fat 5th percentile to less than the 85th percentile, over body fat (obese) was defined as a percentage of body fat 85th to less than the 95th percentile, and excess body fat (obese) was defined as a percentage of body fat 95th percentile or greater.
Uric acid status
Hyperuricemia in adolescent has been defined as a fasting serum uric acid more than 6 mg/dL in girls and more than 7 mg/dL in boys.
Ethic approval and permissions
The study was approved by the ethical clearance committee on human rights related to Research Involving Human Subjects Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Written informed consents were obtained from students and legal guardians.
Statistical analyses were performed using the SPSS software package version 18.0 for Window (SPSS Inc., Chicago, IL, USA). Compare the difference data using independent t-test. One-way ANOVA with post hoc (Tukey) analysis was used to analyze the mean ± standard deviation (SD) of serum uric acid among different body weight status and body fat status subgroups. Chi-square test was performed to obtain associations among body composition parameters, serum uric acid level, and various factors. Multivariate analysis was performed using logistic regression to identify various risk factors (independent variables) of hyperuricemia (dependent variable). Variables, which were significantly associated (P < 0.05) in bivariate analysis were included in the multivariate analysis. Adjusted odds ratio (OR) was calculated to measure the independent effect of the risk factors. To assess the independent association of the covariates with the presence of hyperuricemia, all covariates for hyperuricemia were included in one logistic regression model using forward stepwise. The results are presented as mean ± SD for continuous variables and percentage for categorical variables. Two-tailed P values were considered to be statistically significant when P < 0.05.
| Results|| |
This cross-sectional study was conducted among 689 Northern Thai adolescents: 313 boys and 376 girls. Adolescent was divided into 2 periods: Early adolescence (12–14 years of age) and late adolescence (15–18 years of age). Our results are presented based on adolescence periods.
A two-component model of body composition divided the body into a fat component and fat-free component. In both adolescence periods, height, weight, and muscle mass in boys were statistically significantly higher than those in girls, whereas the fat component including percentage of body fat and fat mass in girls were statistically significantly higher than those in boys [Table 1].
|Table 1: Mean±standard deviation of body composition parameters and serum uric acid level classified by gender and adolescence period|
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When comparison was made between adolescent periods within the same sex and total participants, height, weight, and muscle mass at late adolescent period were statistically significantly higher than those at early adolescent period [Table 1].
Boys in all age groups had statistically significantly higher serum uric acid levels than those in girls as well as serum uric acid levels at late adolescent period in both sexes were statistically significantly higher than those at early adolescent period [Table 1].
[Table 2] showed the prevalences of underweight, normal weight, overweight, and obese classified by BMI for age, as well as [Table 3], showed prevalences of low body fat, normal body fat, over body fat, and excess body fat classified by percentage of body fat. We found the prevalence of obesity by BMI for age, 15.3% (χ2 = 14.92, P = 0.002) and percentage of body fat, 12.4% (χ2 = 24.32, P < 0.0001) in boys were statistically significant higher than those in girls, 8.2% and 6.1%, respectively.
|Table 2: Mean±standard deviation of serum uric acid levels of participants according to body weight status|
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|Table 3: Mean±standard deviation of serum uric acid levels of participants according to body fat status|
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Serum uric acid levels in obese boys by BMI for age and by excess body fat were statistically significantly higher than those in normal weight and normal body fat boys. However, these differences were not observed in girls [Table 2] and [Table 3]. In both obese by BMI for age and excess body fat, participants had highest mean serum uric acid levels.
The prevalence of hyperuricemia observed in participants is 19.6% [Table 4]. This research revealed that gender (χ2 = 19.10, P < 0.0001), adolescence period (χ2 = 7.61, P < 0.0001), body weight status (χ2 = 11.42, P < 0.01), and body fat status (χ2 = 14.47, P < 0.002) had effects on prevalence of hyperuricemia. In the multivariate analysis, In the multivariate analysis, boys compared to girls (adjusted OR = 2.24, P < 0.0001), late adolescence period compared to early adolescence period (adjusted OR = 1.61, P < 0.01) as well as excess body fat compared to normal body fat (adjusted OR = 3.72, P < 0.01) were found statistically significant with hyperuricemia [Table 4].
|Table 4: Demographic and body composition status associated with hyperuricemia|
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| Discussion|| |
The gender differences in adolescent body composition were the results of hormone and metabolism. Roemmich et al. have mentioned that the gender difference in leptin concentrations of boys and girls is related to differences in the amounts of subcutaneous fat and greater androgen concentrations in boys. Under the influence of testosterone, boys have a significant increase in the growth of bone and muscle. These evidence supported our findings, the higher muscle mass in boys at late adolescent than early adolescent period.
Our study revealed that the prevalence of obesity by BMI for age for boys was 15.3% while that for girls was 8.2%. The prevalence of obesity by over body fat and excess body fat were 12.4% in boys and 6.1% in girls. These prevalences were comparable with the previous studies from Thailand and Puerto Rico., They postulated that girls may have the awareness of weight control and body image but not in boys.
The mean of serum uric acid level in boys was higher than that in girls. This possibly due to the effects of sex hormones, estrogen on the postsecretory tubular reabsorption of uric acid in women, whereas androgen may play an important role in raising the plasma urate levels in males. The female hormone estrogen decreases serum uric acid. Costa et al. described serum uric acid levels in boys showed an upward trend throughout the adolescence period.
Premgamone et al. studied the prevalence of hyperuricemia and its related factors in the rural community, Khon Kaen province, Thailand. They reported that the prevalence of hyperuricemia was 11.8% of the total participants, consisting of 14.9% found in male and 8.6% in female. They found the association among prevalence of hyperuricemia with sex, especially in men, obesity, and high-purine food intake such as bamboo shoots, meat, and insects. In the present study, the prevalence of hyperuricemia had significant association with obesity which classified by BMI or percentage of body fat. Consistent with other studies, Tanaka study showed that BMI was significantly associated with uric acid, after adjusting for both genetic and familial factors in both men and women. Recently, a Mendelian randomization analysis, reported that uric acid levels were associated with BMI, and that reduction of BMI could help improve uric acid level. Nakagawa et al. studied in 1279 adolescents provided an association between obesity and hyperuricemia and suggested that uric acid level could be used as indicator of obesity in early adolescence.
| Conclusion|| |
The prevalence of hyperuricemia observed in 689 Northern Thai adolescents is 19.6%. The findings of the present study clearly indicate that hyperuricemia is a multifactorial condition associated with gender, adolescence period, and obesity. Especially, boys, late adolescence period, and obese adolescents had higher serum uric acid levels. Hyperuricemia is considered to be a common lifestyle disorder related with obesity. Thus, we recommend that early nutritional management and encourage obese adolescents to change behaviors for weight control and lower serum uric acid level. It is very important for reducing the incidence and severity of diet-related chronic diseases at the adult or aging periods. Further research is needed to determine in a large population and long-term study for causes and consequence of hyperuricemia in Thai adolescents.
We are grateful to SW. PY. students and their legal guardians for participation in this study. We have to express our appreciation to SW. PY. administrators and staffs for their continuing support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, et al.
Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment. J Am Heart Assoc 2005;111:1999-2012.
Jain S, Pant B, Chopra H, Tiwari R. Obesity among adolescents of affluent public schools in Meerut. Indian J Public Health 2010;54:158-60.
] [Full text]
Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences of childhood obesity. Gerontology 2014;60:222-8.
Álvarez-Lario B, Macarrón-Vicente J. Uric acid and evolution. Rheumatology (Oxford) 2010;49:2010-5.
Asayama K, Ozeki T, Sugihara S, Ito K, Okada T, Tamai H, et al.
Criteria for medical intervention in obese children: A new definition of 'obesity disease' in Japanese children. Pediatr Int 2003;45:642-6.
Oyama C, Takahashi T, Oyamada M, Oyamada T, Ohno T, Miyashita M, et al.
Serum uric acid as an obesity-related indicator in early adolescence. Tohoku J Exp Med 2006;209:257-62.
Ford ES, Li C, Cook S, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 2007;115:2526-32.
Rattanayosee Y, Leelahagul P. Obesity and cardiovascular risk factors in secondaryshool-aged students of princess Chulabhorn's college Chiangrai. Ann Nutr Metab 2009;55:667.
Puengputtho W, Leelahagul P, Klawisait K, Thongsuk N, Janthranant G, Hoiyeepho K. Salt intake and salt reduction in secondary school-age students of princess Chulabhorn's college Chiangrai (regional science school). Ann Nutr Metab 2013;63 Suppl 1:1229.
Satoh S, Leelahagul P, Khamvang S, Chaiwut N. Effect of obesity on self-esteem in secondary school-age students of Northern Region of Thailand. Ann Nutr Metab 2013;63 Suppl 1:1285.
Leelahagul P, Klawisat K, Kongpun P, Udomlap J, Janthranant G, Hoiyeephoo K. Segmental bioelectrical impedance analysis in Northern Thai secondary school-age students (pcccr). Ann Nutr Metab 2013;63 Suppl 1:1426.
Report of a WHO Expert Committee. WHO Technical Report Series 854: Physical Status: The Use and Interpretation of Anthropometry. Geneva: WHO; 1995. p. 293.
McCarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes (Lond) 2006;30:598-602.
Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med 2008;359:1811-21.
Levesque R. SPSS Programming and Data Management: A Guide for SPSS and SAS Users. 4th
ed. Chicago: SPSS Inc.; 2007.
Gatford KL, Egan AR, Clarke IJ, Owens PC. Sexual dimorphism of the somatotrophic axis. J Endocrinol 1998;157:373-89.
Roemmich JN, Clark PA, Mai V, Berr SS, Weltman A, Veldhuis JD, et al.
Alterations in growth and body composition during puberty: III. Influence of maturation, gender, body composition, fat distribution, aerobic fitness, and energy expenditure on nocturnal growth hormone release. J Clin Endocrinol Metab 1998;83:1440-7.
Marshall WA. The relationship of puberty to other maturity indicators and body composition in man. J Reprod Fertil 1978;52:437-43.
Sukhonthachit P, Aekplakorn W, Hudthagosol C, Sirikulchayanonta C. The association between obesity and blood pressure in Thai public school children. BMC Public Health 2014;14:729.
Elías-Boneta AR, Toro MJ, Garcia O, Torres R, Palacios C. High prevalence of overweight and obesity among a representative sample of Puerto Rican children. BMC Public Health 2015;15:219.
Antón FM, García Puig J, Ramos T, González P, Ordás J. Sex differences in uric acid metabolism in adults: Evidence for a lack of influence of estradiol-17 beta (E2) on the renal handling of urate. Metabolism 1986;35:343-8.
Nishida Y, Akaoka I, Nishizawa T. Effect of sex hormones on uric acid metabolism in rats. Experientia 1975;31:1134-5.
Hak AE, Choi HK. Menopause, postmenopausal hormone use and serum uric acid levels in US women – The Third National Health and Nutrition Examination Survey. Arthritis Res Ther 2008;10:R116.
Costa A, Igualá I, Bedini J, Quintó L, Conget I. Uric acid concentration in subjects at risk of type 2 diabetes mellitus: Relationship to components of the metabolic syndrome. Metabolism 2002;51:372-5.
Premgamone A, Ditsatapornjaroen T, Jindawong B, Krusun N, Kessomboon P. Theprevalence of hyperuricemia and associated factors in the rural community, Khon Kaen Province. Srinagarind Med J 2011;26:41-7.
Tanaka K, Ogata S, Tanaka H, Omura K, Honda C; Osaka Twin Research Group, et al.
The relationship between body mass index and uric acid: A study on Japanese adult twins. Environ Health Prev Med 2015;20:347-53.
Palmer TM, Nordestgaard BG, Benn M, Tybjærg-Hansen A, Davey Smith G, Lawlor DA, et al.
Association of plasma uric acid with ischaemic heart disease and blood pressure: Mendelian randomisation analysis of two large cohorts. BMJ 2013;347:f4262.
Nakagawa T, Tuttle KR, Short RA, Johnson RJ. Hypothesis: Fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat Clin Pract Nephrol 2005;1:80-6.
[Table 1], [Table 2], [Table 3], [Table 4]