Serum uric acid levels among children and adolescents in China: percentile reference values and national prevalence estimates of hyperuricemia

No nationally representative cut-offs of serum uric acid (SUA) have been proposed for screening high SUA levels in children and adolescents in China. We aim to develop percentile cut-offs for SUA among children and adolescents based on the China national survey. We used SUA data from 42,227 normal-weight children and adolescents aged 6–17 years from the China National Nutrition and Health Survey of Children and Lactating Mothers conducted in 2016—2017. Age- and sex-specific percentile values for SUA were established using the General Additive Model for Location Scale and Shape (GAMLSS). Appropriate SUA cut-offs were selected according to the association between high SUA levels and the clustering of metabolic syndrome (MetS) risk factors. Furthermore, we assessed the effectiveness of the established cut-offs in screening high SUA levels compared with the adult cut-offs. We determined smoothed age- and sex-specific SUA percentiles (P3-P97) using a normal-weight sample, showing a sharp increase in SUA levels in boys and a steady rise in girls from age 10, with both genders leveling off between ages 14 and 17. Based on the association of high SUA levels with ≥ 2 or ≥ 3 MetS risk factors, the P90 level of SUA could be a potential threshold for screening high SUA. Furthermore, we suggest simplified SUA cut-offs based on P90 values: for boys, > 360 μmol/L (ages 6–9), > 400 μmol/L (ages 10–12), and > 500 μmol/L (ages 13–17); for girls, > 350 μmol/L, > 380 μmol/L, and > 400 μmol/L. In the 2016–2017 Chinese national survey, the prevalence of high SUA was 13.2% with P90 cut-offs, 12.9% with simplified cut-offs, and 15.9% with adult cut-offs. Overweight and obese children and adolescents showed higher rates: 18.2% and 29.7% (P90), 17.6% and 28.5% (simplified), and 21.7% and 29.9% (adult). The newly established SUA cut-offs, including the P90 values by age and sex and the simplified cut-offs, could be useful for screening high SUA levels or hyperuricemia among children and adolescents in China. The prevalence of high SUA in Chinese children and adolescents is concerning, particularly within overweight and obese populations.