Serum Uric Acid as a Risk Factor for Cardiometabolic Disease in Children: A Systematic Review

Background: Cardiometabolic diseases (CMD), including obesity, hypertension, and metabolic syndrome (MS), are increasingly prevalent in pediatric populations. Early identification of biomarkers associated with cardiometabolic risk is essential for effective prevention. Serum uric acid (UA), traditionally linked to gout and renal disease, has recently emerged as a potential marker and mediator of metabolic dysfunction. Aim: This systematic review aimed to evaluate the relationship between serum UA levels and cardiometabolic risk factors in children and adolescents and to determine whether UA functions as an independent risk factor or a biomarker of CMD. Methods: A systematic literature search was conducted using PubMed, ScienceDirect, and Google Scholar for studies published up to 2025. Keywords included “uric acid,” “children,” “adolescents,” “cardiometabolic risk,” “metabolic syndrome,” “obesity,” “insulin resistance,” and “hypertension.” Eligible studies included original research and reviews involving individuals aged 0–18 years. A qualitative analisys was performed focusing on associations between UA and specific cardiometabolic conditions. Results: Elevated UA levels were consistently associated with obesity, MS, hypertension, and early markers of atherosclerosis in children. UA showed strong correlations with body mass index and waist circumference and may help distinguish between metabolically healthy and unhealthy obesity phenotypes. Higher UA levels were also linked to primary hypertension and appeared to precede its development. Additionally, UA was associated with increased carotid intima–media thickness, suggesting a role in early vascular changes. However, the strength of these associations was sometimes reduced after adjusting for confounding factors such as adiposity and insulin resistance. Conclusions: Serum UA is closely associated with multiple cardiometabolic risk factors in pediatric populations and may serve both as a biomarker and a potential contributor to early disease processes. Although its causal role remains uncertain, UA represents a promising, accessible marker for early risk stratification. Further longitudinal and interventional studies are needed to clarify its clinical utility and determine whether reducing UA levels can improve cardiometabolic outcomes in children.