Nutrition, Metabolism & Cardiovascular Diseases (xxxx) xxx, xxx

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Nutrition, Metabolism & Cardiovascular Diseases

journal homepage: www.elsevier.com/locate/nmcd

Uricaemia and associated health determinants in a paediatric

population in Mexico
E. Lares-Villaseñor a, S. Salazar-García a, P.E. Cossío-Torres b, C. Aradillas-García b,
D.P. Portales-Pérez a, J.M. Vargas-Morales a
a
Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, Mexico
b
Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Mexico

Received 21 September 2021; received in revised form 11 February 2022; accepted 14 February 2022
Handling Editor: A. Siani
Available online - - -

KEYWORDS Abstract Background and aim: Uric acid (UA) is a product of the catabolism of purines, and its
Uric acid; increase in blood may be related to the development of cardiometabolic diseases. Whether UA is
Health determinants; the result or causal determinant of the appearance of risk factors for cardiometabolic disease is
Cardiometabolic not yet known. UA levels among the young student population in San Luis Potosi have increased
diseases in recent years, which may be indicative of a serious future public health concern. Therefore, the
objective of this study was to evaluate the association of sociodemographic, lifestyle and cardi-
ometabolic determinants with UA levels in children and adolescents in San Luis Potosí.
Methods and results: A total of 730 students (54.1% female and 45.9% male, 6e19 years old) partic-
ipated in the study. The subjects attended one of five public schools located in San Luis Potosí.
Venous blood samples were collected, blood serum was separated by centrifugation, and UA concen-
trations were measured with an automated analytical platform. UA was associated with most of the
independent variables studied. It presented a positive correlation with body mass index (r Z 0.363,
p < 0.01). Male sex, socioeconomic status, total screen time, exercise, adequate sleep, systolic blood
pressure, total cholesterol, and high-density lipoprotein cholesterol explained 23%e39% (p < 0.001)
of the variability of plasma concentrations of UA in children and adolescents.
Conclusion: Early detection of these determinants will prevent future diseases. Moreover, it will help
with the implementation of preventive strategies that could improve the health of this population.
ª 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian
Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II Univer-
sity. Published by Elsevier B.V. All rights reserved.

1. Introduction deaths worldwide [4]. Overweight and obesity in school-

The determinants of health encompass individual, social,
economic, environmental, biological, nutritional, and cul-
tural factors, among others [1e3]. Specifically, the greater
accessibility and use of electronic screens, unhealthy diet,
physical inactivity and alterations in the biochemical
components of plasma have led to the development of
cardiometabolic diseases, which cause 80% of premature
E-mail address: juan.vargas@uaslp.mx (J.M. Vargas-Morales).
children have increased in recent years, leading to higher
cardiometabolic risk at an early age. For example, in
Mexico, the National Health and Nutrition Survey revealed
that more than 30% of children and adolescents were
overweight and obese [5], and most of them presented
comorbidities such as borderline blood pressure, dyslipi-
daemia, insulin resistance (IR), prediabetes and hyper-
uricaemia [6,7], generating high expenditures in public
health [8].
Uric acid (UA) is the product of the catabolism of endog-
enous purines and exogenous sources [9,10], which appears

https://doi.org/10.1016/j.numecd.2022.02.010
0939-4753/ª 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical
Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
2 E. Lares-Villaseñor et al.

to contribute to the elimination of purine residues from the
body or serves as an antioxidant [11,12]. Additionally, there is
more evidence of the relationship between increased UA
levels and the appearance of cardiometabolic diseases
[13e15] associated with hypertension, IR, obesity, and
metabolic syndrome (MS), among others, during childhood
and adolescence [2,16,17]. Consequently, elevated UA levels
could be an alternative marker to assess cardiometabolic risk
in schoolchildren. However, it has not yet been described
whether hyperuricaemia is a cause or effect of diseases with
cardiometabolic risk [15,18e20]. In this sense, sociodemo-
graphic, lifestyle and cardiometabolic determinants could
influence UA levels in young people; nevertheless, the
availability of such data is still limited for young Mexicans.
Therefore, the objective of this work was to evaluate the
association of these health determinants with UA levels in
children and adolescents attending public schools in San Luis
Potosí, México.
2. Methods
2.1. Study population
The subjects were selected in a stratified manner from
different elementary, middle and high schools located in five
cities of the state of San Luis Potosí, México: Ahualulco,
Moctezuma, San Luis Potosí, Matehuala and Villa de
Guadalupe (Fig.1). The data were collected in the period from
2015 to 2016. A total of 955 schoolchildren agreed to partic-
ipate; however, only 730 Mexican subjects between the ages
of 6 and 19 provided complete data on anthropometric,
clinical and biochemical variables and a written consent
letter from the participant’s parent or guardian. The study
was approved by the State Committee for Ethics in Health
Research of the State of San Luis Potosí, SLP/003e2015.
2.2. Variables
The variables were classified as sociodemographic, lifestyle
and cardiometabolic variables. The variables were
considered independent variables, while UA plasma levels
were the dependent variable.
2.3. Measurement tools
All the information on the sociodemographic and lifestyle
variables was collected through a questionnaire that was
designed for this purpose. The questionnaires were
answered by the children and adolescents together with
their parents.
2.3.1. Evaluation of sociodemographic variables
Age, sex, and socioeconomic status were included. Socio-
economic status was measured using a socioeconomic

Figure 1 Study area. Location of the different elementary, middle and high schools education centres from which the data were collected, located in
the municipal seats of San Luis Potosí, Mexico: (a) Ahualulco, Moctezuma, San Luis Potosí, (b) Matehuala and Villa de Guadalupe according to the
degree of marginalization.

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
Uricaemia and associated health determinants 3

level index (SES) established by the Mexican Association of
Opinion Agencies and Market Intelligence (AMAI), which
classifies Mexican families based on their level of satis-
faction of essential household needs [21].
2.3.2. Assessment of lifestyle variables
Among the variables related to lifestyle, we assessed the
time in hours spent in front of cell phones, video games
and television, exercise patterns, hours of sleep and diet.
The exercise pattern was categorized as adequate or
inadequate depending on the answers provided in the
questionnaire. According to the recommendations made
by the World Health Organization [22], children and ado-
lescents who engaged in at least 60 min per day of pri-
marily moderate-to vigorous-intensity aerobic physical
activity during the week or at least three days per week of
vigorous-intensity aerobic activity were classified as hav-
ing adequate activity levels. The sleep pattern was cate-
gorized as adequate (more than 8 h a day) or inadequate
according to the National Sleep Foundation’s sleep time
duration recommendations [23]. The diet was evaluated
based on an adapted and validated healthy eating index for
the Mexican population [24].
2.4. Statistical analysis
The normality of the data was examined using the
KolmogoroveSmirnov test. To evaluate the association, the
Spearman correlation coefficient and multiple linear
regression were used. To perform a multiple linear regres-
sion, different models were built with the independent var-
iables, while also considering sex and exercise patterns. The
final models included all the variables with correlations
<0.300 and p values < 0.05 as well as a variance inflation
factor (VIF) < 4 to avoid multicollinearity. All analyses were
performed using SPSS software, version 20.0 (SPSS Inc.,
Chicago, IL, USA).
3. Results
The sample included 730 subjects, of whom 395 were
women (Table 1). Regarding the socioeconomic level, close
to 60% had their basic needs covered, although with a
higher proportion of the expenditure allocated for trans-
portation, food, beverages and personal care. A total of
38.8% did not exercise regularly (less than 3 times a week).

2.3.3. Evaluation of cardiometabolic variables

2.3.3.1. Anthropometric measurement Height was assessed Table 1 Sociodemographic determinants and lifestyle characteris-
with a SECA 213, 205 mobile stadiometer (Seca 213, Seca, tics (n Z 730).
Hanover, MD, USA, 2009) [25]. The weight was obtained Variable Category n or average % ors SD
using calibrated electronic equipment TANITAUM-081
Sex Male 335 45.9
(Tanita UM-081, Tokyo, Japan). Body mass index (BMI) Socioeconomic Female 395 54.1
was calculated using Quetelet’s formula (weight/height2 level
[kg/m2]). BMI for age percentiles (pBMI) for boys and A/B (193 þ)c Planning and 43 6.2
girls were established as well [26]. future
Cþ (155e192)c Entertainment 96 13.9
and
2.3.4. Blood pressure communication
Blood pressure was taken on the dominant arm in the C (128e154)c Practical life 143 20.7
sitting position using appropriately sized Welch Allyn cuffs C (105e127)c Minimum of 169 24.5
following clinical standards [27,28]. practicality
Dþ (80e104)c Basic sanitary 132 19.1
conditions
2.3.5. Biochemical measurements D (33e79)c Walls and some 105 15.2
Fasting venous blood samples were collected from the services
forearm using standard techniques. The previously labelled E (0e32)c Shortage 2 0.3
samples were placed in a secondary container and then in a Time in front of TV 2.12a 1.47b
electronic Cell phones 2.15a 2.35b
rigid thermal tertiary container identified as containing screens Videogames 0.64a 1.22b
infectious material. Cold packs were used to maintain the Total screen time 4.90a 3.33b
internal temperature of the thermal box. The blood samples Hours of sleep e 8.36a 1.74b
were transported to a laboratory where the blood serum Sleep pattern Adequate 397 70.1
was separated by centrifugation. Inadequate 169 29.9
Exercise pattern Adequate 443 61.2
Finally, the blood serum samples were transported Inadequate 281 38.8
using the same technique previously described to a single Healthy eating Adequate 7 1
central laboratory in the capital of San Luis Potosí for index Inadequate 660 99
analysis. Serum concentrations of total cholesterol, low- a
Mean in hours; bSD Z Standard deviation; c Socioeconomic level
density lipoprotein cholesterol (LDL), high-density lipo- (scores). Note: The exercise pattern was classified as adequate when
protein cholesterol (HDL), triacylglycerols and UA were > 1 hour daily or > 1 hour for 3 times per week and inadequate
measured with a BS300 automated analytical platform when <1 hour daily or <1 hour for 3 times per week. The sleep
pattern was made by categorizing it as adequate at least 8 hours per
(Mindray, Nanshan, Shenzhen, China) following internal
day.
protocols and the use of commercially available reagents.

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
4 E. Lares-Villaseñor et al.

Moreover, 9 out of 10 subjects had an inadequate diet (low
consumption of fibre, fruits and vegetables). The other
parameters are summarized in Table 2. pBMI was also
analysed by age percentiles for boys and girls. The pBMIs
were as follows, respective to sex: 5th percentile (14.14 kg/
m2, 14.62 kg/m2), 25th percentile (16.41 kg/m2, 17.18 kg/
m2), 50th percentile (19.31 kg/m2, 20.29 kg/m2), 85th
percentile (25.35 kg/m2, 25 kg/m2), and 95th percentile
(29.77 kg/m2, 29.23 kg/m2). According to these results, 85
out of 100 boys and girls had BMIs lower than 25 kg/m2;
therefore, 15% qualified as overweight or obese.
Increased age, socioeconomic level, time in hours spent
using cell phones and video games, BMI, systolic and dia-
stolic blood pressure, total cholesterol, LDL cholesterol and
triacylglycerols were found to correlate positively with
uricaemia. In contrast, sleeping more than 8 h per day and
high serum HDL cholesterol levels showed negative corre-
lations with UA (Table 3). On the other hand, when cate-
gorizing by sex, we found that most of the variables were
significantly correlated with UA levels, except for time in
front of the television, total cholesterol, LDL cholesterol, and
eating index in boys. In contrast, in girls, BMI, systolic blood
pressure, total cholesterol, HDL cholesterol, LDL cholesterol,
and triacylglycerols were the only variables that were
significantly correlated with UA levels (Table 3).
The multiple linear regression models are summarized
in Table 4. Most of the variables were associated with and
predicted the levels of uricaemia, so they appear to be
important clinical factors in the prediction of serum UA
concentrations, except for socioeconomic level, the total
time in hours in front of electronic screens and diastolic
blood pressure. In particular, Models 2a and 2b offered
greater explanatory value UA serum concentrations than
the rest of the models, accounting for 26.1% and 23.7% of
the variance, respectively.
In Model 2b, the subjects who exercised less than 3 times
per week showed an association with a decrease of
0.312 mg/dL of UA. On the other hand, in Model 2a, being
male qualified as a risk determinant because increases in
uricaemia levels were found at 0.522 mg/dL compared to
females. Interestingly, when categorized by sex (Table 5),
the different models explained between 24% and 39% of the
variations in serum UA concentrations in boys compared to
girls.
4. Discussion
Uricaemia has been found to be related to the onset of car-
diometabolic diseases that increasingly affect younger pop-
ulations. However, the limited information available on the
young Mexican population makes it difficult to clarify the
possible influence of health determinants on UA levels.
Consequently, this research focused on evaluating the asso-
ciation of sociodemographic, lifestyle and cardiometabolic

Table 2 Characteristics of the cardiometabolic risk determinants.

Total sample (n Z 730)

Variable Average SD Median Minimum-maximum
a
Uric acid 4.8 1.31 4.7 1.6e10.2
BMI 20 4.59 20 12e38
Systolic blood pressure 115 12.98 114 40e108
Diastolic blood pressure 65 9.25 65 40e108
Total Cholesterola 150 29.68 148 27e276
HDL Cholesterola 54.4 11.51 53.2 5.4e110.4
LDL Cholesterola 76.4 24.92 74.1 15.9e199.9
Triacylglycerolsa 98 54.77 84 23e608
Male (n Z 335)
Uric acida 5.1 1.42 4.9 1.9e10.3
BMI 20 4.93 19 12e38
Systolic blood pressure 117 14.38 116 78e162
Diastolic blood pressure 65 9.63 64 40e105
Total Cholesterola 150 28.80 148 86e240
HDL Cholesterola 55.3 11.60 54.2 29.9e110.4
LDL Cholesterola 76.1 24.11 73.2 22.0e155.6
Triacylglycerolsa 92 56.63 79 23e608
Female (n Z 395)
Uric acida 4.6 1.15 4.5 1.6e9.6
BMI 20 4.29 20 13e36
Systolic blood pressure 113 11.47 113 72e150
Diastolic blood pressure 66 8.90 66 43e108
Total Cholesterola 151 30.43 149 27e276
HDL Cholesterola 53.7 11.39 52.5 5.4e91.5
LDL Cholesterola 77 25.60 74 16e200
Triacylglycerolsa 103 86 53 23e333
BMI Z Body mass index (kg/m2); BP Z Blood pressure (mmHg); SD Z Standard deviation.
a
Units expressed in mg/dL.

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
Uricaemia and associated health determinants 5

determinants with UA serum levels in Mexican children and

STES: Sum of total time in hours in front of electronic screens; BMI: Body mass index (kg/m2); SBP: Systolic blood pressure (mmHg); DBP: Diastolic blood pressure (mmHg); TC: Total cholesterol (mg/
dL); HDL: HDL cholesterol (mg/dL); LDL: LDL cholesterol (mg/dL); TG: Triacylglycerols (mg/dL); HEI: Healthy eating index (scores); UA: Uric acid (mg/dL). ** The correlation is significant at p < 0.01
Age (years); SES: Socioeconomic level (scores); TV: Time in hours in front of the TV; Sleep (hours); Cell phone: time in hours spent looking at cell phones; VG: Time in hours in front of video games;
0.041

0.108
adolescents.

0.018
HEI
We found that the significant predictor variables of
elevated UA levels were age, male sex, excessive use of cell
phones or video games, exercising more than 3 times a

0.217**

0.242**
0.262**
week, sleeping less than 8 h a day, increased BMI, elevated
TG

systolic blood pressure, high triacylglycerol levels, total

0.132** cholesterol and LDL cholesterol, and low HDL cholesterol

0.205**
levels. These differences were more noticeable in boys
0.069
LDL

than in girls, in addition to high diastolic blood pressure

and high socioeconomic level.
The positive correlation found between age and UA was
L0.222**

L0.326**

L0.171**
consistent with the study by Luciano et al., wherein the
correlation and multiple analysis found that age predicted
HDL

an increase in UA levels [29]. UA levels change during

development, gradually increasing from birth to early
0.104**

0.205**

adolescence in both sexes [30]. The increase in UA levels is

0.021

more pronounced at puberty due to hormonal changes. This

TC

could be explained by an increase in testosterone, which is a

hormone capable of stimulating muscle anabolism, with
0.143**

0.290**

muscle mass being a main source of purines; this factor,

0.023
DBP

together with an increased metabolism of adenosine

triphosphate, might promote an increase in UA [31].
Regarding sex, other studies have reported that UA
0.278**

0.424**

0.099**

values are higher in men than in women [32e34]. Addi-

SBP

tionally, several studies indicate that high UA levels in men

are affected by the onset of puberty, differences in body
0.363**

0.548**

0.225**

mass, and hormonal effects such as testosterone, as

BMI

testosterone can inhibit UA excretion, while oestrogen can

promote its excretion [31,35,36].
Socioeconomic level showed a positive correlation with
0.124**

0.256**

0.008

UA concentrations; however, this factor did not predict UA

STES

levels when analysed in the total sample, in contrast, it

was a predictive factor when analysed by sex.
Some authors mention that individuals in countries
0.177**

0.175**

0.039

with higher economic incomes have a higher risk of

VG

suffering from cardiometabolic disease [37,38]. However,

some studies indicate the opposite [39,40]. Thus, more
Table 3 Spearman’s correlations of determinants with uric acid levels.

Cell phone

studies are needed to evaluate the association between

0.097**

0.257**

0.018

socioeconomic level and UA levels considering place of

(bilateral). * The correlation is significant at p < 0.05 (bilateral).

residence and educational level.

No studies were found describing the relationship be-
tween prolonged time in front of electronic screens and
L0.251**

L0.480**

UA. Rojas et al. indicated that there is a relationship be-

0.095
Sleep

tween a sedentary lifestyle and uricaemia [41]. Reilly et al.

mentioned that young people who spend more time in
front of electronic screens are more likely to be identified
0.005

0.019

as having a sedentary lifestyle [42].

0.044

It would be interesting to speculate that increased pe-

TV

riods of time in front of electronics is related to a sedentary

lifestyle while at the same time be reflected in UA con-
0.119**

0.194**

0.030

centrations. On the other hand, it has been shown that

Total sample (n Z 730)
SES

more time in front of electronic screens is associated with

Female (n Z 395)

a higher intake of cardiogenic foods, such as energy snacks

Male (n Z 335)
0.234**

0.526**

and sugary drinks. Sugary drinks containing fructose are

0.023

associated with hyperuricaemia because depletion of

Age

intracellular phosphate and adenosine triphosphate occurs

during fructose metabolism. Thus, the generation and
UA

UA

UA

degradation of adenosine monophosphate by adenosine

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
6 E. Lares-Villaseñor et al.

Table 4 Final models of multiple linear regression analysis for uric acid levels.

Model Independent variable Coefficient (b) SD p R2

Unstandardized Standardized
1a Age 0.093 0.256 0.013 <0.001* 0.121
SES 0.002 0.062 0.001 0.095
Time in front of video games 0.097 0.091 0.040 0.016*
Sex (Male vs. Female) 0.516 0.195 0.101 <0.001*
1b Age 0.093 0.256 0.013 <0.001* 0.126
SES 0.002 0.051 0.001 0.171
Time in front of video games 0.149 0.139 0.038 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.541 0.199 0.098 <0.001*
2a Hours of sleep 0.115 0.152 0.031 <0.001* 0.261
SES 0.002 0.056 0.001 0.165
Total time in front of electronic screens 0.014 0.036 0.015 0.367
Systolic blood pressure 0.028 0.291 0.004 <0.001*
Total cholesterol 0.007 0.149 0.002 <0.001*
HDL cholesterol 0.029 0.248 0.005 <0.001*
Sex (Male vs. Female) 0.522 0.197 0.102 <0.001*
2b Hours of sleep 0.099 0.132 0.031 0.001* 0.237
SES 0.002 0.060 0.001 0.145
Total time in front of electronic screens 0.016 0.042 0.016 0.294
Systolic blood pressure 0.030 0.313 0.004 <0.001*
Total cholesterol 0.006 0.135 0.002 0.001*
HDL cholesterol 0.027 0.227 0.005 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.312 0.118 0.102 0.002*
3a Time in front of the cell phone 0.079 0.141 0.020 <0.001* 0.150
Triacylglycerols 0.007 0.289 0.001 <0.001*
LDL cholesterol 0.005 0.091 0.002 0.011*
Sex (Male vs. Female) 0.633 0.241 0.092 <0.001*
3b Time in front of the cell phone 0.084 0.150 0.020 <0.001* 0.130
Triacylglycerols 0.007 0.268 0.001 <0.001*
LDL cholesterol 0.004 0.075 0.002 0.037*
Exercise pattern (Inadequate vs. Adequate) 0.527 0.195 0.096 <0.001*
4a Body mass index 0.102 0.361 0.010 <0.001* 0.201
Time in front of video games 0.088 0.083 0.037 0.019*
Total cholesterol 0.005 0.103 0.001 0.002*
Diastolic blood pressure 0.008 0.056 0.005 0.108
Sex (Male vs. Female) 0.491 0.188 0.092 <0.001*
4b Body mass index 0.101 0.357 0.010 <0.001* 0.206
Time in front of video games 0.136 0.128 0.036 <0.001*
Total cholesterol 0.004 0.094 0.001 0.005*
Diastolic blood pressure 0.008 0.059 0.005 0.091
Exercise pattern (Inadequate vs. Adequate) 0.513 0.192 0.090 <0.001*
*Significant relationship p < 0.05; SES Z socioeconomic level; SD Z standard deviation.

monophosphate deaminase leads to the synthesis of UA
[43,44].
The evaluation of exercise with UA showed a result that
was not consistent with other studies. It would be reasonable
to speculate that adequate exercise reduces the concentra-
tion of UA. However, our results indicated the opposite.
Although some authors conclude that the level of ex-
ercise can affect UA levels, specifically intense and acute
exercise causing increased UA concentrations [45,46],
more studies are needed to evaluate the effect of this
factor on UA levels using longer observation periods.
Research shows that prolonged aerobic exercise can lower
UA levels [45,47] in combination with a healthy diet [47].
Our data show that adequate sleep is associated with a
decrease in UA concentrations. This finding is interesting
and consistent with other results in young subjects [48]. In
fact, it has been observed that obese adolescents have
inadequate sleep caused by the development of tissue
hypoxia as a consequence of oxygen desaturation under-
lying respiratory disorders; therefore, tissue hypoxia could
lead to increased UA [49].
Elevated blood pressure values were positively associ-
ated with UA levels. These findings are consistent with the
results reported in previous studies [50,51]. This could be
because the increase in blood pressure leads to a reduction
in renal blood flow, which could stimulate the reabsorp-
tion of UA. On the other hand, UA levels >4 mg/dL should
be considered a warning sign for the development of car-
diovascular disease in young people [52].
Regarding BMI, different investigations confirm our
results [16,37,53], concluding that an increase in BMI
predicts the development of hyperuricaemia. Possible
mechanisms are as follows: obesity interferes with the
synthesis and excretion of urates [54], causes kidney
damage through glomerular dysfunction and can lead to
dysfunction of the renin-angiotensin system, resulting in

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
Uricaemia and associated health determinants 7

Table 5 Final models of multiple linear regression analysis for uric acid levels by sex.

Sex Model Independent variable Coefficient (b) SD p R2

Unstandardized Standardized
Male 1 Systolic blood pressure 0.035 0.355 0.005 <0.001* 0.340
SES 0.003 0.098 0.002 0.038*
HDL cholesterol 0.032 0.257 0.006 <0.001*
Triacylglycerols 0.005 0.190 0.001 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.401 0.130 0.143 0.005*
2 Hours of sleep 0.164 0.201 0.046 <0.001* 0.0336
Body mass index 0.126 0.434 0.017 <0.001*
Time in front of video games 0.002 0.002 0.052 0.969
Diastolic blood pressure 0.012 0.085 0.008 0.124
Exercise pattern (Inadequate vs. Adequate) 0.351 0.118 0.155 0.024*
3 Age 0.179 0.018 0.443 <0.001* 0.391
Time in front of video games 0.040 0.042 0.043 0.332
HDL cholesterol 0.032 0.263 0.005 <0.001*
Triacylglycerols 0.005 0.001 0.196 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.465 0.150 0.134 0.001*
4 Time in front of the cell phone 0.114 0.176 0.034 0.001* 0.243
Time in front of video games 0.054 0.057 0.048 0.261
HDL cholesterol 0.040 0.324 0.006 <0.001*
Diastolic blood pressure 0.024 0.162 0.008 0.002*
SES 0.005 0.146 0.002 0.004*
Exercise pattern (Inadequate vs. Adequate) 0.482 0.155 0.155 0.002*
Female 1 Body mass index 0.051 0.191 0.013 <0.001* 0.161
HDL cholesterol 0.005 0.054 0.005 0.273
LDL cholesterol 0.005 0.121 0.002 0.010*
Triacylglycerols 0.005 0.239 0.001 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.313 0.136 0.110 0.004*
2 Systolic blood pressure 0.012 0.115 0.005 0.018* 0.140
HDL cholesterol 0.008 0.079 0.005 0.110
LDL cholesterol 0.005 0.121 0.002 0.011*
Triacylglycerols 0.006 0.256 0.001 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.283 0.123 0.111 0.011*
3 Total cholesterol 0.006 0.170 0.002 <0.001* 0.113
Body mass index 0.068 0.254 0.013 <0.001*
Exercise pattern (Inadequate vs. Adequate) 0.411 0.178 0.110 <0.001*
4 Total cholesterol 0.006 0.167 0.002 0.001* 0.073
Systolic blood pressure 0.016 0.160 0.005 0.001*
Exercise pattern (Inadequate vs. Adequate) 0.392 0.170 0.113 0.001*
*Significant relationship p < 0.05; SES Z socioeconomic level; SD Z standard deviation.

negligible elimination of UA [55,56]. Finally, in public
school students in Brazil, it was found that with higher
BMI values, UA also increased [57].
The relationship found between total cholesterol, LDL
cholesterol, HDL cholesterol and triacylglycerols with UA
coincides with other reported results [29,58]. This could be
explained by a study in which it was explained that UA can
stimulate hepatic lipogenesis as a result of intracellular
oxidative stress [59].
One limitation of this study was that separate evalua-
tions relative to the different stages of maturation of the
students were not made. Additionally, this was a cross-
sectional study; therefore, it is not possible to determine
causality, and the use of the questionnaires constructed for
this study limited the screening scope. Finally, the data
were collected in a selected Mexican population of stu-
dents attending public institutions, who are not repre-
sentative of the whole Mexican population.
For future research, it is important to further study the
pathophysiological role of UA, including hereditary family
history and age subgroups (prepubertal, pubertal, and
postpubertal individuals). Finally, lifestyle is an important
determinant for the development of hyperuricaemia, just
as important as individual or biological causes in Mexican
children and adolescents, and the timely identification of
each of these determinants in younger populations with a
predisposition to cardiometabolic diseases may be useful
to establish future prevention measures and strategies to
improve their quality of life at the individual and social
levels.
Funding
This research was financed by the Mix Fund of CONACYT-
Government of the State of San Luis Potosí through the
project “Identification of genetic profiles, proteomics and
risk factors associated with noncommunicable diseases
and their comorbidities and the implementation of
educational interventions for prevention” (FMSLP- 2014-
C02-251723).

Please cite this article as: Lares-Villaseñor E et al., Uricaemia and associated health determinants in a paediatric population in Mexico,
Nutrition, Metabolism & Cardiovascular Diseases, https://doi.org/10.1016/j.numecd.2022.02.010
8 E. Lares-Villaseñor et al.
Declaration of competing interest
The authors declare no conflicts of interest.
Acknowledgements
We thank all the participants and schools that supported
this effort.
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