Uric acid reference values for children and adolescents should be stratified by pubertal stage

To establish reference values for hyperuricemia (HUA) in children and adolescents.

The study enrolled 4807 students from "The Evaluation and Monitoring on School-based Nutrition and Growth in Shenzhen study." Utilizing quantile regression, associations between age, body mass index (BMI), pubertal stage, and serum uric acid (SUA) were examined, alongside the relationship between SUA and cardiovascular disease (CVD) risk factors. Reference values for SUA were explored using receiver operating characteristic analysis, considering sex and pubertal stage. The prevalence of HUA was 34.3 % for boys and 29 % for girls (using the adult HUA diagnostic criteria: >420 μmol/L for males, >360 μmol/L for females), increasing with higher BMI, age, and pubertal stage. Pubertal stage had the largest influence on SUA in boys, while nutritional status was the most significant factor affecting SUA in girls. Adjusting for age and pubertal stage, higher SUA levels correlated with an increased risk of CVD risk factors. Proposed reference values included >360 μmol/L for girls ages 6-17 years and prepubertal boys. For pubertal boys, reference values varied based on age: >392 μmol/L for ages 9-11 in early-middle puberty, >429 μmol/L for ages 12-14 in early-middle puberty, >478 μmol/L for ages 12-14 in late puberty, and >505 μmol/L for ages 15-17 in late puberty.

Stratifying HUA reference values by pubertal stage, particularly for boys, is crucial. Long-term follow-up of individuals with high SUA levels may aid in refining SUA reference values.