Combined effects of dietary zinc at 3 years of age and obesity at 7 years of age on the serum uric acid levels of Korean children

  • Lee, Sung Hee (Department of Preventive Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University) ;
  • Lee, Hye Ah (Clinical Trial Center, Ewha Womans University Mokdong Hospital) ;
  • Park, Eun Ae (Department of Pediatrics, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University) ;
  • Cho, Su Jin (Department of Pediatrics, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University) ;
  • Oh, Se Young (Department of Food & Nutrition, College of Human Ecology, Kyung Hee University) ;
  • Park, Bohyun (Department of Preventive Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University) ;
  • Park, Hyesook (Department of Preventive Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University)
  • Received : 2019.01.22
  • Accepted : 2020.01.16
  • Published : 2020.08.01


BACKGROUND/OBJECTIVES: To assess the longitudinal associations of the antioxidant capacity of zinc and body mass index (BMI) with serum uric acid (SUA) in South Korean children. SUBJECTS/METHODS: Using follow-up data from the Ewha Birth and Growth Cohort, we included subjects who were seen at 3 and 7 years of age (n = 183; 90 boys, 93 girls). Daily zinc intake and BMI were assessed at 3 and 7 years of age. SUA measured at 7 years was used as the outcome variable. Using a general linear model, the effects of dietary zinc intake and BMI on SUA were assessed. We also assessed the combined effect of early dietary zinc intake and BMI on SUA in children. RESULTS: The dietary zinc intake at 3 years of age was negatively correlated (ρ = -0.18, P = 0.04), whereas the BMI at 7 years of age was positively correlated (r = 0.18, P = 0.01), with the SUA level at 7 years of age. The dietary zinc intake level at 3 years of age and the BMI level at 7 years of age were, together, significantly related to SUA in children at 7 years of age. SUA was lower in group 1 (normal-weight, high-zinc group) than in the other two groups (group 2: normal-weight, low-zinc and overweight, high-zinc group; and group 3: overweight, low-zinc group). Our results demonstrate the combined effect of zinc intake and BMI on SUA. The combined association remained significant in both the crude and adjusted models (P < 0.01). CONCLUSIONS: SUA was related to combined BMI and dietary zinc intake, and increased zinc intake and normal body weight had a beneficial effect on reducing SUA in children.


  1. Feig DI, Nakagawa T, Karumanchi SA, Oliver WJ, Kang DH, Finch J, Johnson RJ. Hypothesis: uric acid, nephron number, and the pathogenesis of essential hypertension. Kidney Int 2004;66:281-7.
  2. Feig DI. The role of uric acid in the pathogenesis of hypertension in the young. J Clin Hypertens (Greenwich) 2012;14:346-52.
  3. Feig DI, Johnson RJ. The role of uric acid in pediatric hypertension. J Ren Nutr 2007;17:79-83.
  4. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007;298:874-9.
  5. Riley M, Bluhm B. High blood pressure in children and adolescents. Am Fam Physician 2012;85:693-700.
  6. Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet Public Health 2017;2:e375-86.
  7. Viazzi F, Antolini L, Giussani M, Brambilla P, Galbiati S, Mastriani S, Stella A, Pontremoli R, Valsecchi MG, Genovesi S. Serum uric acid and blood pressure in children at cardiovascular risk. Pediatrics 2013;132:e93-9.
  8. Loeffler LF, Navas-Acien A, Brady TM, Miller ER 3rd, Fadrowski JJ. Uric acid level and elevated blood pressure in US adolescents: National Health and Nutrition Examination Survey, 1999-2006. Hypertension 2012;59:811-7.
  9. Park B, Lee HA, Lee SH, Park BM, Park EA, Kim HS, Cho SJ, Park H. Association between serum levels of uric acid and blood pressure tracking in childhood. Am J Hypertens 2017;30:713-8.
  10. Towiwat P, Li ZG. The association of vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and gout. Int J Rheum Dis 2015;18:495-501.
  11. Vos MB, Colvin R, Belt P, Molleston JP, Murray KF, Rosenthal P, Schwimmer JB, Tonascia J, Unalp A, Lavine JENASH CRN Research Group. Correlation of vitamin E, uric acid, and diet composition with histologic features of pediatric NAFLD. J Pediatr Gastroenterol Nutr 2012;54:90-6.
  12. Tang L, Kubota M, Nagai A, Mamemoto K, Tokuda M. Hyperuricemia in obese children and adolescents: the relationship with metabolic syndrome. Pediatr Rep 2010;2:e12.
  13. Park B, Park E, Cho SJ, Kim Y, Lee H, Min J, Ha E, Kang D, Park H. The association between fetal and postnatal growth status and serum levels of uric acid in children at 3 years of age. Am J Hypertens 2009;22:403-8.
  14. Tsou TC, Chao HR, Yeh SC, Tsai FY, Lin HJ. Zinc induces chemokine and inflammatory cytokine release from human promonocytes. J Hazard Mater 2011;196:335-41.
  15. Marreiro DD, Cruz KJ, Morais JB, Beserra JB, Severo JS, de Oliveira AR. Zinc and oxidative stress: current mechanisms. Antioxidants 2017;6:E24.
  16. Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med 2008;14:353-7.
  17. Powell SR. The antioxidant properties of zinc. J Nutr 2000;130:1447S-1454S.
  18. Xie DX, Xiong YL, Zeng C, Wei J, Yang T, Li H, Wang YL, Gao SG, Li YS, Lei GH. Association between low dietary zinc and hyperuricaemia in middle-aged and older males in China: a cross-sectional study. BMJ Open 2015;5:e008637.
  19. Zhang Y, Liu Y, Qiu H. Association between dietary zinc intake and hyperuricemia among adults in the United States. Nutrients 2018;10:E568.
  20. Min J, Kim YJ, Lee H, Park EA, Cho SJ, Hong YM, Oh SY, Ha E, Kang D, Park H. Is the association between ACE genes and blood pressure mediated by postnatal growth during the first 3 years? Early Hum Dev 2012;88:425-9.
  21. Korean Nutrition Society. CAN-Pro: computer aided nutritional analysis program. Version 3.0. Seoul: Korean Nutrition Society; 2006.
  22. Korean Center for Disease Control and Prevention. Division of Chronic Disease Surveillance: 2007 Korean Children and Adolescent Growth Standard. Seoul: The Korean Pediatric Society, The Committee for the Development of Growth Standards for Korean Children and Adolescents; 2007.
  23. Juraschek SP, Miller ER 3rd, Gelber AC. Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 2011;63:1295-306.
  24. Wang H, Wang L, Xie R, Dai W, Gao C, Shen P, Huang X, Zhang F, Yang X, Ji G. Association of serum uric acid with body mass index: a cross-sectional study from Jiangsu Province, China. Iran J Public Health 2014;43:1503-9.
  25. Civantos Modino S, Guijarro de Armas MG, Monereo Mejias S, Montano Martinez JM, Iglesias Bolanos P, Merino Viveros M, Ladero Quesada JM. Hyperuricemia and metabolic syndrome in children with overweight and obesity. Endocrinol Nutr 2012;59:533-8.
  26. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol 2011;23:192-202.
  27. Chasapis CT, Loutsidou AC, Spiliopoulou CA, Stefanidou ME. Zinc and human health: an update. Arch Toxicol 2012;86:521-34.
  28. Prasad AS. Discovery of human zinc deficiency: its impact on human health and disease. Adv Nutr 2013;4:176-90.
  29. Sautin YY, Johnson RJ. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008;27:608-19.
  30. Vijayaraghavan K, Iyyam Pillai S, Subramanian SP. Design, synthesis and characterization of zinc-3 hydroxy flavone, a novel zinc metallo complex for the treatment of experimental diabetes in rats. Eur J Pharmacol 2012;680:122-9.
  31. Navarro-Alarcon M, Reyes-Perez A, Lopez-Garcia H, Palomares-Bayo M, Olalla-Herrera M, Lopez- Martinez MC. Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers. Biol Trace Elem Res 2006;113:209-22.
  32. Hait HI, Lemeshow S, Rosenman KD. A longitudinal study of blood pressure in a national survey of children. Am J Public Health 1982;72:1285-7.
  33. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and metaregression analysis. Circulation 2008;117:3171-80.
  34. Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002;40:441-7.
  35. Liu CS, Li TC, Lin CC. The epidemiology of hyperuricemia in children of Taiwan aborigines. J Rheumatol 2003.30:841-5.