Background— The association between concentrations of uric acid and the metabolic syndrome in children and adolescents remains incompletely understood. The objective of this study was to examine how these 2 were associated in a nationally representative sample of US children and adolescents.

Methods and Results— We performed a cross-sectional analysis of 1370 males and females aged 12 to 17 years using data from the National Health and Nutrition Examination Survey 1999–2002. The prevalence of the metabolic syndrome was <1% among participants in the lowest quartile of serum concentration of uric acid, 3.7% in the second quartile, 10.3% in the third quartile, and 21.1% in the highest quartile. Compared with the lowest 2 quartiles of uric acid together (≤291.5 μmol/L), the odds ratios were 5.80 (95% confidence interval, 3.22 to 10.46) for those in the third quartile (>291.5 to ≤339 μmol/L or >4.9 to ≤5.7 mg/dL) and 14.79 (95% confidence interval, 7.78 to 28.11) for those in the top quartile (>339 μmol/L) after adjustment for age, sex, race or ethnicity, and concentrations of C-reactive protein. Starting with the lowest quartile of concentration of uric acid, mean concentrations of serum insulin were 66.2, 66.7, 79.9, and 90.9 pmol/L for ascending quartiles, respectively (P for trend <0.001).

Conclusions— Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.