The association between body mass index and serum uric acid levels: a narrative review

Abstract

Hyperuricemia represents an escalating global public health challenge, acting as the fundamental precursor to gout and a significant contributor to systemic inflammation, hypertension, and cardiovascular disease. In Indonesia, the prevalence of physician-diagnosed gout is particularly pronounced in regions such as Bali and Buleleng, coinciding with a steady nationwide increase in overweight and obesity rates. Given this parallel epidemiological trend, understanding the precise biological interactions between adiposity and urate metabolism is essential for developing effective preventive strategies. This narrative review aims to synthesize current evidence regarding the epidemiological association and the underlying pathophysiological mechanisms linking Body Mass Index (BMI) to serum uric acid levels. Findings from diverse international cohorts and Indonesian-specific studies consistently demonstrate a significant positive correlation between elevated BMI and serum uric acid across various demographic groups. This association is underpinned by four interrelated biological pathways: adipose-driven insulin resistance that enhances renal urate reabsorption; leptin resistance that impairs urinary urate excretion; upregulated xanthine oxidase activity in adipose tissue that augments endogenous production; and obesity-associated oxidative stress that accelerates cellular purine degradation. These synergistic mechanisms create a metabolic environment conducive to chronic urate accumulation. Consequently, BMI is a critical, modifiable risk factor; integrated weight management strategies, encompassing regular physical activity and targeted dietary modifications that restrict purine-rich foods, fructose, and alcohol, are foundational to the clinical prevention and management of hyperuricemia and its associated metabolic sequelae.