Elevated salivary uric acid levels among adolescents with eating disorders

  • Ruth Giesser
  • Tanya Goltser-Dubner
  • Dalya Pevzner
  • Amit Shalev
  • Ranin Masarwa
  • Laura Canetti
  • Ayelet Meltzer
  • Nidal Qutna
  • Roi Ratson
  • Ela Kianski
  • Shikma Keller
  • Esti Galili-Weisstub
  • Ronen SegmanEmail author
Brief Report



Uric acid (UA) is increasingly recognized as having important physiological roles and associated with several peripheral and central pathophysiological outcomes, and might play a role in eating disorders (ED) pathogenesis. We investigated whether UA levels are altered among adolescents with ED.


Morning salivary UA concentrations were compared between adolescents referred to treatment at the Herman Dana Center receiving a DSM-V diagnosis of an ED and matched healthy controls.


Salivary UA was significantly elevated among ED compared with control values (ED mean 3.9 ± 1.2 mg/dl, control mean 2.9 ± 1.9 mg/dl, t = − 3.13 df = 81, p = 0.003).


Salivary UA is elevated among adolescents with ED. Further studies are required to replicate and extend this finding and evaluate its generalizability as a state or trait marker as regards ED subtypes, other body fluids (plasma and cerebrospinal fluid), and recovery or premorbid stages, as well as its putative mechanistic relevance to ED.

Level of Evidence

Level III, case-control analytic study.


Salivary uric acid Eating disorder Anorexia nervosa Adolescents Bulimia nervosa 



This work was supported in part by the Herman Dana Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were approved by the Hadassah Medical Center Ethics Committee Review Board, and performed in accord with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained and forms signed by all individual participants included in the study, and their parents in the case of minors.


  1. 1.
    Abraham A, Drory VE (2014) Influence of serum uric acid levels on prognosis and survival in amyotrophic lateral sclerosis: a meta-analysis. J Neurol 261(6):1133–1138. CrossRefPubMedGoogle Scholar
  2. 2.
    Adam O, Goebel FD (1987) Secondary gout and pseudo-Bartter syndrome in females with laxative abuse. Klin Wochenschr 65(17):833–839CrossRefGoogle Scholar
  3. 3.
    Adamopoulos D, Vlassopoulos C, Seitanides B, Contoyiannis P, Vassilopoulos P (1977) The relationship of sex steroids to uric acid levels in plasma and urine. Acta Endocrinol (Copenh) 85(1):198–208CrossRefGoogle Scholar
  4. 4.
    Alvarez-Lario B, Macarron-Vicente J (2010) Uric acid and evolution. Rheumatology (Oxford) 49(11):2010–2015. CrossRefGoogle Scholar
  5. 5.
    Bartoli F, Crocamo C, Mazza MG, Clerici M, Carra G (2016) Uric acid levels in subjects with bipolar disorder: a comparative meta-analysis. J Psychiatr Res 81:133–139. CrossRefPubMedGoogle Scholar
  6. 6.
    Bartoli F, Trotta G, Crocamo C, Malerba MR, Clerici M, Carra G (2018) Antioxidant uric acid in treated and untreated subjects with major depressive disorder: a meta-analysis and meta-regression. Eur Arch Psychiatry Clin Neurosci 268(2):119–127. CrossRefPubMedGoogle Scholar
  7. 7.
    Bell S, Kolobova I, Crapper L, Ernst C (2016) Lesch–Nyhan syndrome: models, theories, and therapies. Mol Syndromol 7(6):302–311. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Black CN, Bot M, Scheffer PG, Snieder H, Penninx B (2018) Uric acid in major depressive and anxiety disorders. J Affect Disord 225:684–690. CrossRefPubMedGoogle Scholar
  9. 9.
    Bobulescu IA, Moe OW (2012) Renal transport of uric acid: evolving concepts and uncertainties. Adv Chronic Kidney Dis 19(6):358–371. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bruderer SG, Bodmer M, Jick SS, Meier CR (2015) Association of hormone therapy and incident gout: population-based case-control study. Menopause 22(12):1335–1342. CrossRefPubMedGoogle Scholar
  11. 11.
    Burnstock G (2008) Purinergic signalling and disorders of the central nervous system. Nat Rev Drug Discov 7(7):575–590. CrossRefPubMedGoogle Scholar
  12. 12.
    Chen X, Wu G, Schwarzschild MA (2012) Urate in Parkinson’s disease: more than a biomarker? Curr Neurol Neurosci Rep 12(4):367–375. CrossRefPubMedGoogle Scholar
  13. 13.
    Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 350(11):1093–1103. CrossRefPubMedGoogle Scholar
  14. 14.
    Cipriani S, Chen X, Schwarzschild MA (2010) Urate: a novel biomarker of Parkinson’s disease risk, diagnosis and prognosis. Biomark Med 4(5):701–712. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Denburg MR, Leonard MB, Jemielita TO, Golden NH, Tasian G, Copelovitch L (2017) Risk of urolithiasis in anorexia nervosa: a population-based cohort study using the health improvement network. Eur Eat Disord Rev 25(5):406–410. CrossRefPubMedGoogle Scholar
  16. 16.
    Dick WH, Lingeman JE, Preminger GM, Smith LH, Wilson DM, Shirrell WL (1990) Laxative abuse as a cause for ammonium urate renal calculi. J Urol 143(2):244–247CrossRefGoogle Scholar
  17. 17.
    Du N, Xu D, Hou X, Song X, Liu C, Chen Y, Wang Y, Li X (2016) Inverse association between serum uric acid levels and Alzheimer’s disease risk. Mol Neurobiol 53(4):2594–2599. CrossRefPubMedGoogle Scholar
  18. 18.
    Fukai M, Hirosawa T, Nakatani H, Muramatsu T, Kikuchi M, Minabe Y (2017) Ammonium acid urate urolithiasis in anorexia nervosa: a case report and literature review. Clin Case Rep 5(5):685–687. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gualtieri CT (2002) Brain injury and mental retardation: psychopharmacology and neuropsychiatry. Lippincott Williams & WilkinsGoogle Scholar
  20. 20.
    Gupta MA, Kavanaugh-Danelon D (1989) Elevated serum uric acid in eating disorders: a possible index of strenuous physical activity and starvation. Int J Eat Disord 8:4.;2-%23 CrossRefGoogle Scholar
  21. 21.
    Hayem G, Delahousse M, Meyer O, Palazzo E, Chazerain P, Kahn MF (1996) Female premenopausal tophaceous gout induced by long-term diuretic abuse. J Rheumatol 23(12):2166–2167PubMedGoogle Scholar
  22. 22.
    Johnson RJ, Sautin YY, Oliver WJ, Roncal C, Mu W, Gabriela Sanchez-Lozada L, Rodriguez-Iturbe B, Nakagawa T, Benner SA (2009) Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? J Comp Physiol B 179(1):67–76. CrossRefPubMedGoogle Scholar
  23. 23.
    Johnson RJ, Titte S, Cade JR, Rideout BA, Oliver WJ (2005) Uric acid, evolution and primitive cultures. Semin Nephrol 25(1):3–8CrossRefGoogle Scholar
  24. 24.
    Jung JH, Song GG, Lee YH, Kim JH, Hyun MH, Choi SJ (2018) Serum uric acid levels and hormone therapy type: a retrospective cohort study of postmenopausal women. Menopause 25(1):77–81. CrossRefPubMedGoogle Scholar
  25. 25.
    Kishibe M, Sakai H, Iizuka H (2010) Chronic tophaceous gout secondary to self-induced vomiting in anorexia nervosa. J Dermatol 37(6):578–580. CrossRefPubMedGoogle Scholar
  26. 26.
    Krzystek-Korpacka M, Patryn E, Kustrzeba-Wojcicka I, Chrzanowska J, Gamian A, Noczynska A (2011) Gender-specific association of serum uric acid with metabolic syndrome and its components in juvenile obesity. Clin Chem Lab Med 49(1):129–136. CrossRefPubMedGoogle Scholar
  27. 27.
    Mikami T, Sorimachi M (2017) Uric acid contributes greatly to hepatic antioxidant capacity besides protein. Physiol Res 66(6):1001–1007PubMedGoogle Scholar
  28. 28.
    Misra M, Klibanski A (2016) Anorexia nervosa and its associated endocrinopathy in young people. Horm Res Paediatr 85(3):147–157. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mumford SL, Dasharathy SS, Pollack AZ, Perkins NJ, Mattison DR, Cole SR, Wactawski-Wende J, Schisterman EF (2013) Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study. Hum Reprod 28(7):1853–1862. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Nakazawa F, Ishihara H, Tanaka K (2004) A case of female premenopausal tophaceous gout requiring surgical management. Mod Rheumatol 14(5):383–387. CrossRefPubMedGoogle Scholar
  31. 31.
    Nunes LA, Brenzikofer R, Macedo DV (2011) Reference intervals for saliva analytes collected by a standardized method in a physically active population. Clin Biochem 44(17–18):1440–1444. CrossRefPubMedGoogle Scholar
  32. 32.
    Nyhan WL, O’Neill JP, Jinnah HA, Harris JC (1993) Lesch–Nyhan syndrome. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A (eds) GeneReviews((R)). Seattle (WA)Google Scholar
  33. 33.
    Ortiz R, Ulrich H, Zarate CA Jr, Machado-Vieira R (2015) Purinergic system dysfunction in mood disorders: a key target for developing improved therapeutics. Prog Neuropsychopharmacol Biol Psychiatry 57:117–131. CrossRefPubMedGoogle Scholar
  34. 34.
    Schwarzschild MA, Ascherio A, Beal MF, Cudkowicz ME, Curhan GC, Hare JM, Hooper DC, Kieburtz KD, Macklin EA, Oakes D, Rudolph A, Eaton K (2014) Inosine to increase serum and cerebrospinal fluid urate in Parkinson disease: a randomized clinical trial. JAMA Neurol 71(2):141–150. CrossRefPubMedGoogle Scholar
  35. 35.
    Riis JL, Bryce CI, Matin MJ, Stebbins JL, Kornienko O, Huisstede LV, Granger DA (2018) The validity, stability, and utility of measuring uric acid in saliva. Biomark Med 12(6):583–596. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Schmidt JA, Crowe FL, Appleby PN, Key TJ, Travis RC (2013) Serum uric acid concentrations in meat eaters, fish eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort. PLoS ONE 8(2):e56339. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sharaf El Din UAA, Salem MM, Abdulazim DO (2017) Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: a review. J Adv Res 8(5):537–548. CrossRefPubMedGoogle Scholar
  38. 38.
    Simeunovic Ostojic M, Maas J (2018) Anorexia nervosa and uric acid beyond gout: an idea worth researching. Int J Eat Disord 51(2):97–101. CrossRefPubMedGoogle Scholar
  39. 39.
    Singh U, Solanki V, Mehrotra S, Sharma R (2019) An evaluation of applicability of salivary uric acid measurement in preeclampsia and normal pregnancy and its correlation with serum uric acid. J Obstet Gynaecol India 69(1):62–68. CrossRefPubMedGoogle Scholar
  40. 40.
    Soukup M, Biesiada I, Henderson A, Idowu B, Rodeback D, Ridpath L, Bridges EG, Nazar AM, Bridges KG (2012) Salivary uric acid as a noninvasive biomarker of metabolic syndrome. Diabetol Metab Syndr 4(1):14. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Umeki S (1988) Biochemical abnormalities of the serum in anorexia nervosa. J Nerv Ment Dis 176(8):503–506. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ruth Giesser
    • 1
  • Tanya Goltser-Dubner
    • 1
    • 2
  • Dalya Pevzner
    • 1
    • 2
  • Amit Shalev
    • 1
  • Ranin Masarwa
    • 1
  • Laura Canetti
    • 2
  • Ayelet Meltzer
    • 1
  • Nidal Qutna
    • 1
  • Roi Ratson
    • 1
  • Ela Kianski
    • 1
  • Shikma Keller
    • 2
  • Esti Galili-Weisstub
    • 1
  • Ronen Segman
    • 1
    • 2
    Email author
  1. 1.Herman-Dana Division of Child and Adolescent Psychiatry, Department of PsychiatryHadassah - Hebrew University Medical CenterJerusalemIsrael
  2. 2.Molecular Psychiatry Laboratory, Department of PsychiatryHadassah - Hebrew University Medical CenterJerusalemIsrael

Personalised recommendations