Different Criteria for the Definition of Insulin Resistance and ItsRelation with Dyslipidemia in Overweight and Obese Childrenand Adolescents

다국어 초록 (Multilingual Abstract)

Purpose: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia.Methods: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests.Results: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP.Conclusion: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.

참고문헌 (Reference)

1 Nogueira-de-Almeida CA, "Ultrasonographic assessment of the common carotid intima-media complex in normal weight children and in overweight/obese children" 30 : 2016

2 DeFronzo RA. Lilly lecture, "The triumvirate: beta-cell, muscle, liver. A collusion responsible for NIDDM" 37 : 667-687, 1987

3 Madeira IR, "The role of metabolic syndrome components and adipokines in insulin resistance in prepubertal children" 24 : 289-295, 2011

4 Zimmet P, "The metabolic syndrome in children and adolescents-an IDF consensus report" 8 : 299-306, 2007

5 Pastucha D, "The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI" 62 : 277-283, 2013

6 Wallace TM, "The assessment of insulin resistance in man" 19 : 527-534, 2002

7 Garcia Cuartero B, "The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children" 66 : 481-490, 2007

8 Salazar MR, "Relationships among insulin resistance, obesity, diagnosis of the metabolic syndrome and cardio-metabolic risk" 8 : 109-116, 2011

9 de Onis M, "Preventing childhood overweight and obesity" 91 : 105-107, 2015

10 Sekokotla MA, "Prevalence of metabolic syndrome in adolescents living in Mthatha, South Africa" 13 : 131-137, 2017

11 Tandon N, "Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)" 26 : 1123-1130, 2013

12 Sinaiko A, "Obesity, insulin resistance and the metabolic syndrome" 83 : 3-4, 2007

13 Weiss R, "Obesity and the metabolic syndrome in children and adolescents" 350 : 2362-2374, 2004

14 Pinho AP, "Metabolic syndrome in overweight/obese female adolescents" 30 : 51-56, 2012

15 da Silva RC, "Metabolic syndrome and insulin resistance in normal glucose tolerant brazilian adolescents with family history of type 2 diabetes" 28 : 716-718, 2005

16 Todendi PF, "Metabolic risk in schoolchildren is associated with low levels of cardiorespiratory fitness, obesity, and parents' nutritional profile" 92 : 388-393, 2016

17 Must A, "Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935" 327 : 1350-1355, 1992

18 Ten S, "Insulin resistance syndrome in children" 89 : 2526-2539, 2004

19 Maffeis C, "Insulin resistance is a risk factor for high blood pressure regardless of body size and fat distribution in obese children" 20 : 266-273, 2010

20 Kurtoglu S, "Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods" 2 : 100-106, 2010

21 Romualdo MC, "Insulin resistance in obese children and adolescents" 90 : 600-607, 2014

22 Levy-Marchal C, "Insulin resistance in children: consensus, perspective, and future directions" 95 : 5189-5198, 2010

23 Moran A, "Insulin resistance during puberty: results from clamp studies in 357 children" 48 : 2039-2044, 1999

24 Sanches Pde L, "Insulin resistance can impair reduction on carotid intima-media thickness in obese adolescents" 99 : 892-898, 2012

25 Barja S, "Insulin resistance and other expressions of metabolic syndrome in obese Chilean children" 131 : 259-268, 2003

26 Juarez-Lopez C, "Insulin resistance and its association with the components of the metabolic syndrome among obese children and adolescents" 10 : 318-, 2010

27 Back Giuliano Ide C, "I guidelines of prevention of atherosclerosis in childhood and adolescence" 85 (85): 4-36, 2005

28 Mieldazis SF, "Hyperinsulinism assessment in a sample of prepubescent children" 86 : 245-249, 2010

29 Keskin M, "Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents" 115 : 500-503, 2005

30 Ng M, "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013" 384 : 766-781, 2014

31 Kim HA, "Gender differences in the association of insulin resistance with metabolic risk factors among Korean adolescents: Korea National Health and Nutrition Examination Survey 2008-2010" 99 : 54-62, 2013

32 Tester J, "Gender differences in prediabetes and insulin resistance among 1356 obese children in Northern California" 7 : 161-165, 2013

33 Nogueira-de-Almeida CA, "Echocardiography evaluation as a marker of cardiovascular risk on obese children and adolescents" 30 : 2016

34 Aradillas-Garcia C, "Distribution of the homeostasis model assessment of insulin resistance in Mexican children and adolescents" 166 : 301-306, 2012

35 Angulo N, "Diagnosis of insulin resistance by indirect methods in obese school children" 54 : 149-160, 2013

36 de Onis M, "Development of a WHO growth reference for school-aged children and adolescents" 85 : 660-667, 2007

37 Almeida CA, "Determination of glycemia and insulinemia and the homeostasis model assessment (HOMA) in schoolchildren and adolescents with normal body mass index" 84 : 136-140, 2008

38 Brasil AR, "Criancas e adolescentes com sobrepeso ou obesidade: avaliacao da reacao inflamatoria atraves da dosagem da proteina c-reativa ultra-sensivel e prevalencia de sindrome metabolica" 2006

39 Nogueira-de-Almeida CA, "Correlation between ultrasonographic measures of the abdominal adiposity and indicators of obesity in normal and overweight/obesity children" 30 : 2016

40 Nogueira-de-Almeida CA, "Comparacao de indicadores de perfis glicemico e lipidico entre criancas e adolescentes obesos egressos de servico publico ou privado da cidade de Ribeirao Preto (SP)" 49 : 504-510, 2016

41 Harrell JS, "Changing our future: obesity and the metabolic syndrome in children and adolescents" 21 : 322-330, 2006

42 Moran A, "Changes in insulin resistance and cardiovascular risk during adolescence: establishment of differential risk in males and females" 117 : 2361-2368, 2008

43 Zachurzok-Buczynska A, "Are metabolic syndrome and its components in obese children influenced by the overweight status or the insulin resistance?" 62 : 102-108, 2011

44 Jeffery AN, "Age before stage: insulin resistance rises before the onset of puberty: a 9-year longitudinal study (EarlyBird 26)" 35 : 536-541, 2012