A Study of Insulin Resistance by HOMA-IR and its Cut-off Value to Identify Metabolic Syndrome in Urban Indian Adolescents

Abstract

Objective: Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS.Methods: A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model.Results: Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p <0.0001) and WC (4.8, p <0.0001), compared to WHR (3.3, p <0.0001).Conclusions: In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria.Conflict of interest:None declared.

Identificação dos pontos de corte do índice Homeostatic Model Assessment for Insulin Resistance em adolescentes: revisão sistemática

“…Six studies,18 , 20 - 23 were carried out in foreign countries between 2005 and 2015 and one19 was performed with Brazilian adolescents in 2011. The smallest sample consisted of 57 participants23 and the largest had 3203 22.…”

“…Six studies17 , 18 , 20 , 23 preferred the use of the cutoff point with high sensitivity and specificity and one study19 prioritized the cutoff with greater sensitivity. The lower cutoff points found were 1.65 for girls and 1.95 for boys19 and the highest were 3.82 for girls and 5.22 for boys 18…”

“…This procedure takes into account the sensitivity and specificity of the test being assessed, which are related to the probability that the test will correctly distribute the studied population in not healthy/ill patients (positive) and healthy/not ill (negative) respectively 2935 In the present review, it was observed that six17 , 18 , 20 - 23 of the included studies prefer to use the cutoff points with higher sensitivity and specificity. Only the Brazilian study19 assumed the cutoff with greater sensitivity.…”

Prevalence of Insulin Resistance and its Association with Obesity and Alcoholism in Male Medical Students of Bhopal

“…Their study on adolescents found 34.5% insulin resistance with mean HOMA-IR increasing with sexual maturity and obesity. [9] John et al reported 14.4% insulin resistance in their study on students of a medical college in South India, [12] but they chose to measure insulin resistance by triglycerides to HDL-cholesterol ratio instead of by HOMA-IR.…”

“…[8] HOMA-IR > 2.5 has been reported to identify a large number of adolescents as having metabolic syndrome in different categories of Body Mass Index (BMI). [9] High prevalence of insulin resistance in the general school and college population has been reported. [10] However, studies on medical students is mostly restricted to obesity.…”