Insulin Resistance and Clustering of Cardiometabolic Risk Factors in Urban Teenagers in Southern India

Abstract

OBJECTIVE -We sought to study the occurrence of cardiometabolic risk variables, their clustering, and their association with insulin resistance among healthy adolescents in urban south India.RESEARCH DESIGN AND METHODS -School children aged 12-19 years (n ϭ 2,640; 1,323 boys and 1,317 girls) from diverse socioeconomic backgrounds were studied. Demographic, social, and medical details were obtained; anthropometry and blood pressure were measured. Fasting plasma glucose, insulin, and lipid profiles were measured. Clusters of risk variables were identified by factor analysis. Association of insulin resistance (homeostasis model assessment) with individual risk variables and their clusters were assessed.RESULTS -One or more cardiometabolic abnormalities (i.e., low HDL cholesterol, elevated triglycerides, fasting plasma glucose, or blood pressure) was present in 67.7% of children (in 64.8% of normal weight and 85% of overweight children). Insulin resistance was associated with the above abnormalities except HDL cholesterol. It also showed significant positive association with BMI, waist circumference, body fat percentage, and total cholesterol (P Ͻ 0.0001). Factor analysis identified three distinct clusters, with minor differences in the sexes: 1) waist circumference and blood pressure; 2) dyslipidemia, waist circumference, and insulin; and 3) waist circumference, glucose, and plasma insulin, with minor differences in the sexes. Insulin was a component of the lipid and glucometabolic cluster. In girls, it was a component of all three clusters.CONCLUSIONS -Cardiometabolic abnormalities are present in nearly 68% of young, healthy, Asian-Indian adolescents and even among those with normal weight. Insulin resistance is associated with individual cardiometabolic factors, and plasma insulin showed association with clustering of some variables. Diabetes Care 30:1828-1833, 2007I nsulin resistance is associated with obesity, type 2 diabetes, cardiovascular disease, and subclinical cardiometabolic risk markers, such as dyslipidemia, hypertension, and central adiposity (1,2). In fact, many have hypothesized that insulin resistance may be the common pathophysiological factor tying together a "syndrome" of cardiometabolic disturbance, affecting adiposity, glucose intolerance, dyslipidemia, and altered blood pressure control (2-4). On the other hand, the concept that such a syndrome exists has recently been challenged (5).The association between insulin resistance and cardiometabolic risk factors is often confounded once the disease sets in. The ideal population for examining these associations in depth would be one that is: 1) at high risk of insulin resistance, 2) young and has not yet acquired clinical disease, and 3) undergoing rapid environmental and lifestyle change.Asian Indians are at high risk of type 2 diabetes and cardiovascular disease and have an insulin-resistant phenotype, characterized by low muscle mass, upperbody adiposity, and high percentage of body fat (6,7). While insulin resistance runs in families and may h...

Plasma Adiponectin Does Not Correlate With Insulin Resistance and Cardiometabolic Variables in Nondiabetic Asian Indian Teenagers

“…Our recent study in adolescents showed a high prevalence of insulin resistance and cardiovascular risk factors; 65% of normal weight and 85% of overweight children and adolescents showed presence of at least one cardiovascular risk factor (15). Whereas many studies in white teenagers had demonstrated such abnormalities in obese subjects (10), we observed these abnormalities even in nonobese subjects.…”

“…METHODS -A school-based crosssectional survey of 2,640 teenagers (1,323 boys and 1,317 girls) aged 12-19 years from 16 schools in Chennai, India, was done (15). Approximately 200 subjects of the cohort were selected for this analysis, which had an equal number of boys and girls of normal weight and overweight, with a fair representation of agegroups.…”

“…In light of evidence showing an important role for adiponectin in regulation of insulin action and having antiatherogenic properties, we studied its association with cardiometabolic variables including insulin resistance and proinsulin in Asian Indian teenagers. A subsample from the cohort of our previous study (15) was used for this analysis.…”

Efficacy of a continuous metabolic syndrome score in Indian children for detecting subclinical atherosclerotic risk

“…In contrast to this approach, some studies have reported clustering of MS risk using factor analyses or principle component analyses, where cumulative risk score is generated to identify independent correlates of risk. 19,29 Reports of previous cross-sectional studies have also suggested the advantage of cMetS as being statistically more sensitive and error proof as compared with binary classification. 9 Thus, the present study has used cMetS to investigate children with risk of atherosclerosis.…”

Bariatric and Metabolic Surgery for Asians

“…(47) In addition, increased waist circumference has been associated with substantially increased risk of developing diabetes (48,49) as well as increased risk of cardiovascular and all-cause mortality, independent of BMI. (50,51,52,53) In the 1980s, Japanese researchers first revealed that reduced early insulin response was an independent predictor for diabetes. (54) Fukushima et al (55) found that at all stages of glucose intolerance, Japanese individuals had reduced early and late phases of insulin responses.…”