Prevalence and Determinants of Insulin Resistance Among U.S. Adolescents

Abstract

OBJECTIVE -We sought to examine the distribution of insulin and homeostasis model assessment of insulin resistance (HOMA-IR) and associations of HOMA-IR with sex, race/ ethnicity, age, and weight status, as measured by BMI, among U.S. adolescents. Health and Nutrition Examination Survey 1999 -2002, analysis was performed for a nationally representative subsample of 1,802 adolescents without diabetes who had fasting laboratory measurements. The main outcome measure was HOMA-IR, calculated from fasting insulin and glucose and log transformed for multiple linear regression analyses. RESEARCH DESIGN AND METHODS -Of 4,902 adolescents aged 12-19 years who participated in the NationalRESULTS -In adjusted regression models that included age and weight status, girls had higher HOMA-IR than boys and Mexican-American children had higher HOMA-IR levels than white children. There were no significant differences in adjusted HOMA-IR between black and white children. Obese children (BMI Ն95th percentile) had significantly higher levels of HOMA-IR compared with children of normal weight (BMI CONCLUSIONS -Obesity in U.S. adolescents represents the most important risk factor for insulin resistance, independent of sex, age, or race/ethnicity. The prevalence of insulin resistance in obese children foreshadows a worrisome trend for the burden of type 2 diabetes in the U.S. Diabetes Care 29:2427-2432, 2006T he pathogenesis of type 2 diabetes in children is hypothesized to be related to two principal factors: insulin resistance and impaired insulin secretion (1). Insulin resistance represents an insensitivity of the peripheral tissues (e.g., muscle, liver, adipose tissue) to the effects of insulin. To maintain glucose homeostasis, pancreatic ␤-cells compensate for insulin resistance by augmenting insulin secretion, leading to a state of chronic hyperinsulinemia. However, the progressive failure of the ␤-cells to maintain adequate insulin secretion is believed to result in the development of type 2 diabetes (2). Longitudinal studies in adults have demonstrated that insulin resistance is strongly predictive of the development of type 2 diabetes (3). Furthermore, studies in obese children have shown that insulin resistance is associated with abnormalities in glucose metabolism, such as impaired glucose tolerance or type 2 diabetes (4). Therefore, there is increasing recognition of the important role of insulin resistance in the pathogenesis of type 2 diabetes in children (1,2,5).Given that insulin resistance represents an important risk factor for development of type 2 diabetes, identification of children with insulin resistance has been proposed as a strategy for identifying high-risk children for targeted diabetes prevention interventions (6). The goldstandard test for insulin resistance includes the hyperinsulinemic-euglycemic clamp (7), and another accepted method is the minimal-model analysis frequently sampled intravenous glucose tolerance test (FSIVGTT) (8). These tests are invasive, labor intensive, and expensive, which discourage...

The Relationship between Changes in Weight Status and Insulin Resistance in Youth

“…While numerous cross-sectional studies have noted positive associations ( r = 0.31 to 0.85) between insulin and measures of adiposity in youth, the relationships between change in weight status and change in IR have not been examined thoroughly [2–8]. The few longitudinal studies of youth have consistently reported that change in weight is positively associated with change in insulin or IR and negatively associated with insulin sensitivity [9–11].…”

Lack of Effect of Stimulant Combination with Second-Generation Antipsychotics on Weight Gain, Metabolic Changes, Prolactin Levels, and Sedation in Youth with Clinically Relevant Aggression or Oppositionality

“…Insulin resistance was determined with the homeostatic model (HOMA-IR: fasting insulin mmolÂglucose mmol=22.5) (Matthews et al 1985). HOMA-IR values >4.39 were diagnostic for insulin resistance (Lee et al 2006). As done previously (Saito et al 2004), hyperprolactinemia was defined stringently as per our laboratory threshold as >25.4 ng=dL for males and females.…”

“…Children suffering from these disorders and symptoms have problems functioning in families, in school, and with their peers. They are also at risk for long-term interpersonal and academic difficulty, legal problems, substance abuse or dependence, and frequent use of social and mental health services (Loeber et al 2000;Ezpeleta et al 2001;Nock et al 2007). …”

“…Disruptive behavior disorders that are frequently associated with relevant aggression and oppositionality occur in approximately 7-11% of the pediatric population (Loeber et al 2000;Nock et al 2007), with an estimated 75% referral rate to psychiatric care among children with these diagnoses (Arcelus and Vostanis 2003). Children suffering from these disorders and symptoms have problems functioning in families, in school, and with their peers.…”

Análise crítica do uso dos índices do Homeostasis Model Assessment (HOMA) na avaliação da resistência à insulina e capacidade funcional das células-beta pancreáticas

“…Em virtude de associação entre RI e disfunção endotelial, passo inicial para o processo de aterosclerose (8,9), também tem-se considerado como fator preditor independente de doença cardiovascular (10)(11)(12). Em vários países, a incidência crescente de RI, associada ao aumento das prevalências de obesidade e DM2, tem sido observada (13)(14)(15)(16)(17)(18).…”