Relation Between Acanthosis Nigricans and Insulin Sensitivity in Overweight Hispanic Children at Risk for Type 2 Diabetes

Abstract

OBJECTIVE -To investigate in a population of Hispanic children if 1) the presence of acanthosis nigricans (AN) is related to insulin sensitivity (S i ) independent of adiposity and 2) scale scoring AN severity adds to the clinical estimation of insulin sensitivity, above and beyond the presence or absence AN alone. RESEARCH DESIGN AND METHODS-The study population, 131 Hispanic overweight children (mean BMI percentile 97.0 Ϯ 3.1, 72 boys, 59 girls, ages 8 -13 years, mean Tanner stage 2.4 Ϯ 1.5) with a family history of type 2 diabetes, underwent a physical examination of the neck to determine AN absence or presence (0 -1), AN extent score (0 -4 scale), AN texture score (0 -3 scale), and an AN combined score (extent ϩ texture; 0 -7 scale). S i was measured by the frequently sampled intravenous glucose tolerance test and minimal modeling. Multivariate linear regression analysis was used to determine the role of BMI and AN in predicting S i .RESULTS -BMI was the main predictor of S i , explaining ϳ41% of the variance. The presence of AN explained an additional 4% of the variability in S i ; scale scoring of AN extent or texture did not significantly improve the prediction.CONCLUSIONS -Although AN is an independent risk factor for insulin resistance in overweight Hispanic children at risk for type 2 diabetes, body adiposity is the primary determinant of insulin sensitivity. In addition, scale scoring AN seems of minimal usefulness in clinically estimating the severity of insulin resistance over and above assessing the presence or absence of AN and calculating BMI. Diabetes Care 27:1412-1416, 2004W ith the rise of overweight (1) and type 2 diabetes (2,3) in the pediatric population, especially in young Hispanics and other minority groups, early identification of those at elevated health risk is important so that appropriate interventions can be established. Insulin resistance is thought to be a major factor in the pathophysiology of type 2 diabetes in both adults and children (4 -6). Acanthosis nigricans (AN), a skin disorder characterized by hyperpigmentation, hyperkeratosis, and papillomatosis, is a clinical marker that has been linked to surrogate markers of insulin resistance in adults (7,8) and adolescents (9), but only a few studies have explored the relation between directly measured insulin sensitivity (S i ) and AN in children (10 -12). Studies in adults have suggested that those with AN have elevated fasting insulin levels (13,14). However, these studies were limited in that they did not measure S i directly, neither did they evaluate the severity of AN. Burke et al. (8) proposed a classification system to grade the severity of AN and found that the severity of AN was associated with elevated fasting insulin and increased BMI. Previous studies that have examined the relation between S i and the severity of AN in adults and children have found mixed results (10 -12). Thus, the interrelation between obesity, insulin resistance, and severity of AN still needs to be clarified, particularly in children at risk fo...

Acanthosis nigricans: a clinical marker of insulin resistance

“…Although several studies have found AN to be an independent predictor of hyperinsulinemia others have not. [3][4][5][6][7] Very little information is available in this regard from rural areas of India. Therefore this study was carried out with the aim and objectives to study the association between acanthosis nigricans, and insulin resistance and to evaluate correlation of acanthosis severity, neck severity and neck texture severity with serum insulin especially in this rural part of central India.…”

Acantosis nigricans is associated with risk factors related to cardiovascular disease in Mexican children with obesity

“…AN is reportedly heavily influenced by genetic factors, being frequently found with Hispanic, Afro-American and Indian people, and infrequently encountered with Caucasians. This dermatological condition is associated with insulin resistance and metabolic disorders, and is known to be a good predictor of hyperinsulinemia, which can lead to DM-2 (12)(13)(14).…”

Risk factors of type 2 diabetes and cardiovascular diseases among Jamaican adolescents

“…Previous research have found that the presence of AN is an independent risk factor for T2DM since AN is associated with hyperinsulinemia and high BMI (Kong, et al, 2007;Kobaissi, Weigensberg, Ball et al, 2004). One third of our sample had high BMI.…”

“…They found that AN was present in 17% of the children and adolescent in their sample. Another study of 131 obese children (BMI of 28.4+5.5) ages 7-13 found that up to 73% of the children had AN (Kobaissi, et al, 2004). Findings of overweight associated with AN in children and adolescents are significant.…”

“…Three studies (Nguyen et al, 2001;Hirschler, et al, 2002& Kobaissi, et al, 2004 found closer relationships between AN and BMI when compared to AN and hyperinsulinemia and IR. Only 35% of the obese children with hyperinsulinemia also had AN despite ethnicity (Nguyen et al, 2001).…”