The incidence of insulin resistance based on indices calculated using the HOMA and Belfiore methods and its impact on the occurrence of metabolic complications in prepubertal children born small for gestational age

Abstract

Introduction: Children born small for gestational age (SGA) are predisposed to obesity, insulin resistance (IR), and lipid disorders. The HOMA-IR index is commonly used to assess IR (IRI HOMA ), calculated from fasting glucose and insulin. However, sometimes, during the oral glucose tolerance test (OGTT), elevated and prolonged postprandial insulin secretion is observed despite normal fasting insulin levels. IRI Belfiore is an IR index that analyses glucose and insulin levels during OGTT according to the method proposed by Belfiore. The aim of the study was to assess the frequency of IR based on IRI HOMA and IRI Belfiore results in SGA children aged 6-8 years, after catch-up phenomenon, to determine the usefulness of IRI Belfiore in diagnosis of IR and in predicting future metabolic complications. Material and methods: In 129 SGA normal-height children, aged 6-8 years, height, weight, waist circumference, blood pressure, as well as lipids, IGF-1, cortisol, C-peptide, leptin, adiponectin, and resistin concentrations were measured. The glucose and insulin concentrations were evaluated at 0, 60, and 120 minutes of OGTT. Results: IRI HOMA was normal in all children, while elevated IRI Belfiore was found in 22.5% of them. Children with IR diagnosed by IRI Belfiore were taller, had higher blood pressure, higher leptin, and lower HDL-cholesterol concentrations. Conclusions: It seems worth recommending IRI Belfiore derived from OGTT as a valuable diagnostic tool for identifying IR in SGA prepubertal children. Abnormal IRI Belfiore is related to higher blood pressure and lower HDL-cholesterol concentration in this group.

Comparison of the Clinical Utility of Two Insulin Resistance Indices: IRI-HOMA and IRI-Belfiore in Diagnosing Insulin Resistance and Metabolic Complications in Children Based on the Results Obtained for the Polish Population

“…On the other hand, elevated fasting insulin levels were usually associated with higher insulin levels at 120 min of OGTT, as demonstrated in our study. A similar relationship was observed in another study involving prepubertal children who were diagnosed as being born small for gestational age (SGA) [35]. Elevated IRI-HOMA and the development of hepatic IR were largely associated with previously diagnosed peripheral IR (elevated IRI-Belfiore).…”

“…Elevated IRI-HOMA and the development of hepatic IR were largely associated with previously diagnosed peripheral IR (elevated IRI-Belfiore). This issue affected over 80% of obese children with SGA in that study [35].…”

“…In another study conducted on a group of prepubertal patients born as SGA, we also observed a negative relationship between HDL cholesterol levels and both IRI-HOMA and IRI-Belfiore. However, triglyceride levels were statistically significantly higher only in patients with hepatic IR diagnosed based on IRI-HOMA [35]. The lack of a relationship between IRI-Belfiore and triglyceride levels likely stems from the fact that the majority of patients in this group had not yet developed obesity.…”

IGF-1 and IGF-2 as Molecules Linked to Causes and Consequences of Obesity from Fetal Life to Adulthood: A Systematic Review

“…Lower IGF-1 levels at birth were associated with greater increases in both length and weight by the time infants reached 2 months of age. Children who experience rapid early weight gain develop an elevated BMI and insulin resistance, even as early as 8 years of age [63].…”