Abstract:Objectives:To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, … Show more
“…The homeostatic model assessment of insulin resistance (HOMA‐IR) was calculated as the product of insulin (μU/L) and glucose (mmol/L) divided by 22.5 [35]. There is no clear consensus for the cut‐off values of HOMA to define IR in children and adolescents [36], but we used two approaches to corroborate our findings: (1) common in the literature within 10–15 years, IR was defined as HOMA‐IR >2.5 for prepubertal children (Tanner stage 1 [37])and >4.0 for pubertal stages (Tanner stage >1), and (2) most recent years and based on validation using hyperglycaemic clamp, >3.22 for pubertal and >2.91 for post‐pubertal adolescents [38].…”
BackgroundAntiretroviral therapy‐associated adverse effects and comorbidities are still pervasive in people living with HIV, especially metabolic syndrome (MetS). We investigated the age‐dependent prevalence of components of MetS and insulin resistance in children and adolescents living with HIV (CALWH).MethodsA cross‐sectional pilot study of CALWH treated at the Baylor Uganda Clinical Centre of Excellence in Kampala, Uganda, May to August 2021. The primary outcome of MetS was defined by both the International Diabetes Federation (IDF) and the Adult Treatment Panel (ATP III) criteria. We estimated the prevalence of MetS and its components for all participants and by the stratification factors.ResultsWe enrolled 90 children and adolescents, aged 6 to <10 years (n = 30), 10 to <16 years (n = 30), and ≥ 16 to <19 years (n = 30). Fifty‐one percent were females. The estimated prevalence of MetS was 1.11% (1 of 90) using either IDF or ATPIII criteria for all participants, and 3.33% in the oldest age group. Notably, while only one among study participants met the criterion based on having central obesity or blood pressure, over 55% of participants had one or more IDF component, with 47% having low high‐density lipoprotein (HDL) cholesterol. Two participants (6.67%) in the group aged 10 to <16 years met one of the definitions for insulin resistance (IR) using the Homeostatic Model Assessment (HOMA‐IR) index. For every 1‐year increase in age, HOMA‐IR index increased by 0.04 (95% confidence interval: 0.01–0.08; p = 0.02).ConclusionsWith increasing survival of CALWH into adulthood, lifetime exposure to ART, the frequency of MetS in this population may rise, increasing the lifetime risk for associated health problems. There is a need to study the natural history of MetS in CALWH to inform preventative and treatment interventions as needed.
“…The homeostatic model assessment of insulin resistance (HOMA‐IR) was calculated as the product of insulin (μU/L) and glucose (mmol/L) divided by 22.5 [35]. There is no clear consensus for the cut‐off values of HOMA to define IR in children and adolescents [36], but we used two approaches to corroborate our findings: (1) common in the literature within 10–15 years, IR was defined as HOMA‐IR >2.5 for prepubertal children (Tanner stage 1 [37])and >4.0 for pubertal stages (Tanner stage >1), and (2) most recent years and based on validation using hyperglycaemic clamp, >3.22 for pubertal and >2.91 for post‐pubertal adolescents [38].…”
BackgroundAntiretroviral therapy‐associated adverse effects and comorbidities are still pervasive in people living with HIV, especially metabolic syndrome (MetS). We investigated the age‐dependent prevalence of components of MetS and insulin resistance in children and adolescents living with HIV (CALWH).MethodsA cross‐sectional pilot study of CALWH treated at the Baylor Uganda Clinical Centre of Excellence in Kampala, Uganda, May to August 2021. The primary outcome of MetS was defined by both the International Diabetes Federation (IDF) and the Adult Treatment Panel (ATP III) criteria. We estimated the prevalence of MetS and its components for all participants and by the stratification factors.ResultsWe enrolled 90 children and adolescents, aged 6 to <10 years (n = 30), 10 to <16 years (n = 30), and ≥ 16 to <19 years (n = 30). Fifty‐one percent were females. The estimated prevalence of MetS was 1.11% (1 of 90) using either IDF or ATPIII criteria for all participants, and 3.33% in the oldest age group. Notably, while only one among study participants met the criterion based on having central obesity or blood pressure, over 55% of participants had one or more IDF component, with 47% having low high‐density lipoprotein (HDL) cholesterol. Two participants (6.67%) in the group aged 10 to <16 years met one of the definitions for insulin resistance (IR) using the Homeostatic Model Assessment (HOMA‐IR) index. For every 1‐year increase in age, HOMA‐IR index increased by 0.04 (95% confidence interval: 0.01–0.08; p = 0.02).ConclusionsWith increasing survival of CALWH into adulthood, lifetime exposure to ART, the frequency of MetS in this population may rise, increasing the lifetime risk for associated health problems. There is a need to study the natural history of MetS in CALWH to inform preventative and treatment interventions as needed.
“…First, the detailed assessment of metabolic parameters in a large sample of adolescents is rarely found in the literature and allows further investigations on the association of lifestyle and sensitive markers of metabolic disorders, which was extended to a subsample of individuals who participated in the hyperglycemic clamp protocol, a gold standard for insulin secretion evaluation, and a direct measurement of insulin sensitivity (28). Statistical correction for pubertal status and sleep was an important asset, as these factors are well-known confounders, as shown by previous studies with the BRAMS-P dataset using the hyperglycemic clamp protocol (30,39). Another advantage of the present study was to use the time spent sitting and time spent on moderate-to high-intensity physical activity as confounding factors of each other's exposure, which favors the interpretation of the results.…”
IntroductionObesity and metabolic syndrome (MetS) have immediate and long-term consequences on adolescent health and well-being. Among the available treatments for MetS in adolescents, behavioral interventions such as increasing physical activity (PA) are preferred. This study aimed to investigate the association of PA and sitting time with MetS and a complete set of metabolic health parameters.MethodsData from the Pediatric Brazilian Metabolic Syndrome Study (BRAMS-P), a cross-sectional multicenter study conducted using a convenience sample of 448 Brazilian adolescents (10y–19y), were used. Sociodemographic and lifestyle information were collected using a standardized questionnaire. Daily PA and sitting time were estimated from the International PA Questionnaire. Anthropometric parameters, body composition, and blood pressure were measured by trained researchers. Blood lipids, uric acid, hepatic enzymes, creatinine, glycated hemoglobin, glucose, and insulin were measured in fasting blood samples, and the Homeostasis Model Assessment for Insulin Resistance was calculated. A subsample of 57 adolescents underwent the hyperglycemic clamp protocol.ResultsThe odds for metabolic syndrome were higher among adolescents who spent >8h sitting (OR (95%CI)=2.11 (1.02 – 4.38)), but not in those classified as active (OR (95%CI)=0.98 (0.42 – 2.26)). Adolescents who spent more time sitting had higher BMI, waist circumference, sagittal abdominal diameter, neck circumference, percentage of body fat, and worse blood lipid profile. The insulin sensitivity index was moderately and positively correlated with moderate-to-high PA in minutes per day (rho=0.29; p=0.047).ConclusionTime spent sitting was associated with worse metabolic parameters and must be restricted in favor of adolescent health. Regular PA is associated with improved insulin sensitivity and may be encouraged not only in adolescents with obesity or metabolic disorders but also to prevent adverse metabolic outcomes in normal-weight adolescents.
Insulin resistance (IR) plays an important role in the development of non-alcoholic fatty liver disease (NAFLD). IR markers are divided into two types: (1) insulin-based IR marker, homeostatic model assessment of IR (HOMA-IR); and (2) non-insulin-based IR markers, such as triglyceride-glucose (TyG) index, TyG index with body mass index (TyG-BMI), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), and metabolic score for IR (METS-IR). The non-insulin-based IR markers are often associated with lipids. The aim of this study was to analyse the association between IR markers and NAFLD in non-diabetic population. Baseline data of NAFLD and non-NAFLD groups were compared. Logistic regression was used to evaluate the relationship between five IR markers and NAFLD risk. The odds ratios (ORs) and 95% confidence intervals (CIs) of IR markers were calculated. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate the ability of different IR markers to detect NAFLD. Subgroup analyses were performed in obese and non-obese subgroups. This study found a positive correlation between NAFLD risk and elevation in five IR markers (HOMA-IR, TyG, TyG-BMI, TG/HDL-c, and METS-IR). In non-obese subjects, the AUC of TyG-BMI was larger than that of the other four IR markers to detect NAFLD. The AUC of HOMA-IR was larger than that of the other four IR markers to detect NAFLD in obese subjects. In non-diabetic population, the five IR markers are associated with the risk of NAFLD, including non-obese and obese NAFLD. TyG-BMI and HOMA-IR can be used to detect non-obese and obese NAFLD, respectively, with better detection ability compared with the other IR markers.
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