PDF
ePub
Citation
Print
Abstract
Purpose
This study was performed to evaluate the distribution of homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance, and its association with metabolic risk factors among Korean adolescents.
Methods
This study was based on data from Korean National Health and Nutrition Examination Survey (KNHANES) 2008~2009. Data from 2,035 adolescents (1,053 boys, 982 girls; aged 10~19 years) were analyzed. We classified all subjects into four groups, based on the quartiles of HOMA-IR, and the highest quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis to determine the independent risk factors for insulin resistance.
Results
The highest quartile values of HOMA-IR representing insulin resistance were 3.4 for boys and 3.6 for girls. Mean body mass index, waist circumference, systolic blood pressure, serum triglyceride, alanine aminotransferase (ALT), fasting glucose and insulin increased, whereas HDL cholesterol decreased with increased HOMA-IR. We found HOMA-IR has significant positive correlation with waist circumference, triglyceride, ALT level and systolic/diastolic blood pressure, while it has negative correlation with HDL-cholesterol level (p<0.005). Independent predictors (odds ratio) for insulin resistance were elevated ALT (3.53 for boys; 4.04 for girls), central obesity (3.01 for boys; 3.20 for girls), and hypertriglyceridemia (3.03 for boys; 1.94 for girls).
Figures and Tables
Table 1
General Characteristics of the Subjects
Data are expressed as Mean±SE for continuous variables and percentage (%) for categorical variables. Obesity level was determined according to the gender and age-specific BMI percentile; normal (BMI<85 percentile), overweight (BMI≥85 percentile and <95 percentile) and obese (BMI≥95 percentile). *HDL: high density lipoprotein, †AST: serum aspartate aminotransferase, ‡ALT: serum alanine aminotransferase, §HOMA-IR: homeostasis model assessment of insulin resistance.
Table 2
Metabolic Risk Factors Stratified by HOMA-IR Quartiles
Data are shown as means±SE. The subjects were stratified into four groups according to HOMA-IR quartiles. Obesity level was determined according to gender and age-specific BMI percentile; normal (BMI<85 percentile), overweight (BMI≥85 percentile and <95 percentile) and obese (BMI≥95 percentile). *HOMA-IR: homeostasis model assessment of insulin resistance, †BP: blood pressure, ‡HDL: high density lipoprotein, §AST: aspartate aminotransferase, ∥ALT: alanine aminotransferase.
Table 3
Age-adjusted Correlations between Homeostasis Model Assessment of Insulin Resistance and Metabolic Risk Factors
Table 4
Age-adjusted Odds Ratios (95% Confidence Intervals) for Insulin Resistance by Multivariate Logistic Regression
Subjects with a homeostasis model assessment of insulin resistance (HOMA-IR) level greater than the highest quartile (≥3.4 for boys and ≥3.6 for girls) were defined as insulin resistant. Elevated fasting glucose: Fasting glucose ≥100 mg/dL, Elevated ALT: ALT ≥32 IU/L for boys, ALT ≥24 IU/L for girls. Central obesity: Waist circumference ≥90 percentile of sex and age specific reference, Hypertriglyceridemia: TG ≥110 mg/dL. Low HDL: HDL <40 mg/dL, Hypertension: systolic BP or diastolic BP ≥90 percentile of sex, age and height specific reference. *OR: odds ratio, †CI: confidence interval, ‡ALT: alanine aminotransferase, §HDL: high density lipoprotein.
References
1. Chu MA, Choe BH. Obesity and metabolic syndrome among children and adolescents in Korea. J Korean Med Assoc. 2010. 53:142–152.
2. Oh K, Jang MJ, Lee NY, Moon JS, Lee CG, Yoo MH, et al. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr. 2008. 51:950–955.
3. Park MJ, Boston BA, Oh M, Jee SH. Prevalence and trends of metabolic syndrome among Korean adolescents: from the Korean NHANES survey, 1998-2005. J Pediatr. 2009. 155:529–534.
4. Groop L, Orho-Melander M. The dysmetabolic syndrome. J Intern Med. 2001. 250:105–120.
5. Reaven GM. Banting Lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988. 37:1597–1607.
6. Park MJ. Epidemiology of the metabolic syndrome among Korean children and adolescents. Korean J Pediatr. 2008. 51:564–568.
7. Song Y, Park MJ, Paik HY, Joung H. Secular trends in dietary patterns and obesity-related risk factors in Korean adolescents aged 10-19 years. Int J Obes (Lond). 2010. 34:48–56.
8. Long SD, O'Brien K, MacDonald KG, Leggett-Frazier N, Swanson MS, Pories WJ, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes Care. 1994. 17:372–375.
9. Bergman RN, Phillips LS, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest. 1981. 68:1456–1467.
10. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985. 28:412–419.
11. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005. 115:e500–e503.
12. Lee JK, Kim YT. Korean National Health and Nutrition Examination Survey (KNHANES) IV progress report. 2008. accessed on 20 Feb 2011. Chungbuk, Korea: Korea centers for disease control and prevention;Available at http://knhanes.cdc.go.kr/.
13. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008. 51:1–25.
14. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007. 8:299–306.
15. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003. 157:821–827.
16. Kang HS, Um SH, Seo YS, An H, Lee KG, Jin J, et al. Healthy range for serum ALT and the clinical significance of "unhealthy" normal ALT levels in the Korean population. J Gastroenterol Hepatol. 2011. 26:292–299.
17. McAuley KA, Williams SM, Mann JI, Walker RJ, Lewis-Barned NJ, Temp Duncan AW. Diagnosing insulin resistance in the general population. Diabetes Care. 2001. 24:460–464.
18. Goran MI, Ball GD, Cruz ML. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. 2003. 88:1417–1427.
19. Moran A, Jacobs DR, Steinberger J, Hong CP, Prineas R, Luepker R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999. 48:2039–2044.
20. Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001. 50:2444–2450.
21. Hirschler V, Maccallini G, Karam C, Gonzalez C, Aranda C. Are girls more insulin-resistant than boys? Clin Biochem. 2009. 42:1051–1056.
22. Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG. Prevalence and determinants of insulin resistance among U.S. adolescents: a population based study. Diabetes Care. 2006. 29:2427–2432.
23. Bao W, Srinivasan SR, Berenson GS. The Bogalusa Heart Study. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. Circulation. 1996. 93:54–59.
24. Balkau B, Charles MA. European Group for the Study of Insulin Resistance (EGIR). Comment on the provisional report from the WHO consultation. Diabet Med. 1999. 16:442–443.
25. Kang HT, Yoon JH, Kim JY, Ahn SK, Linton JA, Koh SB, et al. The association between the ratio of triglyceride to HDL-C and insulin resistance according to waist circumference in a rural Korean population. Nutr Metab Cardiovasc Dis. 2011. 07. 14. [Epub ahead of print].
26. Sung KC, Lim S, Rosenson RS. Hyperinsulinemia and homeostasis model assessment of insulin resistance as predictors of hypertension: a 5-year follow-up study of Korean sample. Am J Hypertens. 2011. 24:1041–1045.
27. Ausk KJ, Boyko EJ, Ioannou GN. Insulin resistance predicts mortality in nondiabetic individuals in the U.S. Diabetes Care. 2010. 33:1179–1185.
28. Pande RL, Perlstein TS, Beckman JA, Creager MA. Association of insulin resistance and inflammation with peripheral arterial disease: the National Health and Nutrition Examination Survey, 1999 to 2004. Circulation. 2008. 118:33–41.
29. Cha BS. Cho HK, editor. Pathophysiology of insulin resistence. Metabolic syndrome 2009. 2009. 2nd ed. Seoul: Jin publishing Co;39–50.
30. Sadur CN, Yost TJ, Eckel RH. Insulin responsiveness of adipose tissue lipoprotein lipase is delayed but preserved in obesity. J Clin Endocrinol Metab. 1984. 59:1176–1182.
31. Golay A, Zech L, Shi MZ, Chiou YA, Reaven GM, Chen YD. High density lipoprotein (HDL) metabolism in noninsulin-dependent diabetes mellitus: measurement of HDL turnover using titrated HDL. J Clin Endocrinol Metab. 1987. 65:512–515.
32. Byun SH, Jeon JD, Kim HS, Kim SY. A study of serum adiponectin and insulin resistance in children and adolescents. J Korean Soc Pediatr Endocrinol. 2007. 12:63–70.
33. Ahn JG, Kim JM, Shin JH. Factors related to complications of childhood obesity. J Korean Soc Pediatr Endocrinol. 2006. 11:76–84.
34. Lee SH, Choi SH, Kim HJ, Chung YS, Lee KW, Lee HC, et al. Cutoff values of surrogate measures of insulin resistance for metabolic syndrome in Korean non-diabetic Adults. J Korean Med Sci. 2006. 21:695–700.
35. Choi HJ, Yun KE. Predictors of insulin resistance in postmenopausal women. J Korean Soc Menopause. 2010. 16:93–98.
36. Amiel SA, Sherwin RS, Simonson DC, Lauritano AA, Tamborlane WV. Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med. 1986. 315:215–219.
37. Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003. 107:1448–1453.
38. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003. 98:960–967.
39. Vozarova B, Stefan N, Lindsay RS, Saremi A, Pratley RE, Bogardus C, et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes. 2002. 51:1889–1895.
40. Hanley AJ, Williams K, Festa A, Wagenknecht LE, D'Agostino RB Jr, Haffner SM. Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study. Diabetes. 2005. 54:3140–3147.
XML Download