Identifying metabolic syndrome in African American children using fasting HOMA-IR in place of glucose

Sushma Sharma, Robert H Lustig, Sharon E Fleming, Sushma Sharma, Robert H Lustig, Sharon E Fleming

Abstract

Introduction: Metabolic syndrome (MetS) is increasing among young people. We compared the use of homeostasis model assessment of insulin resistance (HOMA-IR) with the use of fasting blood glucose to identify MetS in African American children.

Methods: We performed a cross-sectional analysis of data from a sample of 105 children (45 boys, 60 girls) aged 9 to 13 years with body mass indexes at or above the 85th percentile for age and sex. Waist circumference, blood pressure, and fasting levels of blood glucose, insulin, triglycerides, and high-density lipoprotein cholesterol were measured.

Results: We found that HOMA-IR is a stronger indicator of MetS in children than blood glucose. Using HOMA-IR as 1 of the 5 components, we found a 38% prevalence of MetS in this sample of African American children and the proportion of false negatives decreased from 94% with blood glucose alone to 13% with HOMA-IR. The prevalence of MetS was higher in obese than overweight children and higher among girls than boys.

Conclusion: Using HOMA-IR was preferred to fasting blood glucose because insulin resistance was more significantly interrelated with the other 4 MetS components.

References

    1. Grundy SM, Brewer HB, Jr, Cleeman JI, Smith SC, Jr, Lenfant C. Definition of MetS: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109(3):433–438.
    1. de Ferranti SD, Gauvreau K, Ludwig DS, Newburger JW, Rifai N. Inflammation and changes in metabolic syndrome abnormalities in US adolescents: findings from the 1988-1994 and 1999-2000 National Health and Nutrition Examination surveys. Clin Chem. 2006;52(7):1325–1330.
    1. 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(8):821–827.
    1. de Ferranti SD, Gauvreau K, Ludwig DS, Newfeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110(16):2494–2497.
    1. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–359.
    1. Lee S, Bacha F, Arslanian SA. Waist circumference, blood pressure, and lipid components of the metabolic syndrome. J Pediatr. 2006;149(6):809–816.
    1. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004;89(1):108–113.
    1. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents — an IDF consensus report. Pediatr Diabetes. 2007;8(5):299–306.
    1. Hickman TB, Briefel RR, Carroll MD, Rifkind BM, Cleeman JI, Maurer KR, et al. Distributions and trends of serum lipid levels among United States children and adolescents ages 4-19 years: data from the Third National Health and Nutrition Examination Survey. Prev Med. 1998;27(6):879–890.
    1. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics. 2004;114(2):e198–e205.
    1. Camhi SM, Kuo JA, Young DR. [Accessed November 19, 2010];Identifying adolescent metabolic syndrome using body mass index and waist circumference. Prev Chronic Dis. 2008 5(4):A115. .
    1. Berenson GS, Srinivasan SR, Bao W, Newman WP, 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338(23):1650–1656.
    1. Raman A, Fitch MD, Hudes ML, Lustig RH, Murray CB, Ikeda JP, et al. Baseline correlates of insulin resistance in inner city high-BMI African-American children. Obesity (Silver Spring) 2008;16(9):2039–2045.
    1. Kullkarni KR, Garber DW, Jones MK, Segrest JP. Identification and cholesterol quantification of low density lipoprotein subclasses in young adults by VAP-II methodology. J Lipid Res. 1995;36(11):2291–2302.
    1. Raman A, Lustig R, Fitch MD, Fleming S. Accuracy of self-assessed Tanner staging against hormonal assessment of sexual maturation in overweight African-American children. J Pediatr Endocrinol Metab. 2009;22(7):609–622.
    1. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–576.
    1. Fernandez JR, Redden DR, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004;145(4):439–444.
    1. Madeira IR, Carvalho CN, Gazolla FM, de Matos, HJ, Borges MA, Bordallo MA. Cut-off point for homeostatic model assessment for insulin resistance (HOMA-IR) index established from receiver operating characteristic (ROC) curve in the detection of metabolic syndrome in overweight pre-pubertal children. [Article in Portuguese.] Arq Bras Endocrinol Metabol. 2008;52(9):1466–1473.
    1. Dabelea D, Pettitt DJ, Jones KL, Arslanian SA. Type 2 diabetes mellitus in minority children and adolescents. An emerging problem. Endocrinol Metab Clin North Am. 1999;28(4):709–729.
    1. Reaven GM. The individual components of the metabolic syndrome: is there a raison d'être? J Am Coll Nutr. 2007;26(3):191–195.
    1. Conwell LS, Trost ST, Brown WJ, Batch JA. Indexes of insulin resistance and secretion in obese children and adolescents. Diabetes Care. 2004;27(2):314–319.
    1. Tresaco B, Bueno G, Pineda I, Moreno LA, Garagorri JM, Bueno M. Homeostatic model assessment (HOMA) index cut-off values to identify the metabolic syndrome in children. J Physiol Biochem. 2005;61(2):381–388.

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