Singh Yashpal, Garg M K, Tandon Nikhil, Marwaha Raman Kumar
International Life Sciences, Scientific Advisor (Projects), New Delhi, India. E-mail:
J Clin Res Pediatr Endocrinol. 2013;5(4):245-51. doi: 10.4274/Jcrpe.1127.
Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS.
A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model.
Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p p<0.0001) and WC (4.8, p p<0.0001), compared to WHR (3.3, p p<0.0001).
In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria.
胰岛素抵抗（IR）及相关代谢异常在青少年人群中的报道日益增多。青少年中作为代谢综合征（MS）指标的稳态模型评估IR（HOMA-IR）的截断值尚未确定。本研究旨在通过HOMA-IR调查印度城市青少年的IR情况，并确定用于定义MS的HOMA-IR截断值。
本横断面研究共纳入691名表面健康的青少年（295名体重指数（BMI）正常，205名超重，199名肥胖）。青少年MS根据国际糖尿病联盟（IDF）和成人治疗小组III（ATP III）标准定义。使用HOMA模型计算IR。
男孩的平均身高、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）和血压显著高于女孩。男女两性的HOMA-IR值均从正常体重青少年到肥胖青少年逐渐升高。男女两性的平均HOMA-IR值根据性成熟等级逐渐升高。HOMA-IR值为2.5时，对MS的敏感性>70%，特异性>60%。与使用IDF或ATP III标准诊断MS相比，该截断值在不同BMI类别中识别出更多患有MS的青少年（正常体重者中为19.7%，超重者中为51.7%，肥胖者中为77.0%）。与WHR（3.3，p<0.0001）相比，WHtR（4.9，p<0.0001）和WC（4.8，p<0.0001）时发生IR（HOMA-IR>2.5）的比值比最高。
在印度青少年中，HOMA-IR随性成熟以及从正常体重到肥胖的进展而升高。根据ATP III和IDF标准，HOMA-IR截断值为2.5在诊断两性MS时提供了最大的敏感性和特异性。
