Vilela Brunna Sullara, Vasques Ana Carolina Junqueira, Cassani Roberta Soares Lara, Forti Adriana Costa E, Pareja José Carlos, Tambascia Marcos Antonio, Geloneze Bruno
LIMED - Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, Sao Paulo, Brazil.
School of Applied Sciences, University of Campinas, Limeira, Sao Paulo, Brazil.
PLoS One. 2016 Aug 4;11(8):e0158751. doi: 10.1371/journal.pone.0158751. eCollection 2016.
The major adverse consequences of obesity are associated with the development of insulin resistance (IR) and adiposopathy. The Homeostasis Model Assessment-Adiponectin (HOMA-AD) was proposed as a modified version of the HOMA1-IR, which incorporates adiponectin in the denominator of the index.
To evaluate the performance of the HOMA-AD index compared with the HOMA1-IR index as a surrogate marker of IR in women, and to establish the cutoff value of the HOMA-AD.
SUBJECTS/METHODS: The Brazilian Metabolic Syndrome Study (BRAMS) is a cross-sectional multicenter survey. The data from 1,061 subjects met the desired criteria: 18-65 years old, BMI: 18.5-49.9 Kg/m² and without diabetes. The IR was assessed by the indexes HOMA1-IR and HOMA-AD (total sample) and by the hyperglycemic clamp (n = 49). Metabolic syndrome was defined using the IDF criteria.
For the IR assessed by the clamp, the HOMA-AD demonstrated a stronger coefficient of correlation (r = -0.64) compared with the HOMA1-IR (r = -0.56); p < 0.0001. In the ROC analysis, compared with the HOMA1-IR, the HOMA-AD showed higher values of the AUC for the identification of IR based on the clamp test (AUC: 0.844 vs. AUC: 0.804) and on the metabolic syndrome (AUC: 0.703 vs. AUC: 0.689), respectively; p < 0.001 for all. However, the pairwise comparison did not show evidence of superiority for the HOMA-AD in comparison with the HOMA1-IR in the diagnosis of IR and metabolic syndrome (p > 0.05). The optimal cutoff identified for the HOMA-AD for the diagnosis of IR was 0.95.
The HOMA-AD index was demonstrated to be a useful surrogate marker for detecting IR among adult women and presented a similar performance compared with the HOMA1-IR index. These results may assist physicians and researchers in determining which method to use to evaluate IR in light of the available facilities.
肥胖的主要不良后果与胰岛素抵抗（IR）和脂肪组织病变的发展有关。稳态模型评估 - 脂联素（HOMA - AD）是作为HOMA1 - IR的改良版本提出的，该指数在分母中纳入了脂联素。
评估HOMA - AD指数与HOMA1 - IR指数相比，作为女性IR替代标志物的性能，并确定HOMA - AD的临界值。
对象/方法：巴西代谢综合征研究（BRAMS）是一项横断面多中心调查。来自1061名受试者的数据符合所需标准：年龄18 - 65岁，体重指数（BMI）：18.5 - 49.9 Kg/m²且无糖尿病。通过HOMA1 - IR和HOMA - AD指数（总样本）以及高血糖钳夹法（n = 49）评估IR。使用国际糖尿病联盟（IDF）标准定义代谢综合征。
对于通过钳夹法评估的IR，与HOMA1 - IR（r = -0.56）相比，HOMA - AD表现出更强的相关性系数（r = -0.64）；p < 0.0001。在ROC分析中，与HOMA1 - IR相比，HOMA - AD在基于钳夹试验识别IR（AUC：0.844对AUC：0.804）和代谢综合征（AUC：0.703对AUC：0.689）方面分别显示出更高的AUC值；所有p均< 0.001。然而，成对比较未显示HOMA - AD在诊断IR和代谢综合征方面优于HOMA1 - IR的证据（p > 0.05）。确定的用于诊断IR的HOMA - AD的最佳临界值为0.95。
HOMA - AD指数被证明是检测成年女性IR的有用替代标志物，并且与HOMA1 - IR指数表现相似。这些结果可能有助于医生和研究人员根据现有设施确定使用哪种方法来评估IR。
