Choi Young Sammy, Klaric John S, Beltran Thomas H
1 Department of Medicine, Womack Army Medical Center, Fort Bragg, North Carolina.
2 Department of Pediatrics, Womack Army Medical Center, Fort Bragg, North Carolina.
Metab Syndr Relat Disord. 2019 Feb;17(1):37-45. doi: 10.1089/met.2018.0072. Epub 2018 Nov 3.
Adolescent obesity is an important risk factor for cardiovascular disease in part due to its relationship to type 2 diabetes. Therefore, screening for type 2 diabetes is recommended. However, since insulin resistance (IR) is an early precursor of diabetes, it would be beneficial if IR predictors from routine assessments could identify those at greatest metabolic risk before diabetes has developed.
Adolescents aged 14-18 years with normal fasting plasma glucose (n = 252) were selected from the National Health and Nutrition Examination Survey 2013-2014. IR was estimated with homeostatic model assessment (HOMA). Multivariable linear/logistic regressions with demographic covariates assessed HOMA Index (HI)-determined IR associations with common clinical measurements.
The constellation of body mass index (BMI) percentile (P < 0.0001), diastolic blood pressure (DBP, P = 0.0056), and serum alanine aminotransferase (ALT, P = 0.0295) predicted log-transformed HI; cholesterol, triglycerides, and high- and low-density lipoprotein cholesterol were not predictive. Secondary gender analyses indicated significant associations in males (BMI percentile, P = 0.0008; DBP, P = 0.0003; ALT, P = 0.0436), but only BMI percentile in females (P = 0.0001). After stratifying predictors at clinical thresholds, logistic regressions had increased specificity at HI's 85th percentile compared with its 75th [85th: area under curve (AUC) = 0.87, 75th: AUC = 0.80]. At the 85th HI percentile, IR was associated with these components [BMI percentile: adjusted odds ratio (aOR) = 34.31, 95% confidence interval (CI): 8.5-139.3; ALT: aOR = 11.36, 95% CI: 3.0-43.7; DBP: aOR = 7.73, 95% CI: 2.4-24.6]. In males, IR was associated with elevated BMI percentile (aOR 24.0) and ALT (aOR 23.9) and in females with elevated BMI percentile (aOR 45.8) and DBP (aOR 17.9).
Three routine clinical assessments, BMI percentile, DBP, and ALT, predicted IR at HI's 75th and 85th percentiles in nondiabetic adolescents. Prospective validation may yield simple gender-specific screening identifying nondiabetic adolescents at greatest need of treatment intervention.
青少年肥胖是心血管疾病的重要危险因素，部分原因是其与2型糖尿病的关系。因此，建议对2型糖尿病进行筛查。然而，由于胰岛素抵抗（IR）是糖尿病的早期先兆，如果常规评估中的IR预测指标能够在糖尿病发生之前识别出代谢风险最高的人群，将大有裨益。
从2013 - 2014年国家健康与营养检查调查中选取14 - 18岁空腹血糖正常的青少年（n = 252）。采用稳态模型评估（HOMA）估算IR。多变量线性/逻辑回归结合人口统计学协变量评估HOMA指数（HI）确定的IR与常见临床测量指标的关联。
体重指数（BMI）百分位数（P < 0.0001）、舒张压（DBP，P = 0.0056）和血清丙氨酸氨基转移酶（ALT，P = 0.0295）可预测对数转换后的HI；胆固醇、甘油三酯以及高密度和低密度脂蛋白胆固醇无预测作用。按性别进行的二次分析表明，男性存在显著关联（BMI百分位数，P = 0.0008；DBP，P = 0.0003；ALT，P = 0.0436），而女性仅BMI百分位数有显著关联（P = 0.0001）。在将预测指标按临床阈值分层后，与HI第75百分位数相比，HI第85百分位数时的逻辑回归特异性增加[第85百分位数：曲线下面积（AUC）= 0.87，第75百分位数：AUC = 0.80]。在HI第85百分位数时，IR与这些指标相关[BMI百分位数：调整比值比（aOR）= 34.31，95%置信区间（CI）：8.5 - 139.3；ALT：aOR = 11.36，95% CI：3.0 - 43.7；DBP：aOR = 7.73，95% CI：并在女性中与升高的BMI百分位数（aOR 45.8）和DBP（aOR 17.9）相关。
三项常规临床评估指标，即BMI百分位数、DBP和ALT，可预测非糖尿病青少年HI第75和85百分位数时的IR。前瞻性验证可能会产生简单的针对特定性别的筛查方法，以识别最需要治疗干预的非糖尿病青少年。 2.4 - 24.6]。在男性中，IR与升高的BMI百分位数（aOR 24.0）和ALT（aOR 23.9）相关，
