Gemelli Ivanice Fernandes Barcellos, Silva Thais Rasia, Farias Edson Dos Santos, Olinto Maria Teresa Anselmo, Spritzer Poli Mara
Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
Federal University of Rondônia, Rondônia, Brazil.
Diabetol Metab Syndr. 2021 Oct 19;13(1):113. doi: 10.1186/s13098-021-00730-8.
It has been described that physiological changes in glucose metabolism, represented by insulin resistance (IR), are predicted during pubertal evolution, and obesity may be associated with its persistence even at the end of puberty. The aim of this study was to investigate the prevalence of IR in female adolescents with possible associated factors and evaluate the relationship of time since menarche (< 2 vs. ≥ 2 years) in the occurrence of IR in two Brazilian capital cities: Porto Velho (RO) and Porto Alegre (RS).
This is a cross-sectional school-based study, using information from the Study of Cardiovascular Risks (ERICA) database for adolescents aged 12-17 years, enrolled in public and private schools, in municipalities with more than 100,000 inhabitants in Brazil, between 2013 and 2014. The present study included 889 adolescents, 382 in Porto Velho (PVh) and 507 in Porto Alegre (PoA). The homeostasis model assessment for insulin resistance (HOMA-IR) ≥ 3.16 and fasting insulin ≥ 15 mU/L was used to determine the outcome variable of IR. Estimates of crude and adjusted prevalence ratios with confidence intervals of 95% were calculated using Poisson regression with robust variance. Sociodemographic, behavioral, reproductive and nutritional characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of IR determination.
In the total sample, the prevalence of IR was 22.03% (95% CI 17.84-26.89). After adjusting the models, age 15-17 years and time since menarche ≥ 2 years were found to act as protective factors for IR; in contrast, the highest probability of IR was observed in black adolescents, with increased waist circumference (WC) and overweight/obesity (Ow/Ob). The protective effect of two or more years since menarche (post-menarche) was observed for both higher HOMA-IR and fasting insulin in PVh; in PoA, such protection was maintained only for fasting insulin ≥ 15 mU/L after adjustments in the multivariate models.
IR is more prevalent during the peri-menarche period, especially in younger and black adolescents, compared to their white and post-menarche counterparts. The association between Ow/Ob and high WC with the occurrence of IR was independent of age and ethnicity variables.
已有研究表明，以胰岛素抵抗（IR）为代表的葡萄糖代谢生理变化在青春期发育过程中可被预测，肥胖可能与青春期结束后IR的持续存在有关。本研究旨在调查可能存在相关因素的女性青少年中IR的患病率，并评估月经初潮时间（<2年与≥2年）与巴西两个首府城市（波多韦柳（RO）和阿雷格里港（RS））IR发生情况之间的关系。
这是一项基于学校的横断面研究，使用了2013年至2014年间巴西人口超过10万的城市中，公立和私立学校12至17岁青少年的心血管风险研究（ERICA）数据库中的信息。本研究纳入了889名青少年，其中波多韦柳有382名（PVh），阿雷格里港有507名（PoA）。采用胰岛素抵抗稳态模型评估（HOMA-IR）≥3.16和空腹胰岛素≥15mU/L来确定IR的结局变量。使用稳健方差的泊松回归计算95%置信区间的粗患病率和调整患病率比值估计值。在基于IR确定概念框架的多变量模型中，社会人口学、行为学（行为）、生殖和营养特征被视为潜在的混杂因素。
在总样本中，IR的患病率为22.03%（95%CI 17.84-26.89）。调整模型后，发现15至17岁和月经初潮时间≥2年是IR的保护因素；相反，在黑人青少年中观察到IR的可能性最高，且腰围（WC）增加和超重/肥胖（Ow/Ob）。在PVh中，月经初潮后两年或更长时间（初潮后）对较高的HOMA-IR和空腹胰岛素均有保护作用；在PoA中，多变量模型调整后，这种保护仅对空腹胰岛素≥15mU/L维持。
与白人及初潮后青少年相比，IR在初潮前后时期更为普遍，尤其是在较年轻和黑人青少年中。Ow/Ob和高WC与IR发生之间的关联独立于年龄和种族变量。
