Tantari Giacomo, Bassi Marta, Pistorio Angela, Minuto Nicola, Napoli Flavia, Piccolo Gianluca, La Valle Alberto, Spacco Giordano, Cervello Carla, D'Annunzio Giuseppe, Maghnie Mohamad
Pediatric Clinic and Endocrinology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.
DINOGMI (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health), University of Genoa, Genoa, Italy.
Front Endocrinol (Lausanne). 2024 Nov 22;15:1439901. doi: 10.3389/fendo.2024.1439901. eCollection 2024.
Insulin resistance in children and adolescents with obesity is linked to increased risk of type 2 diabetes mellitus and cardiovascular disease. The SPISE index, based on values of fasting triglycerides (mg/dL), HDL cholesterol (mg/dL), and BMI (kg/m2), shows promise in predicting insulin resistance in children.
This study aimed to identify a SPISE cut-off for detecting insulin resistance and evaluate its relationship with pubertal development, anthropometrics, and glycometabolic profile in 232 children and adolescents, 105 males and 127 females (median age 13.2 years) with overweight (n=48) and obesity (n=184). SPISE index was calculated with the formula: 600 x HDL Cholesterol/Triglyceridesx BMI, and patients were categorized based on Tanner stages [(Group 1 (18.8%) Tanner 1, Group 2 (44.6%) Tanner 2-3-4, Group 3 (36.6%) Tanner 5)].
A SPISE cut-off ≤ 6.92 or ≤ 6.13 (based on the method used for insulin resistance detection), in subjects with Tanner stages I and II, showed good sensitivity and specificity as a marker of insulin resistance. SPISE index decreased significantly with the advancement of pubertal status (P < 0.0001) and with worsening severity of obesity (P < 0.0001). While no significant differences in SPISE marker were observed between patients with normal and abnormal glucose tolerance during OGTT within any pubertal stage, SPISE values were significantly lower in patients with confirmed insulin resistance (total sum of insulin OGTT ≥ 535 µu/mL) in all three pubertal groups (Group 1: P=0.008; Group 2: P=0.0008 and Group 3: P=0.002, respectively).
In children and adolescents with obesity the SPISE index can be proposed as an alternative to OGTT and other insulin-based methods for evaluating insulin resistance. Its advantage lies in using readily available and inexpensive laboratory tests, making it suitable for large-scale studies and follow-up monitoring across diverse populations.
肥胖儿童和青少年的胰岛素抵抗与2型糖尿病和心血管疾病风险增加有关。基于空腹甘油三酯（mg/dL）、高密度脂蛋白胆固醇（mg/dL）和体重指数（kg/m²）值的SPISE指数在预测儿童胰岛素抵抗方面显示出前景。
本研究旨在确定用于检测胰岛素抵抗的SPISE临界值，并评估其与232名儿童和青少年（105名男性和127名女性，中位年龄13.2岁，超重48名，肥胖184名）的青春期发育、人体测量学和糖代谢谱的关系。SPISE指数通过公式计算：600×高密度脂蛋白胆固醇/甘油三酯×体重指数，患者根据坦纳分期进行分类[（第1组（18.8%）坦纳1期，第2组（44.6%）坦纳2 - 3 - 4期，第3组（36.6%）坦纳5期）]。
在坦纳I期和II期的受试者中，SPISE临界值≤6.92或≤6.13（基于用于检测胰岛素抵抗的方法）作为胰岛素抵抗标志物显示出良好的敏感性和特异性。SPISE指数随着青春期状态的进展（P < 0.0001）和肥胖严重程度的加重（P < 0.0001）而显著降低。虽然在任何青春期阶段的口服葡萄糖耐量试验（OGTT）期间，糖耐量正常和异常的患者之间在SPISE标志物上未观察到显著差异，但在所有三个青春期组中，确诊为胰岛素抵抗（胰岛素OGTT总和≥535微单位/毫升）的患者的SPISE值显著较低（第1组：P = 0.008；第2组：P = 0.0008；第3组：P = 0.002）。
在肥胖儿童和青少年中，SPISE指数可作为评估胰岛素抵抗的口服葡萄糖耐量试验和其他基于胰岛素的方法的替代方法。其优势在于使用现成且廉价的实验室检测，使其适用于大规模研究和对不同人群的随访监测。
