Insulin resistance in school-age children: comparison surrogate diagnostic markers.

BACKGROUND

This study aimed to identify surrogate markers suitable for evaluating insulin resistance in children and adolescents with overweight and obesity.

METHODS

Forty-nine reported surrogate markers of insulin resistance were selected, including 14 insulin-based markers and 35 non-insulin-based markers. The markers were analyzed in 800 children aged 7-12 years. The demographic characteristics, physical measurements, and clinical indicators of these children were obtained through a cross-sectional study.

RESULTS

27 surrogate markers of insulin resistance were associated with overweight and obesity in children. Insulin-based surrogate markers exhibited a strong linear relationship with HOMA-IR (r > 0.85). Markers such as CRP/HDL-C ratio, Castelli's risk index I, and Castelli's risk index II, which lack evidence from pediatric studies, showed a low linear correlation with HOMA-IR (r ≥ 0.2). Among non-insulin-based surrogate markers, comprehensive indicators such as TyG-WC, TyG-BMI, lipid accumulation product index (LAP), and METS-IR had better diagnostic value for insulin resistance (AUC > 0.8) than single markers. The ALT/AST ratio not only had a strong linear relationship with other surrogate markers but also had a strong diagnostic value for insulin resistance (AUC = 0.771).

CONCLUSIONS

Only some of the published surrogate markers of insulin resistance had good predictive power in school-age children, and the ALT/AST ratio is a good surrogate marker.

IMPACT

This study compared the role of 49 surrogate markers of insulin resistance in Chinese school-age children. The ability of insulin-based surrogate markers to assess insulin resistance was stronger than that of non-insulin-based surrogate markers. Among non-insulin-based surrogate markers, comprehensive indicators such as TyG-WC, TyG-BMI, lipid accumulation product index, and METS-IR had better diagnostic value for insulin resistance than single markers. The results of this study have great public health implications. The diagnostic value of the reported surrogate markers of insulin resistance was clarified, and the ALT/AST ratio was found to have a good evaluation effect on insulin resistance.