Kim Insung, Lee Kyu-Na, Sung Juyoung, Ahn Yoon Ji, Im Minji, Han Kyungdo, Cho Sung Yoon
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Public Health, Catholic University, Seoul, Korea.
Ann Pediatr Endocrinol Metab. 2025 Aug;30(4):213-222. doi: 10.6065/apem.2448180.090. Epub 2025 Aug 31.
Although insulin resistance (IR) varies with age and puberty in children and adolescents, most previous attempts to determine cutoff values for IR indices overlook factor. This study assesses age-related differences in IR index values and evaluates how diagnostic performance varies by age when using a uniform cutoff for diagnosing metabolic syndrome (MetS) without considering age.
We analyzed age-related differences in IR indices (the homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride-glucose [TyG] index, and triglyceride/high-density lipoprotein cholesterol [TG/HDL-C] ratio) among 1,641 participants in the 2019-2021 Korea National Health and Nutrition Examination Survey. We also examined IR index values for diagnosing MetS in 1,574 participants.
IR indices showed significant age-related variations in group-comparison tests, with a peak at ages 12-13 years in males and 11-13 years in females (P<0.001 for the HOMA-IR, P<0.005 for the TG/HDL-C ratio in both males and females, and P=0.003 for the TyG index in females). Applying a uniform cutoff derived from receiver operating characteristic curve analysis for diagnosing MetS showed substantial age-related variation in diagnostic accuracy, with standard deviation-to-mean ratios of age-specific accuracy of >10% for the HOMA-IR and >5% for the TyG index, while showing minor variation (<5%) for the TG/HDL-C ratio. Using age-specific percentiles for the HOMA-IR (80th of the general population) and TyG index (80th of those without MetS) reduced these variations to <5% while maintaining similar diagnostic performance.
This study highlights the importance of age-related variation in IR in children and adolescents.
尽管儿童和青少年的胰岛素抵抗（IR）随年龄和青春期而变化，但以往大多数确定IR指数临界值的尝试都忽略了这一因素。本研究评估IR指数值与年龄的相关差异，并在不考虑年龄的情况下，使用统一临界值诊断代谢综合征（MetS）时，评估诊断性能如何随年龄变化。
我们分析了2019 - 2021年韩国国家健康与营养检查调查中1641名参与者的IR指数（胰岛素抵抗稳态模型评估[HOMA - IR]、甘油三酯 - 葡萄糖[TyG]指数和甘油三酯/高密度脂蛋白胆固醇[TG/HDL - C]比值）与年龄的相关差异。我们还检查了1574名参与者中用于诊断MetS的IR指数值。
在组间比较测试中，IR指数显示出与年龄显著相关的变化，男性在12 - 13岁达到峰值，女性在11 - 13岁达到峰值（HOMA - IR的P<0.001，男性和女性的TG/HDL - C比值的P<0.005，女性TyG指数的P = 0.003）。应用从受试者工作特征曲线分析得出的统一临界值诊断MetS，显示出诊断准确性存在显著的年龄相关变化，HOMA - IR年龄特异性准确性的标准差与均值之比>10%，TyG指数>5%，而TG/HDL - C比值变化较小（<5%）。使用HOMA - IR（一般人群的第80百分位数）和TyG指数（无MetS者的第80百分位数）的年龄特异性百分位数可将这些变化降至<5%，同时保持相似的诊断性能。
本研究强调了儿童和青少年IR与年龄相关变化的重要性。
