Prevalence of insulin resistance and cardiometabolic risk in Korean children and adolescents: A population-based study

doi:10.1016/j.diabres.2013.10.021

Diabetes Research and Clinical Practice

Volume 103, Issue 1, January 2014, Pages 106-113

https://doi.org/10.1016/j.diabres.2013.10.021 Get rights and content

Abstract

Aims

We aimed to establish normal reference values of serum insulin and the homeostasis model assessment of insulin resistance (HOMA-IR). We also aimed to verify HOMA-IR “cut-off values” in predicting cardiometabolic risk among Korean children and adolescents.

Methods

Data from 2716 Korean subjects (1421 male and 1295 female, aged 10–20 years) were evaluated. Insulin resistance was defined as HOMA-IR >95th percentile. The odds ratios of cardiometabolic risk were assessed based on the state of insulin resistance.

Results

Reference values of insulin and HOMA-IR were determined according to sex and age, based on data obtained from normal-weight subjects with normal fasting glucose levels. HOMA-IR values appeared to peak at the age of 14–15 years in male subjects and at the age of 12–13 years in female subjects. The prevalence of insulin resistance in the subjects was 9.8% (male = 10.9%, female = 8.6%). The prevalence of insulin resistance in normal-weight, overweight, and obese subjects were 4.7%, 25.6%, and 47.1% respectively. Subjects with insulin resistance had a higher prevalence of metabolic syndrome (odds ratios = 18.33; 95% confidence interval, 9.62–34.94) and its components, especially hyperglycemia and hypertriglyceridemia.

Conclusion

We established reference values of serum insulin and HOMA-IR according to age and sex. Obesity is the most important risk factor for insulin resistance and metabolic syndrome. However, insulin resistance independently increases cardiometabolic risk. This information may be useful for Korean as well as other Asian in planning programs for the prevention of type 2 diabetes.

Introduction

Insulin resistance or hyperinsulinemia precedes type 2 diabetes mellitus and cardiovascular disease (CVD), and plays a major role in the pathogenesis of these diseases [1], [2]. Insulin resistance precedes the development of impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), which has been shown to predict the development of type 2 diabetes mellitus [3], [4]. Insulin resistance also plays a pivotal role in metabolic syndrome, which precedes the development of CVD, leading to morbidity and mortality [1], [2]. Thus, insulin resistance has been proposed as a strategic target for type 2 diabetes mellitus and CVD prevention interventions [5], [6].

Metabolic syndrome, also called insulin resistance syndrome, is a surrogate marker of type 2 diabetes mellitus and CVD in children and adolescents, as well as adults [7]. Prospective studies have shown that metabolic syndrome develops during childhood and progresses to adulthood type 2 diabetes mellitus and CVD [8], [9], [10]. Thus, many studies have investigated the prevalence of metabolic syndrome in children. The pediatric prevalence of metabolic syndrome varies widely depending on ethnicity, ranging from 0.7% to 4.5% in population-based studies using the International Diabetes Federation (IDF) definition [11], [12], [13], [14]. Furthermore, the clinical features of metabolic syndrome differ according to race or ethnicity. Asians experience higher rates of type 2 diabetes mellitus and CVD, despite much lower levels of obesity, than their non-Asian counterparts [15], [16]. Insulin resistance in Asians is thought to be an important contributor to the increasing rates of these diseases along with increasing prevalence of obesity in this region.

Fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) have been proposed as surrogate markers of insulin resistance for epidemiology studies, outcomes of therapeutic interventions, and clinical applications [17]. Thus, many recent studies have proposed reference ranges and cut-off values for insulin and HOMA-IR [18], [19], [20], [21]. However, population-based studies of insulin concentrations and HOMA-IR in Asian children and adolescents are lacking.

The objectives of this study were as follows: (1) to establish normal reference values of serum insulin and HOMA-IR in healthy Korean children and adolescents, (2) to estimate the prevalence of insulin resistance by HOMA-IR cut-off, and (3) to verify the HOMA-IR “cut-off values” in predicting cardiometabolic risk among a nationally representative population.

Section snippets

Subjects and methods

This study was performed using data acquired during the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007–2009). These surveys have been conducted periodically since 1998 to assess the health and nutritional status of the non-institutionalized civilian population of Korea. KNHANES IV was a cross-sectional and nationally representative survey with a multistage and stratified sampling design conducted by the Division of Chronic Disease Surveillance, Korea Centers

Statistical analyses

We calculated means ± standard deviation (SD), 95% confidence interval (CI), and percentiles for insulin and HOMA-IR references according to age and sex from normal-weight subject with NFG levels (glucose < 100 mg/dL (5.5 mmol/L)) (n = 2116). Insulin resistance was defined by a HOMA-IR reference value of more than 95th percentile in normal-weight subjects with NFG. We calculated the prevalence of insulin resistance in total subjects. We also calculated the prevalence of insulin resistance according to

Results

The anthropometric and laboratory characteristics of the study subjects are summarized in Table 1. Among the 2716 subjects, 323 (11.9%) were overweight and 171 (6.3%) were obese based on BMI. The prevalence of metabolic syndrome among the study group was 1.5% (0.4% in normal weight, 2.5% in overweight, and 19.3% in obese subjects). The contributing factors of metabolic syndrome such as central obesity, hyperglycemia, hypertension, hypertriglyceridemia, and low HDL-C concentrations was observed

Discussion

To our knowledge, this is the first study providing reference ranges for serum insulin concentration and HOMA-IR in Asian children and adolescents in a nationally representative sample. We defined HOMA-IR >95th percentile as the insulin resistance cut-off value and assessed the risks of metabolic syndrome and its components depending on insulin resistance state. We found that insulin resistance depends largely on obesity, but also independently increased cardiometabolic risk in Korean children

Conflict of interest

No potential conflicts of interest relevant to this article were reported.

Financial disclosures

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sector.

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All TyG and modified TyG indices exhibited progressively increased ORs and 95% CIs for NAFLD across all tertiles (all P < .001). In addition, all TyG and modified TyG indices significantly predicted NAFLD through ROC curves. All modified TyG indices were superior to the TyG index for predicting NAFLD in all subjects and in males. Among females, the TyG-waist-to-height ratio was superior to the TyG index, TyG-body mass index (BMI), and TyG-waist circumference (WC), and the TyG-BMI SDS and TyG-WC were superior to the TyG index.
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Prevalence of insulin resistance and cardiometabolic risk in Korean children and adolescents: A population-based study

Abstract

Aims

Methods

Results

Conclusion

Introduction

Section snippets

Subjects and methods

Statistical analyses

Results

Discussion

Conflict of interest

Financial disclosures

Metabolism

Metabolism

Metabolism

Lancet

Am J Cardiol

J Clin Densitom

Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009

Diabetologia

Predictors of progression from impaired glucose tolerance to NIDDM: an analysis of six prospective studies

Diabetes

Progression from newly acquired impaired fasting glusose to type 2 diabetes

Diabetes Care

Insulin resistance and CVD

J Clin Endocrinol Metab

Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents

Pediatrics

IDF Consensus Group the metabolic syndrome in children and adolescents – an IDF consensus report

Pediatr Diabetes

Clustering of long-term trends in metabolic syndrome variables from childhood to adulthood in Blacks and Whites: the Bogalusa Heart Study

Am J Epidemiol

Childhood predictors of the metabolic syndrome in adulthood. The cardiovascular risk in Young Finns study

Ann Med

Prevalence of the metabolic syndrome among U.S. adolescents using the definition from the International Diabetes Federation

Diabetes Care

Ethnic disparities of the metabolic syndrome in population-based samples of german and Iranian adolescents

Metab Syndr Relat Disord

Association between childhood obesity and metabolic syndrome: evidence from a large sample of Chinese children and adolescents

PLoS ONE

Ethnicity modifies the relationships of insulin resistance, inflammation, and adiponectin with obesity in a multiethnic Asian population

Diabetes Care

Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage

Am J Physiol Endocrinol Metab