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