Reference ranges of HOMA-IR in normal-weight and obese young Caucasians
Blegina Shashaj1, Rosa Luciano2, Benedetta Contoli1
1Research Unit for Multifactorial Diseases, Scientific Directorate, Bambino Gesù Children Hospital, Rome, Italy.
Insights
Insulin resistance (IR) in young Caucasians is linked to cardiometabolic risk factors (CMRFs). The 75th percentile of homeostasis model assessment for IR (HOMA-IR) effectively identifies children with CMRFs.
Area of Science:
- Pediatric Endocrinology
- Metabolic Health
- Cardiovascular Risk Assessment
Background:
- Insulin resistance (IR) can emerge early in life, preceding cardiometabolic risk factors (CMRFs).
- Establishing normative values for IR in youth is crucial for early detection of metabolic dysfunction.
- Homeostasis model assessment for IR (HOMA-IR) is a widely used metric for assessing insulin sensitivity.
Purpose of the Study:
- To determine normative HOMA-IR values in young Caucasians.
- To identify HOMA-IR cutoffs indicative of CMRFs in pediatric populations.
- To analyze HOMA-IR variations based on age, sex, and BMI status.
Main Methods:
- Assessed anthropometric and biochemical data in 2753 Caucasian children and adolescents (ages 2-17.8).
- Defined HOMA-IR reference ranges for the general population, normal-weight, and overweight/obese subgroups.
- Utilized receiver operator characteristic (ROC) analysis to establish HOMA-IR cutoffs for identifying CMRFs.
Main Results:
- Overweight/obese youth exhibited significantly higher HOMA-IR levels than normal-weight peers.
- HOMA-IR increased with age, plateauing between 13-15 years, with peak values at 13 in girls and 15 in boys.
- The 75th percentile of HOMA-IR (3.02 overall, 1.68 normal-weight, 3.42 obese) served as the optimal cutoff for identifying individuals with CMRFs.
Conclusions:
- HOMA-IR percentiles in young Caucasians are influenced by sex, age, and BMI.
- The 75th percentile of HOMA-IR is a reliable indicator for suspecting CMRFs, including dyslipidemia and elevated ALT.
- Early identification of IR through HOMA-IR cutoffs can aid in managing pediatric cardiometabolic health.
Aims:
Insulin resistance (IR) may develop very early in life being associated with occurrence of cardiometabolic risk factors (CMRFs). Aim of the present study was to identify in young Caucasians normative values of IR as estimated by the homeostasis model assessment (HOMA-IR) and cutoffs diagnostic of CMRFs.
Methods:
Anthropometrics and biochemical parameters were assessed in 2753 Caucasians (age 2-17.8 years; 1204 F). Reference ranges of HOMA-IR were defined for the whole population and for samples of normal-weight and overweight/obese individuals. The receiver operator characteristic analysis was used to find cutoffs of HOMA-IR accurately identifying individuals with any CMRF among total cholesterol and/or triglycerides higher than the 95th percentile and/or HDL cholesterol lower than the 5th for age and sex, impaired glucose tolerance, and alanine aminotransferase levels ≥40 U/l.
Results:
Overweight/obese individuals had higher HOMA-IR levels compared with normal-weight peers (p < 0.0001) at any age. HOMA-IR index rose progressively with age, plateaued between age 13 and 15 years and started decreasing afterward. HOMA-IR peaked at age 13 years in girls and at 15 years in boys. The 75th percentile of HOMA-IR in the whole population (3.02; AUROC = 0.73, 95 % CI = 0.70-0.75), in normal-weight (1.68; AUROC = 0.76, 95 % CI = 0.74-0.79), and obese (3.42; AUROC = 0.71, 95 % CI = 0.69-0.72) individuals identified the cutoffs best classifying individuals with any CMRF.
Conclusions:
Percentiles of HOMA-IR varied significantly in young Caucasians depending on sex, age, and BMI category. The 75th percentile may represent an accurate cutoff point to suspect the occurrence of one or more CMRFs among high total cholesterol and triglycerides, low HDL cholesterol, and ALT ≥ 40 UI/l.
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