Insulin sensitivity indices: fasting versus glucose-stimulated ındices in pediatric non-alcoholic fatty liver disease

Area of Science:

• Pediatric Endocrinology
• Hepatology
• Metabolic Syndrome

Background:

• Non-alcoholic fatty liver disease (NAFLD) is a growing concern in obese children and adolescents.
• Insulin resistance is a key factor in the development of NAFLD.
• Comparing different insulin sensitivity indices is crucial for accurate assessment in this population.

Purpose of the Study:

• To compare fasting versus glucose-stimulated insulin sensitivity indices in pediatric NAFLD.
• To identify reliable markers for detecting NAFLD in obese youth.
• To evaluate the effectiveness of various indices in distinguishing between prepubertal and pubertal children.

Main Methods:

• Evaluated 211 obese children (median age 11.24 ± 2.65 years).
• Utilized B-mode ultrasonography (USG) for NAFLD diagnosis.
• Assessed insulin sensitivity using Quantitative Insulin Sensitivity Check Index (QUICKI), Homeostatic Model Assessment for Insulin Resistance (Homa-IR), Insulinogenic Index (IGI), Matsuda index, and Oral Glucose Insulin Sensitivity (OGIS) via Oral Glucose Tolerance Test (OGTT).

Main Results:

• NAFLD was present in 59.24% of obese children, with higher prevalence in adolescents (65.8%) vs. prepubertal children (51.5%).
• Significant differences in fasting glucose, insulin, Homa-IR, QUICKI, OGIS, and Matsuda indices were observed between subjects with and without NAFLD.
• Age, waist circumference, and QUICKI were identified as risk factors for NAFLD.

Conclusions:

• QUICKI and Homa-IR are significant indicators for NAFLD in obese children and adolescents.
• Decreasing QUICKI values are associated with an increased probability of developing hepatic steatosis.
• While OGTT provides glucose tolerance information, its derived indices were not superior to traditional surrogates like Homa-IR or QUICKI for NAFLD assessment.