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Insulin resistance in school-age children: comparison surrogate diagnostic markers

Lu Zhang1,2, Na Qiu3, Xiaoping Chen4

  • 1Department of Public Health and Epidemiology, School of Basic Medical Sciences, Henan University, Kaifeng, China. zhanglu9128@126.com.

Pediatric Research
|August 28, 2025
PubMed

Insights

This study identified effective surrogate markers for insulin resistance in overweight children. The ALT/AST ratio demonstrated good predictive value, offering a valuable tool for pediatric health assessments.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Health
  • Biomarker Discovery

Background:

  • Childhood obesity is rising, increasing the risk of insulin resistance.
  • Accurate assessment of insulin resistance is crucial for early intervention in pediatric populations.
  • Existing surrogate markers require validation for use in children and adolescents.

Purpose of the Study:

  • To identify reliable surrogate markers for evaluating insulin resistance in overweight and obese children and adolescents.
  • To compare the efficacy of various insulin-based and non-insulin-based markers.
  • To assess the diagnostic value of selected markers in a pediatric cohort.

Main Methods:

  • A cross-sectional study analyzed 49 reported surrogate markers (14 insulin-based, 35 non-insulin-based).
  • Data were collected from 800 children aged 7-12 years, including demographics, physical measurements, and clinical indicators.
  • Statistical analyses assessed the linear relationship and diagnostic value (AUC) of markers against HOMA-IR.

Main Results:

  • 27 surrogate markers showed association with overweight/obesity in children.
  • Insulin-based markers strongly correlated with HOMA-IR (r > 0.85).
  • Comprehensive non-insulin markers (TyG-WC, TyG-BMI, LAP, METS-IR) showed better diagnostic value (AUC > 0.8) than single markers. The ALT/AST ratio demonstrated good diagnostic value (AUC = 0.771).

Conclusions:

  • Not all previously reported surrogate markers are effective for assessing insulin resistance in school-aged children.
  • Insulin-based markers generally outperform non-insulin-based markers.
  • The ALT/AST ratio is identified as a promising and effective surrogate marker for insulin resistance in pediatric populations.
Abstract

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