Cardiometabolic Risk Clustering and Surrogate Markers of Insulin Resistance in Adolescents

Adolescent obesity is increasingly linked to early insulin resistance (IR) and clustering of cardiometabolic abnormalities, including impaired glucose regulation, dyslipidemia, inflammation, and liver dysfunction. Identifying at-risk adolescents remains challenging due to physiological variability and a lack of standardized definitions.

The aim of this study was to identify simple and reliable surrogate markers of IR and associated cardiometabolic risk in overweight and obese adolescents.

In this cross-sectional study, 182 adolescents aged 10-19 years underwent detailed anthropometric, clinical, and biochemical evaluation, including fasting glucose, insulin, lipid profile, alanine aminotransferase (ALT), uric acid, and high-sensitivity C-reactive protein (hs-CRP). IR was defined as homeostatic model assessment of IR (HOMA-IR) ≥2.5, and associations with demographic, anthropometric, lifestyle, dietary, clinical, and metabolic factors were analyzed.

IR was identified in 62.6% of participants and was more common among obese and pubertal adolescents. Central obesity was present not only in the overweight and obese groups but also in 11.2% of normal-weight adolescents, indicating metabolic risk beyond body mass index (BMI). Measures of central adiposity, particularly waist-to-height ratio (WHtR), showed stronger associations with IR than BMI. IR-positive adolescents demonstrated clustering of metabolic, inflammatory, and hepatic abnormalities, including elevated glucose, insulin, triglycerides, triglyceride: high-density lipoprotein cholesterol (TG: HDL-C) ratio, hs-CRP, uric acid, and ALT, with reduced HDL-C. Acanthosis nigricans, low physical activity, poor sleep, and increased screen time were also more frequent. Metabolic syndrome was present in 13.18% of participants.

IR and cardiometabolic risk are highly prevalent in adolescents with obesity. WHtR, TG: HDL-C ratio, ALT, hs-CRP, and acanthosis nigricans may serve as practical surrogate markers for identifying adolescents with HOMA-IR-defined IR and supporting early preventive strategies.