In adult obesity low-grade systemic inflammation is considered an important step in the pathogenesis of insulin resistance (IR). The association between obesity and inflammation is less well established in adolescents. Here, we ascertain the importance of inflammation in IR among obese adolescents by utilizing either Random Forest (RF) classification or mediation analysis approaches. The inflammation balance score, composed of 8 pro- and anti-inflammatory makers, as well as most of the individual inflammatory markers differed significantly between lean and overweight/obese. In contrast, adiponectin was the only individual marker selected as a predictor of IR by RF, and the balance score only revealed a medium to low importance score. Neither adiponectin nor the inflammation balance score were found to mediate the relationship between obesity and IR. These findings do not support the premise that low grade systemic inflammation is a key for the expression of IR in the human. Prospective longitudinal studies should confirm these findings.

Decline in the biological response to insulin in the presence of normal or high blood concentrations of the hormone is called insulin resistance (IR) [1]. This could be reflective of an insensitivity of peripheral tissues (e.g., muscle, liver, adipose tissue) to the effects of insulin [2] or due to reduction in the maximal response to the hormone [1]. Obesity in adults is linked to IR. In 2011-2012, the US prevalence of overweight/obese children 12-19 years old of all races was 34.5% [3]. Excess weight in youth is a strong predictor of excess weight in adulthood [4,5]. It also is associated with an increased risk of cardiovascular disease and type 2 diabetes [6,7] and a greater likelihood of mortality from those conditions [8]. Furthermore, even among individuals with normal Abstract Purpose: To develop a valid method to identify insulin resistance (IR) in overweight and obese adolescents without requiring a fasting blood sample.