A quantitative scale of acanthosis nigricans.

Burke, J. P.; Hale, Daniel E.; Hazuda, Helen P.; Stern, Michael P.

doi:10.2337/diacare.22.10.1655

Cited by 237 publications

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“…Insulin resistance is thought to be a major factor in the pathophysiology of type 2 diabetes in both adults and children (4 -6). Acanthosis nigricans (AN), a skin disorder characterized by hyperpigmentation, hyperkeratosis, and papillomatosis, is a clinical marker that has been linked to surrogate markers of insulin resistance in adults (7,8) and adolescents (9), but only a few studies have explored the relation between directly measured insulin sensitivity (S i ) and AN in children (10 -12). Studies in adults have suggested that those with AN have elevated fasting insulin levels (13,14).…”

Section: Diabetes Care 27:1412-1416 2004mentioning

confidence: 99%

Relation Between Acanthosis Nigricans and Insulin Sensitivity in Overweight Hispanic Children at Risk for Type 2 Diabetes

et al. 2004

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OBJECTIVE -To investigate in a population of Hispanic children if 1) the presence of acanthosis nigricans (AN) is related to insulin sensitivity (S i ) independent of adiposity and 2) scale scoring AN severity adds to the clinical estimation of insulin sensitivity, above and beyond the presence or absence AN alone. RESEARCH DESIGN AND METHODS-The study population, 131 Hispanic overweight children (mean BMI percentile 97.0 Ϯ 3.1, 72 boys, 59 girls, ages 8 -13 years, mean Tanner stage 2.4 Ϯ 1.5) with a family history of type 2 diabetes, underwent a physical examination of the neck to determine AN absence or presence (0 -1), AN extent score (0 -4 scale), AN texture score (0 -3 scale), and an AN combined score (extent ϩ texture; 0 -7 scale). S i was measured by the frequently sampled intravenous glucose tolerance test and minimal modeling. Multivariate linear regression analysis was used to determine the role of BMI and AN in predicting S i .RESULTS -BMI was the main predictor of S i , explaining ϳ41% of the variance. The presence of AN explained an additional 4% of the variability in S i ; scale scoring of AN extent or texture did not significantly improve the prediction.CONCLUSIONS -Although AN is an independent risk factor for insulin resistance in overweight Hispanic children at risk for type 2 diabetes, body adiposity is the primary determinant of insulin sensitivity. In addition, scale scoring AN seems of minimal usefulness in clinically estimating the severity of insulin resistance over and above assessing the presence or absence of AN and calculating BMI. Diabetes Care 27:1412-1416, 2004W ith the rise of overweight (1) and type 2 diabetes (2,3) in the pediatric population, especially in young Hispanics and other minority groups, early identification of those at elevated health risk is important so that appropriate interventions can be established. Insulin resistance is thought to be a major factor in the pathophysiology of type 2 diabetes in both adults and children (4 -6). Acanthosis nigricans (AN), a skin disorder characterized by hyperpigmentation, hyperkeratosis, and papillomatosis, is a clinical marker that has been linked to surrogate markers of insulin resistance in adults (7,8) and adolescents (9), but only a few studies have explored the relation between directly measured insulin sensitivity (S i ) and AN in children (10 -12). Studies in adults have suggested that those with AN have elevated fasting insulin levels (13,14). However, these studies were limited in that they did not measure S i directly, neither did they evaluate the severity of AN. Burke et al. (8) proposed a classification system to grade the severity of AN and found that the severity of AN was associated with elevated fasting insulin and increased BMI. Previous studies that have examined the relation between S i and the severity of AN in adults and children have found mixed results (10 -12). Thus, the interrelation between obesity, insulin resistance, and severity of AN still needs to be clarified, particularly in children at risk fo...

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Section: Diabetes Care 27:1412-1416 2004mentioning

confidence: 99%

Relation Between Acanthosis Nigricans and Insulin Sensitivity in Overweight Hispanic Children at Risk for Type 2 Diabetes

et al. 2004

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“…A number of studies (15)(16)(17)(18)(19)(20)(21) suggest that overweight status in AfricanAmerican children and adolescents is associated with insulin resistance and that children may be developing IRS early in life. Establishing the relation between obesity and the risk factors of IRS and insulin resistance in young children Ͻ10 years of age will aid in understanding the disease course of the development of type 2 diabetes.…”

mentioning

confidence: 99%

Evaluation of the Insulin Resistance Syndrome in 5- to 10-Year-Old Overweight/Obese African-American Children

et al. 2001

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OBJECTIVE -To characterize the insulin sensitivity of overweight and obese 5-to 10-yearold (Tanner stage 1-3) African-American children screened for participation in a diabetes prevention study and to identify the association of insulin sensitivity with obesity, hyperlipidemia, and hypertension.RESEARCH DESIGN AND METHODS -Measures of insulin resistance (homeostasis model assessment) and insulin sensitivity (Matsuda and DeFronzo's whole-body insulin sensitivity) were calculated from a 2-h oral glucose tolerance test in 137 African-American children recruited into a diabetes prevention study. Measures of lipids (LDL, HDL, total cholesterol, and triglycerides), blood pressure, and body composition were obtained for a subset of the children.RESULTS -In response to a glucose challenge, girls and older and heavier children produced significantly more insulin. As BMI increased, there was a statistically significant decrease in insulin sensitivity, particularly in girls. Insulin sensitivity was inversely correlated with increases in blood pressure, triglycerides, subcutaneous fat, the percentage of total body fat, and Tanner stage, but it was not correlated with LDL and HDL.CONCLUSIONS -Reduced insulin sensitivity and the cluster of risk factors known as the insulin resistance syndrome (IRS) are already apparent in these overweight African-American children. Young African-American girls, in particular, already show evidence of hyperinsulinemia in response to a glucose load, suggesting that the early stages of metabolic decompensation that lead to type 2 diabetes are already occurring. Monitoring of those risk factors known to be part of IRS should become part of routine medical care for overweight or obese African-American children. Diabetes Care 24:1359 -1364, 2001T he prevalence of overweight/obesity is increasing in children, as is the diagnosis of type 2 diabetes (1-3). Obesity and insulin resistance are known risk factors for the development of type 2 diabetes in adults (4). For adults, type 2 diabetes and obesity are more prevalent in the African-American population than in European-Americans, especially among African-American women (5). Minority populations have also seen the greatest increase in childhood and adolescent diagnoses of type 2 diabetes (6).Studies in adults have consistently shown insulin resistance and hyperinsulinemia to be strong predictors of the development of type 2 diabetes (7). In addition to insulin resistance and ␤-cell dysfunction, obesity (specifically central adiposity [8]), dyslipidemia (9 -10), and genetic predisposition (11) are risk factors for the development of impaired glucose tolerance and type 2 diabetes in adults.The clustering of insulin resistance, obesity, hypertension, dyslipidemia, and atherosclerosis has been referred to as the insulin resistance syndrome (IRS), the metabolic syndrome, or syndrome X (12). Increasing rates of type 2 diabetes in the pediatric population suggest the need to explore the development of insulin resistance and other risk factors (13) for type ...

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“…Other studies have also shown that there are many cases with AN in the knuckles without AN in the neck or other classical sites. 17 , 24-26 Consequently, AN in the knuckles should be considered as a classic, highly prevalent, difficult-to-hide clinical sign that arises a caution of compensatory hyperinsulinemia secondary to IR.…”

Section: Discussionmentioning

confidence: 99%

“…24 A fasting blood sample was taken for plasma glucose and serum insulin levels to determine HOMA-IR index. 45 Also, a standardized close-up photography of the neck, axillae, elbows, and knuckles was taken.…”

Section: Methodsmentioning

confidence: 99%

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

González-Saldivar

Rodríguez-Gutiérrez

Treviño-Alvarez

et al. 2018

Dermato-Endocrinology

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Any clinical/biochemical marker revealing obesity or diabetes before their appearance is valuable. Insulin resistance (IR) is present in both disorders many years before occurrence. Accordingly, we determined whether acanthosis nigricans (AN) in the knuckles is associated to higher insulin and homeostasis model assessment for estimated insulin resistance (HOMA-IR) index values, and assessed the influence of body-mass index (BMI) and the diagnostic performance of AN in the knuckles to detect IR. In this cross-sectional controlled study, we included men or women, 18 to 23 years old, with or without AN in the knuckles. In 149 cases with AN in the knuckles and 145 controls, fasting insulin was higher in cases (13.45 µU/mL ± 7.8 vs. 8.59 µU/mL ± 3.63, P < .001, respectively). Mean HOMA-IR index was also higher (2.86 ± 1.68 vs. 1.78 ± 0.77, P < .001). A significant increase in fasting insulin and HOMA-IR values between and within BMI groups from normal through obese category was identified in controls and cases. By multivariate regression analysis, cases with normal BMI were significantly associated to a HOMA-IR ≥2.5 (OR = 3.09, CI95% = 1.75–5.48, P = .001). A model of AN in the knuckles, normal BMI, and increased waist circumference allowed identifying 2 out of 3 cases with HOMA-IR index ≥2.5. AN in the knuckles could be addressed with two aims: as an easy, accessible, and costless diagnostic tool suggesting hyperinsulinemia secondary to IR, and, an early marker of IR even in the absence of overweight or obesity.

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A quantitative scale of acanthosis nigricans.

Cited by 237 publications

References 0 publications

Relation Between Acanthosis Nigricans and Insulin Sensitivity in Overweight Hispanic Children at Risk for Type 2 Diabetes

Relation Between Acanthosis Nigricans and Insulin Sensitivity in Overweight Hispanic Children at Risk for Type 2 Diabetes

Evaluation of the Insulin Resistance Syndrome in 5- to 10-Year-Old Overweight/Obese African-American Children

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

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