Is Acanthosis Nigricans a Marker of Insulin Resistance in Obese Children?

Hirschler, Valeria; Aranda, Claudio; Oneto, Adriana; Gonzalez, Claudio; Jadzinsky, Mauricio

doi:10.2337/diacare.25.12.2353

Cited by 45 publications

(50 citation statements)

References 3 publications

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“…However, our findings support the American Diabetes Association criteria for screening for type 2 diabetes in children with ele- vated BMI and the concomitant presence of AN (17). Our data support previous suggestions that AN is more highly related to increased adiposity than to S i (11,28). However, the presence of AN was an added, albeit minor, predictor for more severe insulin resistance in these children.…”

Section: Physical and Metabolic Characteristics Of Subjectssupporting

confidence: 90%

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: Physical and Metabolic Characteristics Of Subjectssupporting

confidence: 90%

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

et al. 2004

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“…AN in any place in the body is taken as an overall diagnosis; unfortunately, many times the knuckles are overseen and obviated in physical examination. 13 , 16 , 18-22 In fact, without reliable evidence, some authors mention that AN does not exist unless the neck is involved. 16 , 23 They recommend just examining the neck when a clinician is looking for AN.…”

Section: Discussionmentioning

confidence: 99%

“…The few studies of AN carried out in children or young participants, however, have not considered the knuckles as a site for investigation. 13 , 16 , 18 , 44 They have neither studied the diagnostic performance of AN to predict IR by HOMA-IR index.…”

Section: Discussionmentioning

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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“…In general, the presence of AN is likely to correlate with BMI [26] and high BMI has been shown to be associated with risk for T2D and CVD in several studies [27,28]. Acanthosis Nigricans and the associated IR is common among obese minority adolescents such as Native Americans, African Americans and Hispanics [29], similar results are expected among Jamaican adolescents, many of whom are of African descent and who are already showing signs of being overweight.…”

Section: Introductionmentioning

confidence: 86%

Acanthosis Nigricans: relation to risk of Type 2 diabetes and cardiovascular diseases among Jamaican adolescents

Barrett¹,

Huffman²,

Johnson³

et al. 2016

Integr Food Nutr Metab

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adulthood [8,14]. Obesity has been cited as "a risk factor for CVD, ventricular dysfunction, congestive heart failure, stroke, and cardiac arrhythmias" [15]. According to Calderon et al. [16] "Persons with body mass index (BMI) >35 kg/m 2 are 2-3 times more likely than lean persons with lower BMI (18.5-24.9 kg/m 2 ) to die from CVD". Therefore, detection of the early signs of T2D and CVD is needed to help in the prevention of these and other related medical conditions. Similar to higher BMI, abdominal fat or central adiposity is closely associated with hyperinsulinemia and IR [17]. According to Ramachandran (2004) AbstractThe objectives of the study were to determine if Jamaican adolescents were at risk for type 2 diabetes (T2D) and cardiovascular diseases (CVD), and examine the relationship between the presence of Acanthosis Nigricans (AN) and the risk of developing T2D and CVD among Jamaican adolescents.A descriptive epidemiological cross-sectional study of 276 Jamaican adolescents ages 14-19 years (15.6 ± 1.2) participated. Subjects were selected from grades 9-12 from ten high schools on the island and included males (112) and females (164). Fasting blood glucose (FBG), total cholesterol (TC), glycated hemoglobin (A1c), blood pressure (BP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and presence of Acanthosis Nigricans were examined. Of the eight risk factors for T2D and CVD examined, the presence of AN classified more subjects at risk than all the other risk factors. Spearman correlations of AN with the other seven risk factors were highly significant for six of these other risk factors (P<0.05). High A1c was the only risk factor which did not correlate with the presence of AN (P=0.085). Females had significantly higher WC (P<0.041), and presence of AN (P<0.013), whereas, males had significantly higher FBG (P<0.039). Urban subjects had significantly higher BMI (P<0.018) and WC (P<0.021) than rural subjects. High total cholesterol was significant for subjects with lower income (P<0.039). The presence of AN classified more subjects at risk than did the other seven risk factors. Examining students for the presence of AN can be economically and easily performed within the schools. A1c classified more subjects at risk for T2D and CVD than FBG and TC, however, there was no correlation between high A1c and the presence of AN. Over one third of the study subjects reported three or more risk factors for T2D and CVD which indicates early intervention measures are needed for this population.

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Is Acanthosis Nigricans a Marker of Insulin Resistance in Obese Children?

Abstract: Synergism between vascular endothelial growth factor and placental growth factor contributes to angiogenesis and plasma extravasation in pathological conditions.

Cited by 45 publications

References 3 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

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

Acanthosis Nigricans: relation to risk of Type 2 diabetes and cardiovascular diseases among Jamaican adolescents

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