Optimal Cut-off Points of Fasting and Post-Glucose Stimulus Surrogates of Insulin Resistance as Predictors of Metabolic Syndrome in Adolescents According to Several Definitions

Abstract

Objective:The aim of this study was to determine optimal cut-off points for fasting and post-glucose stimulus surrogates of insulin resistance to predict metabolic syndrome in adolescents according to several definitions.Methods:One hundred fifty-five adolescents living in Mexico City were enrolled during 2011 and 2012. Waist circumference and blood pressure were recorded. Subjects received an oral glucose load of 1.75 g per kg up to a maximum dose of 75 g. Blood samples were drawn at baseline and 120 minutes. Concentrations of plasma glucose, triglycerides, high-density lipoprotein cholesterol and insulin were determined.Results:The frequency of metabolic syndrome showed a large variability when using a variety of published definitions; in contrast, the optimal cut-off points for fasting insulin, homeostatic model assessment of insulin resistance and two-hour oral glucose tolerance test insulin were very similar in almost all the definitions considered and had adequate diagnostic performance: area under the curve >0.869, sensitivity >0.835 and specificity >0.755. Insulin resistance surrogates had substantial agreements with Ford, Cook and Salas definitions (Kappa~0.62; agreement~82%); moderate agreement was observed for International Diabetes Federation, Cruz and Ferranti definitions (Kappa~0.41–0.59; agreement~77%).Conclusions:Insulin resistance surrogates may be a better approach for metabolic syndrome assessment in an adolescent population because of reduced variability and a higher predictive value.

Proof on Concept on the Consumption of a Beverage with Ancestral Mexican Corn and Bean Flour and its Cardiometabolic Effects on Adolescents with Obesity

“…Initially, pancreatic β cells increase insulin production with the aim of compensating for insulin resistance and, thus, blood glucose remains at normal levels [38]. It is possible to observe that the patients present baseline insulinemia of 18.91 ± 2.64 µU/ml and final of 23.33 ± 13.68 µU/ml, in both cases, above the reference values of 14.38 µU / ml [39]. In correspondance, an initial HOMA index of 3.62 ± 0.61 and final of 5.18 ± 2.43, indicated high risk of insulin resistance [24,37].…”

Dietary Carbohydrates and Insulin Resistance in Adolescents from Marginalized Areas of Chiapas, México

“…A strength of this study is the assignment of GI values through a systematic protocol published for 24 h recalls [22], and for most of the foods with available carbohydrate content (59.6%), the GI values of a closely related food or an exact match in the GI databases were assigned. Also, we used two cut-off points for HOMA-IR as surrogates of insulin resistance, which were previously validated for adolescents [29] and have been demonstrated as a valid predictor of Metabolic Syndrome in a similar population group [27]. Furthermore, our study was conducted in a sample of adolescents from marginalized communities in the South of México, comprising a high proportion of indigenous population (44% of the adolescents' mothers spoke Mayan language) where few studies have evaluated the association between diet and insulin resistance.…”

“…Serum insulin levels were determined by an immunoassay method (Adaltis Diagnostics) using an Eclectica analyzer (Adaltis Diagnostics). The cut-off point of 14.38 was considered for abnormal insulin levels since it has been proven to have an adequate performance to diagnose metabolic syndrome for a similar population to our sample [27].…”

“…The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated using the formula [28]: [fasting insulin (µU/mL)*fasting glucose (mg/dL)]/405. Two validated cut-off points were used to diagnose insulin resistance: HOMA-IR > 3.16 as proposed by Keskin et al in 2005, which has been widely used in epidemiological studies [29], and HOMA-IR > 2.97 proposed by Piña-Aguero et al in 2018 as a valid cut-off for insulin resistance in Mexican adolescents [27].…”

Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas of Chiapas, Mexico

“…Glucose levels were classified according to IDF (normal blood glucose <100 mg/dL, abnormal blood glucose 100-125 mg/dL). (12) For serum lipid levels, the cut-off points of National Cholesterol Education Program (NECP) were used: triglycerides (acceptable <90 mg/dL, borderline 90-129 mg/dL and high ≥130 mg/dL), total cholesterol (acceptable <170 mg/dL, borderline 170-199 mg/dL, high ≥200 mg/dL), LDL-c (acceptable <110 mg/dL, borderline 110-129 mg/dL, high ≥130 mg/dL) and c-HDL (acceptable >45 mg/dL, borderline 40-45 mg/dL, low <40 mg/dL) (14).…”