Abstract
Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin resistance. HOMA-IR cut-offs for identifying metabolic syndrome might vary across populations and body mass index (BMI) levels. We aimed to investigate HOMA-insulin resistance cut-offs that best discriminate individuals with insulin resistance and with metabolic syndrome for each BMI category in a large sample of adults without diabetes in the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Among the 12,313 participants with mean age of 51.2 (SD 8.9) years, the prevalence of metabolic syndrome was 34.6%, and 60.1% had overweight or obesity. The prevalence of metabolic syndrome among normal weight, overweight and obesity categories were, respectively, 13%, 43.2% and 60.7%. The point of maximum combined sensitivity and specificity of HOMA-IR to discriminate the metabolic syndrome was 2.35 in the whole sample, with increasing values at higher BMI categories. This investigation contributes to better understanding HOMA-IR values associated with insulin resistance and metabolic syndrome in a large Brazilian adult sample, and that use of cut-off points according to ROC curve may be the better strategy. It also suggests that different values might be appropriate across BMI categories.
Highlights
Insulin resistance is one of the pathogenic mechanisms of the metabolic syndrome and is a common condition that allows identification of the risk of diabetes and metabolic syndrome 1
The homeostasis model assessment of insulin resistance (HOMA-IR) is a method based on fasting glucose and insulin plasmatic levels, which was validated by Matthews et al 2 and has been used for defining insulin resistance for clinical and research purposes in several populations
In Brazil, the Brazilian Metabolic Syndrome Study (BRAMS), with a population from 18 to 78 years old, used the 90th percentile to establish 2.7 as a cut-off to define insulin resistance in healthy people (n = 297) with body mass index (BMI) < 30kg/m2, and 2.3 as the value that best discriminates the presence of metabolic syndrome 3
Summary
Insulin resistance is one of the pathogenic mechanisms of the metabolic syndrome and is a common condition that allows identification of the risk of diabetes and metabolic syndrome 1. The gold standard method to assess insulin resistance is the hyperinsulinemic-euglycemic clamp, which is not useful for clinical and epidemiological investigations. In Brazil, the Brazilian Metabolic Syndrome Study (BRAMS), with a population from 18 to 78 years old, used the 90th percentile to establish 2.7 as a cut-off to define insulin resistance in healthy people (n = 297) with body mass index (BMI) < 30kg/m2, and 2.3 as the value that best discriminates the presence of metabolic syndrome 3. HOMA-IR cut-offs might differ across populations and BMI levels and establishing HOMA-IR values that correlate with insulin resistance and with metabolic syndrome is still necessary 4. We aimed to investigate HOMA-IR cut-offs that best discriminate insulin resistance and metabolic syndrome for each BMI category among individuals without diabetes mellitus in this large sample
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