Identification of cutoff points for Homeostatic Model Assessment for Insulin Resistance index in adolescents: systematic review

Maria Izabel Siqueira De Andrade,Juliana Souza Oliveira,Vanessa Sá Leal,Niedja Maria Silva Da Lima,Emília Chagas Costa,Nathalia Barbosa De Aquino,Pedro Israel Cabral De Lira

doi:10.1016/j.rppede.2016.01.004

Maria Izabel Siqueira De Andrade, Juliana Souza Oliveira + Show 5 more

Open Access

https://doi.org/10.1016/j.rppede.2016.01.004

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Abstract

ObjectiveTo identify cutoff points of the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index established for adolescents and discuss their applicability for the diagnosis of insulin resistance in Brazilian adolescents. Data sourceA systematic review was performed in the PubMed, Lilacs and SciELO databases, using the following descriptors: “adolescents”, “insulin resistance” and “Receiver Operating Characteristics Curve”. Original articles carried out with adolescents published between 2005 and 2015 in Portuguese, English or Spanish languages, which included the statistical analysis using Receiver Operating Characteristics Curve to determine the index cutoff (HOMA-IR) were included. Data synthesisA total of 184 articles were identified and after the study phases were applied, seven articles were selected for the review. All selected studies established their cutoffs using a Receiver Operating Characteristics Curve, with the lowest observed cutoff of 1.65 for girls and 1.95 for boys and the highest of 3.82 for girls and 5.22 for boys. Of the studies analyzed, one proposed external validity, recommending the use of the HOMA-IR cutoff>2.5 for both genders. ConclusionsThe HOMA-IR index constitutes a reliable method for the detection of insulin resistance in adolescents, as long as it uses cutoffs that are more adequate for the reality of the study population, allowing early diagnosis of insulin resistance and enabling multidisciplinary interventions aiming at health promotion of this population.

Highlights

Adolescence is a critical period for the onset of obesity and other metabolic disorders associated with body fat accumulation
Brazilian studies have detected the prevalence of insulin resistance (IR) in the age range of adolescence and have reported prevalence rates ranging from 6.5% to 90.8% in adolescents with and without excess weight.3---5
The most commonly used methods for determining IR in epidemiological studies are obtained from practical formulas that use fasting glucose and insulin levels, as the Fasting Glucose/Insulin Ratio (FGIR), the Quantitative insulin sensitivity check index (QUICKI) and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), which has been frequently validated in children and adolescents and is recommended as the most sensitive and specific method for assessing insulin sensitivity in this population.6---8

Summary

Introduction

Adolescence is a critical period for the onset of obesity and other metabolic disorders associated with body fat accumulation. Brazilian studies have detected the prevalence of IR in the age range of adolescence and have reported prevalence rates ranging from 6.5% to 90.8% in adolescents with and without excess weight.3---5. It is noteworthy that one of the important aspects to be observed in the successful application of HOMA-IR index in a given population is the use of specific cutoffs for gender, ethnicity, age and/or sexual maturation level (if used in adolescents). For this reason, several cutoff points have been recommended for the diagnosis of IR based on the index.9---12. Several cutoff points have been recommended for the diagnosis of IR based on the index.9---12 The objective of this study was to identify HOMA-IR index cutoffs established for adolescents and discuss their applicability for the diagnosis of IR in Brazilian adolescents

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