Prevalence Of Acanthosis Nigricans Research Articles

Gender, racial, ethnic, and Fitzpatrick skin type representation in Acanthosis nigricans clinical trials.

Acanthosis nigricans (AN) is characterized by dark, velvety patches and thin plaques primarily in the body folds. AN is more prevalent in skin of color populations, including Black/African American, Native American, and Hispanic patients. As the U.S. population becomes increasingly diverse, the need for inclusive dermatologic research becomes more pressing. Given the increased prevalence of AN in skin of color patients, there is a need to evaluate representation in AN clinical trials. This study aims to uncover gender, race, ethnicity, and Fitzpatrick skin type (FST) representation in AN clinical trials. A systematic literature search was performed across PubMed, Embase, and Cochrane databases to identify participant characteristics in clinical trials focused on AN treatment. Our review yielded 21 clinical trials, totaling 575 participants, with an identified predominance of female participants (69.0%) and a surprising absence of race or ethnicity data. Out of the 11 studies that included FST data, 1.2% of participants were type II, 20.6% were type III, 50.0% were type IV, and 28.2% were type V. None of the participants were FST I or VI. Herein, we highlight a predominate inclusion of female and FST III-V patients in AN clinical trials, the populations most impacted by this condition. We also highlight the need for improved race and ethnicity reporting and the importance of including all FSTs in clinical studies. Addressing this gap is critical for developing safe, efficacious, patient-centered, and equitable treatments for all AN patients. Future research should prioritize comprehensive inclusion of race, ethnicity, and the full spectrum of FSTs.

Utility of "Acanthosis Nigricans" and "Skin Tags" as a screening tool for risk of developing noncommunicable diseases: A cross-sectional study at a health facility in Lucknow (India).

Over the past three decades, there has been a significant rise in the prevalence of noncommunicable diseases (NCDs) globally, accompanied by a relative decline in communicable diseases. With this background, the research was planned to determine the prevalence of acanthosis nigricans (AN) or skin tags (STs) in the study population and to examine the relationship between the presence of AN and ST with commonly used indicators such as waist-to-height ratio (W/Ht.), Indian Diabetes Risk Score (IDRS), and body mass index for predicting the risk of NCDs. This cross-sectional study was done at a health facility in Lucknow (India). Consecutive sampling was employed to select 152 apparently healthy adults as the participants. Data collection involved administering a questionnaire and conducting anthropometry using standardized methods. Visual inspection was conducted to identify AN or ST on the common sites. Data entry was done in Microsoft Office Excel, followed by data analysis using SPSS. To test the association between variables "significance of difference of mean," Chi-square test, logistic regression analysis, and estimation of Kohen's kappa were used. A "P" value was considered statistically significant at <0.05 level. The sensitivity and specificity of AN and ST were also estimated in predicting the risk of NCDs. The prevalence of AN was 19.08% (95% confidence interval [CI] = 12.76%-25.40%), while the prevalence of STs was 28.29% (95% CI = 21.05%-35.53%). AN showed a sensitivity of 22.4% and specificity of 96.3% with W/Ht. ratio as the standard, and a sensitivity of 26.44% and specificity of 90.77% with IDRS as the standard. ST exhibited a sensitivity of 32.0% and specificity of 88.89% with W/Ht. ratio as the standard, and a sensitivity of 37.93% and specificity of 84.62% with IDRS as the standard. AN and ST can be used as simple and time-saving tools in screening protocols for (NCDs). Further research is desirable to validate the findings.

THU626 Impact Of Body Mass Index On Clinical And Endocrinological Characteristics Of Indian PCOS Population

Abstract Disclosure: S. Pandey: None. K. Ojha: None. K. Jayprakasan: None. K. Khanduri: None. The prevalence of polycystic ovarian syndrome (PCOS), defined based on the Rotterdam criteria, in Indian women is about 10% and the clinical characteristics can be different compared to western PCOS population. The objectives of this study are to evaluate the baseline clinical characteristics of PCOS women and to compare the characteristics in different population categorised based on body mass index (BMI). Material &amp; Methods: In this observational study done at a tertiary fertility unit in Northern India, all PCOS women, defined based on the Rotterdam criteria, attended the clinic during 2018-2022 were included (n=554). Women with known endocrine issues were excluded. The baseline characteristics - age, BMI, blood pressure (BP), hirsutism assessed by Ferriman-Galleway (FG) score, acanthosis nigricans, AMH, prolactin, TSH- were assessed. Results: While the mean (±standard deviation) age of patients the study population was found to be 27.2 ±4.1 years, the mean BMI was 25.8±4.4 Kg/m2 and Acanthosis nigricans was observed in 87 (17.51%) women. The mean B.P. was 116/76 (±9/8) mmHg and the mean FG score was 3±1. The mean AMH, TSH and prolactin were 7.26±4.39ng/mL, 3.42±5.21mIU/mL and 17.07±15.92ng/mL respectively. BMI was classified in four categories- ≤22.9 (normal, n=121), 23-24.99 (overweight, n=111), 25-29.99 (pre-obese, n=182) and ≥30.0 (obese, n=76). The mean age across the four BMI groups were 26.1±3.9, 27.5±3.9, 27.2±4.2 and 29.0±4.0 years respectively (P&amp;lt;.001). The BP increases as the BMI increases (114/74 (±8/8), 116/76 (±8/8), 117/76 (±9/8) &amp; 120/77 (±11/8) Kg/m2 respectively; P= &amp;lt;0.05). There was no difference in FG scores across the four BMI groups (3±1, 3±1, 3±2, 3±2, respectively; P=0.8). While the AMH (7.42±4.66, 6.99±4.30, 7.49±4.43, 6.87±3.95ng/mL, respectively; P=0.644) and prolactin (17.38±19.02, 17.84±14.92, 17.55±16.22, 14.27±9.62ng/mL, respectively; P=0.42) were similar across the four BMI groups, the TSH tend to be higher in the higher BMI groups (2.77±1.70, 3.09±1.93, 3.45±4.07, 4.88±11.23mIU/mL respectively; P=0.038). The prevalence of Acanthosis nigricans (12(9.4%), 20(18%), 29 (15.9%), 26 (34.2%), respectively; P=&amp;lt;0.001) was also found higher in the higher BMI groups. After conducting post-hoc analysis, it was found out that obese (≥30) group has highest mean of TSH (4.88±11.23) level, Age (28.97±4.04), B.P. count (120/77 (±11/±8)) and prevalence of acanthosis nigricans (34.2%). Discussion-While the mean (±SD) age of the study population was 27±4.1 years, the mean BMI was 25±4 Kg/m2. When categorized based on BMI (n=182; 32.9%) fell into the pre-obese group. While BMI showed a positive correlation with age, B.P., TSH and Acanthosis nigricans, nevertheless, the mean AMH, prolactin and FG score were similar across the 4 BMI groups. Presentation: Thursday, June 15, 2023

Acanthosis Nigricans: Pointer of Endocrine Entities.

Acanthosis nigricans (AN) has been reported in relation to insulin resistance (IR). We aim to review AN through an endocrine and metabolic perspective focusing on IR in association with metabolic complications such as obesity, diabetes mellitus (DM), and metabolic syndrome (MS) with/without polycystic ovary syndrome (PCOS). We revised English papers on PubMed covering publications from the last 5 years. The current prevalence of AN varies from 4.5 to 74% (or even 100%, depending on the studied population), with equal distribution among females and males. Despite higher incidence with an age-dependent pattern, an alarming escalation of cases has been noted for obesity and MS in younger populations. Most frequent IR-associated sites are the neck, axilla, and knuckles, but unusual locations such as the face have also been reported. Quantitative scales such as Burke have been used to describe the severity of the dermatosis, particularly in correlation with IR elements. Dermoscopic examination are required, for instance, in cases with sulcus cutis, hyperpigmented spots, crista cutis, and papillary projections. A skin biopsy may be necessary, but it is not the rule. Both IR that clinically manifests with or without obesity/MS correlates with AN; most studies are cross-sectional, with only a few longitudinal. The approach varied from screening during school periodic checkups/protocols/programs to subgroups of individuals who were already known to be at high cardio-metabolic risk. AN was associated with type2DM, as well as type 1DM. Females with PCOS may already display metabolic complications in 60–80% of cases, with AN belonging to the associated skin spectrum. AN management depends on underlying conditions, and specific dermatological therapy is not generally required, unless the patient achieves metabolic control, has severe skin lesions, or desires cosmetic improvement. In IR cases, lifestyle interventions can help, including weight control up to bariatric surgery. In addition, metformin is a key player in the field of oral medication against DM type 2, a drug whose indication is extended to PCOS and even to AN itself, outside the specific panel of glucose anomalies. In terms of cosmetic intervention, limited data have been published on melatonin, urea cream, topical retinoids, vitamin D analogs, or alexandrite laser. In conclusion, awareness of IR and its associated clinical features is essential to provide prompt recognition of underlying conditions. AN represents a useful non-invasive surrogate marker of this spectrum in both children and adults. The pivotal role of this dermatosis could massively improve endocrine and metabolic assessments.

Maintenance Outcomes of the Children’s Healthy Living Program on Overweight, Obesity, and Acanthosis Nigricans Among Young Children in the US-Affiliated Pacific Region

Few obesity prevention trials among children have demonstrated sustainable outcomes in the long term. To sustain a community-wide decrease in the prevalence of overweight and obesity among young children in the US-affiliated Pacific region. In the Children's Healthy Living community-randomized clinical trial, hierarchical modeling comparing the change in intervention and control communities accounted for community randomization (community clustering with jurisdictions), and adjusted for the age and sex distribution of the assessed children in a cross-sectional design. The outcome measures were repeated in communities rather than among individual children. A total of 27 communities in 5 jurisdictions (Hawai'i, Alaska, Commonwealth of the Northern Mariana Islands, American Samoa, and Guam) of the US-affiliated Pacific region were included. Participants included children aged 2 to 8 years in the 27 selected communities from October 1, 2012 (4329 in time 1 [baseline]) to August 31, 2015 (4043 in time 2 [intervention end]) and from January 1, 2019, to April 30, 2020 (1469 in time 3 [maintenance period]). Study analysis was completed March 25, 2022. Nineteen activities addressed training, policies, systems, and environments of communities and 6 target behaviors of children (consumption of fruit and vegetables, water, and sugar-sweetened beverages; sleep; physical activity; and screen time) during a 2-year intervention period. Continued partnership with community coalitions, ongoing academic training of community partners, and use of trial data during a 6-year maintenance period. The primary outcome was measured anthropometry; secondary outcomes were the presence of acanthosis nigricans, dietary intake derived from 2 days of food records, and survey questions on screen time and sleep disturbance. Among the 9840 children included in the analysis (4866 girls [49.5%] and 4974 boys [50.5%]; 6334 [64.4%] aged 2-5 years), the intervention group showed significant improvements compared with the control group from times 1 to 3 in prevalence of overweight plus obesity (d = -12.60% [95% CI, -20.92% to -4.28%]), waist circumference (d = -1.64 [95% CI, -2.87 to -0.41] cm), and acanthosis nigricans prevalence (d = -3.55% [95% CI, -6.17% to -0.92%]). Significant improvements were also observed from times 2 to 3 in prevalence of overweight plus obesity (d = -8.73% [95% CI, -15.86% to -1.60%]) but not in waist circumference (d = -0.81 [95% CI, -1.85 to 0.23] cm). This randomized clinical trial found that the outcomes of the Children's Healthy Living intervention were maintained and enhanced 6 years after the intervention among young children in the US-affiliated Pacific region. The prevalence of overweight, obesity, and acanthosis nigricans was further reduced in communities, suggesting that multilevel multicomponent interventions may help reduce child overweight and obesity in this region. ClinicalTrials.gov Identifier: NCT01881373.

Acanthosis Nigricans in Children and Adolescents with Type 1 Diabetes or Obesity: The Potential Interplay Role between Insulin Resistance and Excess Weight.

Acanthosis nigricans (AN) is associated with obesity and type 2 diabetes, where insulin resistance (IR) is considered a predisposing factor. IR can also affect patients with type 1 diabetes (T1D). We evaluated the prevalence of AN in patients with T1D compared to subjects with obesity in order to define the interplay between IR and excess weight. We considered 138 pediatric patients who presented with T1D and 162 with obesity. As controls, 100 healthy normal-weight subjects were included. A physical examination with the detection of AN and biochemical assessments was performed. IR was calculated by using the homeostasis model assessment for IR in patients with obesity and the estimated glucose disposal rate in T1D. The AN prevalence was higher in T1D and obese subjects compared with controls in whom AN was not detected (p = 0.02 and p < 0.001, respectively). A greater number of AN cases were observed in subjects with obesity compared with T1D (p < 0.001). Patients with AN were older than subjects without AN (p = 0.005), and they had higher body mass index (BMI) values, waist circumference (WC), fasting triglycerides and blood pressure (all p < 0.001). Thirty-five patients with AN exhibited IR with an association between AN presence and IR in patients with obesity (p < 0.001). In T1D, there was an association between AN and being overweight/obese (p = 0.02), independently of IR. AN is a dermatological condition associated with obesity. In T1D, the presence of AN was significantly associated with overweight status or obesity but not IR. The presence of AN in the absence of IR supports the interplay role between impaired insulin signaling, IR and excess weight in the pathogenic mechanism.

Prevalence of acanthosis nigricans and its association with physical activity in adolescents - School-based analytical cross-sectional study from Kochi, Kerala.

Introduction:Acanthosis nigricans (AN) is a brown to black, poorly defined velvety hyperpigmentation of the skin. It is a predisposition factor for Type 2 diabetes, malignancies and various endocrinopathies. The available data regarding AN from Kerala is limited. Our study aims to estimate the prevalence of AN and to examine its association with physical activity among the adolescents of age 13–14 years.Methodology:This analytical cross-sectional study was conducted in two grades of a school in Ernakulam district between June and December 2018 among 400 adolescents of age 13–14 years. The study proforma and the Physical activity questionnaire, Adolescents (PAQ-Adolescents), were self-administered to the students and the data were collected. The principal investigator verified the presence of AN by observation in the neck, elbow and knuckles and recorded in the study proforma. Statistical analysis of the data collected was done using SPSS Software program (version 21).Results:The mean age of the group was found to be 13.31 ± 0.46 years. The prevalence of AN was 14.5% in the study population. AN was most prevalent among obese adolescents (61.54%), adolescents with low exercise rate (23.94%), having family history of diabetes (21.18%), family history of hypertension (21.86%) and family history of both diabetes and hypertension (26.32%). The risk factors such as obesity, diabetes, hypertension, family history of diabetes, family history of hypertension and family history of both diabetes and hypertension had a positive association with AN had a negative association with physical activity with p=0.0001. In adolescents with increased exercise rate, there were no reported cases of AN.Conclusion:The results of our study show that there is a strong association between AN and children with obesity, family history of diabetes mellitus, hypertension and low physical activity. Regular adequate physical activity can prevent the onset of AN and thereby reduce the early onset of diabetes, metabolic syndrome, polycystic ovarian syndrome, coronary artery diseases and certain types of malignancies.

1979-P: Thyroid Hormone Associated with Acanthosis Nigricans and Fat Distribution in Obese Patients Nigricans and Fat Distribution in Obese Patients

Obesity exhibits subclinical hypothyroidism (SH) and acanthosis nigricans (AN) easily as an associated complication. We aimed to elucidate the triad interlink between the thyroid hormone levels, fat distribution and AN. In this cross-sectional study, 202 obese men and 239 obese women were enrolled. Anthropometric measurements, glucose-lipid metabolism, thyroid hormone levels, and fat distribution were measured. SH was defined by thyroid-stimulating hormone (TSH) less than 2.5 mU/L. Results showed that the prevalence of AN was significantly higher in the obese group with SH than without SH (47.3% vs. 36.9%, P=0.035). The number of obese women with SH was larger than men (38.1% vs. 28.2%, P=0.029). Obese women have higher TSH levels, lower free triiodothyronine (FT3) and free thyroxin (FT4) than obese men (all P&amp;lt;0.01). In all obesity, FT3 was significantly positively associated with weight, NC, WC, WHR, SBP, DBP, FINS, UA and negatively with HDL-C (all P &amp;lt;0.05). FT4 was significantly positively associated with weight, BMI, NC, WC, SBP, DBP, UA, HGB and FBG (all P &amp;lt;0.05). TSH was negatively correlated with FBG and HGB (all P &amp;lt;0.05). FT3 was positively correlated with Peripheral fat mass, total lean mass and negatively with Total Fat% and Trunk/peripheral fat mass (P=0.025;P=0.029;P&amp;lt;0.001;P=0.034), FT4 was also positively with total lean mass and negatively with Total Fat%(P=0.008; P=0.017), and TSH was positively correlated with Total Fat%(P=0.032). In conclusion, we found that obese patients with SH are more susceptible to AN. Relatively insufficient thyroid function with higher TSH may be a protective factor in obese women with a better metabolism. Thyroid hormone may be beneficial in improving fat distribution and building lean mass in patients with obesity. Disclosure S. Qu: None. X. Wang: None. Funding National Key Research and Development Program of China (2018YFC1314100); National Natural Science Foundation of China (81970677)

Acanthosis nigricans in middle-age adults: A highly prevalent and specific clinical sign of insulin resistance.

Insulin resistance (IR) precedes the diagnosis of many metabolic and non-metabolic illnesses, including type 2 diabetes mellitus (T2DM). Acanthosis nigricans (AN) is a clinical sign associated with IR. However, AN prevalence and diagnostic accuracy in middle-age adults before or at the time of prediabetes/diabetes diagnosis remain uncertain. With the aim to define AN prevalence and diagnostic accuracy, adults between 40 and 60years of age were consecutively invited to participate in the study. Participants were categorised into one of two main groups: individuals with normoglycaemia (group 1) and hyperglycaemia (group 2 [ie, prediabetes/diabetes]). Demographic, clinical, anthropometric characteristics, homeostasis model assessment of IR, homeostatic model assessment of β-cell function, as well as the presence of AN on the neck, axillae, elbows and knuckles were assessed. A total of 320 consecutive participants with a mean age of 49.3years (59.4% women) were included. Overall, AN prevalence was 46.3%, while AN in group 1 and group 2 was 36.3% and 49.6%, respectively (P=.04). The most common affected sites in group 1 (n=80) were the knuckles (21.2%) and the neck (17.5%), while in group 2 (n=240), the neck (29.6%) followed by the knuckles (26.7%). The specificity and positive predictive value of AN for IR were 0.85 and 0.86 in group 1 and 0.90 and 0.96 in group 2, respectively. In middle-age adults, within the entire spectrum of carbohydrate tolerance, AN is highly prevalent and specific. This finding supports its assessment as a reliable and convenient clinical sign of IR. The understanding of AN behaviour through different carbohydrate tolerance strata, and its different locations, could lead to early detection of individuals at high metabolic risk or help direct a more pathophysiological treatment approach in patients with T2DM.

Prevalence of Poly Cystic Ovarian Syndrome (PCOS) in Obese Females in a Tertiary Care Centre in South India‑An Observational Study

Background: Poly cystic ovarian syndrome (PCOS) is more common among obese females. It has many dimensions which is still being explode many studies have tried to characterise the exact presentation of the disease. This study analysed the prevalence of PCOS in obese females. Along with this, the prevalence of acanthosisnigricans which is a surrogate maker of insulin resistance and Hirsuitism has been simultaneously studied. Methodology: It was a cross sectional study which is carried out among medical students in a tertiary care centre in South India for one year. Questionnaire was designed and study was done. It comprised sample size of 113 females. All these candidates had high Body mass index (BMI) and all of them fall under obese category. The candidates who were participating in this study were aware of the PCOS condition and a brief session on PCOS was given before the start of this study. Along with this, Cutaneous manifestations were also assessed based on the severity of the symptoms. Results: This study found that the prevalence rate of PCOS among obese females was 85.8%. More than half of the study patients has acanthosisnigricans (57.5%) and Hirsuitism (59.2%). These results were based on Rotterdamn criteria. In this 93.8% of hyperandrogenism, 57.5% had Acanthosisnegucans and 59.2% had hirsiutism. In this study 50.4% had fulfilled all three criteria according to Rotterdam criteria according to Rotterdam and 35.3% has fulfilled 2 out of 3 criteria and 14.1% faced to fulfillatleast 2 criteria(Figure 3). Thus from the above study we conclude that there is great prevalence rate for PCOS in obese females aged 18 to 22. Conclusion: With 85.8% prevalence rate of PCOS among obese females, it strongly proves that there is a association between the two. Thus increase in BMI causes increased risk of PCOS among females.

Acanthosis Nigricans in the Knuckles of Infants: A Novel Clinical Marker of High Metabolic Risk.

IntroductionAcanthosis nigricans (AN) is an early clinical sign of insulin resistance (IR) primarily in adults. The prevalence and association of AN and IR in infants, however, remains uncertain. We aimed to describe the prevalence of AN and its association with IR in a group of Latin-American infants.MethodsWe studied a random sample of 227 healthy infants between 9 and 24 months of age. After a complete clinical history was obtained and a physical examination was performed, fasting plasma glucose and serum insulin were measured. Three blinded evaluators assessed AN in each patient. Infants with AN were categorized as cases. The HOMA-IR index cutoffs of ≥ 90th and ≥ 95th percentiles were considered IR.ResultsThere were 49 infants with AN (21.6%) (cases) and 178 without AN (78.4%) (controls). Cases had a significantly higher mean serum insulin, fasting plasma glucose, and HOMA-IR levels of 3.67 ± 2.56 µU/ml vs. 2.42 ± 1.45 µU/ml, P = 0.005; 84.2 ± 12.6 mg/dL vs. 77 ± SD 9.9 mg/dL, P ≤ 0.001; HOMA-IR 0.77 ± 0.54 vs. 0.46 ± 0.28, P ≤ 0.001, respectively. More cases than controls presented HOMA-IR levels ≥ 95th percentile (cases 18.4%; controls 0.5%, P ≤ 0.001) and ≥ 90th percentile (cases 32.7%; controls 1.6%, P ≤ 0.001). AN in the knuckles had a high sensitivity and a negative predictive value (NPV) for detecting patients with HOMA-IR levels above the 95th percentile (sensitivity 90%; NPV 99.4%) and above the 90th percentile (sensitivity 84.2%; NPV 98.3%).ConclusionAN in the knuckles is a prevalent, non-invasive, costless, and reliable screening clinical tool that can be used for early detection of infants with IR and a high metabolic risk.

NP30 Children's Healthy Living Center of Excellence (CHL Center) Year 1

Objective To serve as a Center of Excellence to further build capacity and new knowledge for collective impact on child health in the US Affiliated Pacific Region. Description CHL Center continues to strengthen capacity with the Child Health in the Pacific (CHAP) Summer Fellowship Program and the CHL Dietetics Scholarship Program (CHLD), the CHL Summer Institute. Ten fellows from CNMI, Guam and Hawai‘i completed the CHAP Summer Fellowship program and the CHL Summer Institute had a total of 123 students completing online courses (nine offered) related to childhood obesity. To examine the CHL intervention's long-term impact, retraining and standardization workshops are being conducted; and data collection has begun. Eighteen community reports provide a comprehensive compilation of data already collected, and CHL data are available for continued analysis to fill the void in basic nutrition and health information of children in the region. A CHL network multistate project (W1194) has expanded CHL's reach, with members from Arizona and West Virginia. Evaluation The published CHL intervention effect showed significant improvement in intervention communities compared with control in overweight and obesity prevalence (effect size [d] = −3.95%; 95% CI, −7.47% to −0.43%), waist circumference (d = −0.71 cm; 95% CI, −1.37 to −0.05 cm), and acanthosis nigricans prevalence (d = −2.28%; 95% CI, −2.77% to −1.57%). Greater differences existed among intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (−3.99%) vs the group aged 6 to 8 years (−3.40%), and the interaction was significant (d = 0.59%, P Conclusion and Implications Year one built on efforts established by the CHL program to build the CHL Center of Excellence.

Acanthosis nigricans: A cutaneous marker for metabolic syndrome

Background: Acanthosis Nigricans (AN) is an easily identifiable dermatoses characterized by thickened, hyperpigmented plaques. Metabolic syndrome refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. AN is a skin marker associated with this syndrome. Aims and Objectives: This study aimed to determine the relationship between AN and metabolic syndrome by studying its clinico-epidemiological features and also the relation of severity of AN over neck with metabolic syndrome. Methodology: This is a case-control study. One hundred consecutive patients of AN attending dermatology OPD of a tertiary care hospital were included in this study. They were evaluated for AN and severity of AN over neck was assessed. Age and sex matched 100 controls were included in the study. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured of all the cases and controls. Body Mass Index (BMI) was calculated. Fasting Blood Sugar, High Density Lipoprotein and Serum Triglyceride levels were estimated. Result: The average age of the patients was 32.4 years and females (62%) were more than the males (38%). Neck was involved in all the patients. There was statistically significant correlation of increasing severity of AN with each component of Metabolic syndrome. On comparing between cases and controls, each component of metabolic syndrome was raised in cases as compared to the controls. 70% cases had Metabolic syndrome which was statistically significant. Conclusion: There was a high prevalence of AN in subjects with metabolic syndrome. Also there was a positive correlation between severity of AN and Metabolic syndrome.

Acanthosis nigricans in achondroplasia.

Acanthosis nigricans (AN) in those with achondroplasia has been reported occasionally in the literature previously. Other disorders arising from constitutive activation of FGFR3 also manifest AN at various frequencies. We assessed the prevalence of AN in a sequential series of 477 individuals with achondroplasia. Using a REDCap database, we collected and analyzed what other features or medical issues may co-occur with AN in those with achondroplasia. AN arises in approximately 10% of individuals with achondroplasia. It usually first appears in preadolescence or adolescence, is more likely in the non-White population and in those who are obese. It is not severe and generally will need no treatment. It is not associated with any evident risk for neither hyperinsulinemic states nor malignancy, and therefore, no special investigations are warranted when it is recognized. Thus, clinicians should not be surprised or concerned upon discovering this finding in those with achondroplasia. In addition, the mechanisms and genetic causes of AN are detailed.

Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region

Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program. In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01). The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. ClinicalTrials.gov Identifier: NCT01881373.

Effectiveness of the Children's Healthy Living (CHL) Multilevel Multicomponent Community Intervention Program in 5 US affiliated Pacific Jurisdictions

The Children's Healthy Living (CHL) program, a collaboration among Pacific Land Grant Colleges, was developed and implemented with 27 communities across the US affiliated Pacific region in a 24 month community randomized intervention trial to prevent young child obesity. The multilevel, multisite, community‐based intervention consisted of 4 cross‐cutting functions (initiate or strengthen school wellness policies; partner and advocate for environmental change; promote CHL messages; and local capacity building) with 20 activities addressing 6 targeted behaviors (physical activity, sedentary behavior, sleep, fruit and vegetable intake, sugar sweetened beverage intake, and water intake). A common intervention template and outcome measures were developed and implemented; IRB approval or ceding of approval was obtained at each of the 5 collaborating institutions. Controlling for age and sex of 2–10 year old children and accounting for the randomization units and clustering, the CHL intervention communities had significant changes in the following variables compared to control communities: prevalence of acanthosis nigricans (change of −0.1% vs +0.2%), child overweight plus obesity (−3.0% vs +1.7%), child waist circumference (+0.2cm vs +9cm), and daily screen time (−2.4min vs +3.0mins). Accelerometry and food related variables (fruit and vegetable intake, sugar sweetened beverage intake, water intake) are still being analyzed. The results indicate that community‐based multilevel multi‐component interventions can impact young child overweight and obesity and related behaviors and conditions.Support or Funding InformationUSDA/NIFA grant 2011‐68001‐30335

Prevalence of Acanthosis nigricans and Related Factors in Iranian Obese Children.

Recognition of Acanthosis nigricans (AN) provides important opportunities for screening of obesity syndrome, dyslipidemia, hypertension and insulin resistance with diabetes mellitus 2. Considering the high prevalence of obesity among Iranian children, we designed this study to estimate the prevalence of AN and related laboratory factors in Iranian obese children. Seventy-one obese children were enrolled in this study. Diagnosis of AN was done by clinical examination. Body mass index (BMI), fasting blood sugar, total cholesterol, triglycerides (TG), alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, high- and low-density lipoprotein cholesterol, insulin, thyroid-stimulating hormone, free thyroxin (fT4), calcium, phosphorus and 25-hydroxyvitamin D were measured with routine techniques. Collected data were compared between cases with AN and without AN. Independent t-test was used for comparison of variables. Twenty-five of children were female (35.2%). Forty-eight children (67.6%) had AN. In 20 cases (28.2%), homeostasis model assessment-insulin resistance (HOMA-IR) was <2.5 and in 51 (71.8%), HOMA-IR was more than 2.5. Mean BMI, insulin, HOMA-IR, TG and AST levels were significantly higher in cases with AN. Obese children with AN are at risk of developing diabetes. Hence early identification of this feature and precise evaluation of children is recommended.

Cardiovascular Disease Risk Factors in Hispanic Adolescents in South Texas.

Despite a national crisis of increased prevalence of obesity and type 2 diabetes mellitus in adolescents, especially among Hispanics, there is a paucity of data on health indicators among farmworker adolescents and their peers. The main aim of this study was to estimate the prevalence of cardiovascular disease risk factors in a population of Hispanic adolescent students in south Texas. The study also aimed to compare the prevalence of these risk factors between students enrolled in the Migrant Education Program (MEP) and other students, and between boys and girls. In partnership with the Weslaco (Texas) Independent School District and the Migrant Education Department, a cohort study was conducted from 2007 to 2010 to estimate the prevalence of overall obesity (body mass index ≥85th percentile for age and sex), abdominal obesity (waist circumference ≥75th percentile for age, sex, and ethnicity), acanthosis nigricans (AN), and high blood pressure (HBP; ≥90th percentile for age, height, and sex or systolic/diastolic BP ≥120/80 mm Hg) among MEP students compared with other students from two south Texas high schools. Multilevel logistic regression was used to assess the relation between sex and our main outcomes of interest while accounting for within-school nesting of participants. Among 628 sampled students, 508 (80.9%) completed the consent procedure and participated in the study. Of these, 257 were MEP students and 251 were non-MEP peers. Approximately 96.7% of participants were Hispanic and 50.0% were boys. Analyses of data across the years comparing MEP students and non-MEP students show an average prevalence of 44.8% versus 47.7% for overall obesity, 43.2% versus 43.7% for abdominal obesity, 24.7% versus 24.7% for AN, and 29.2% versus 32.8% for HBP. Across recruitment and follow-up years, the prevalence of overall obesity, abdominal obesity, and HBP was 1.3 to 1.5, 1.2 to 1.8, and 2.9 to 4.6 times higher in boys than in girls, respectively. In contrast, the prevalence of AN varied little by sex. The high prevalence of cardiovascular risk factors in both groups suggests a compelling need for comprehensive, culturally targeted interventions to prevent future cardiovascular diseases in these high-risk Hispanic adolescents, especially among boys. There were not, however, substantial differences between MEP students and other students. These findings also support the feasibility of conducting future epidemiologic studies among adolescent farmworkers and their families, as well as culturally appropriate school or community-based interventions.

Child Obesity and Acanthosis Nigricans in the Children's Healthy Living Program (CHL)

Due to high levels of adult obesity and diabetes in the United States (US) Affiliated Pacific region, and paucity of data among young children, the Children's Healthy Living (CHL) program conducted prevalence surveys for young child obesity and acanthosis nigricans in eight jurisdictions. Children (4,017; 2-8yo) were weighed, measured, and assessed for acanthosis nigricans (AN). AN prevalence (%) differed by jurisdiction (X2 = 107.7, p < 0.001): Alaska, 0; American Samoa, 5; Commonwealth of the Northern Marianas (CNMI), 9; Guam, 3; Hawaii, 1; Palau, 5; Pohnpei, 12; Republic of the Marshall Islands (RMI), 11, and Overall, 5. Overweight prevalence (%) differed by jurisdiction (X2 = 72.3, p < 0.001): Alaska, 21; American Samoa, 20; CNMI, 11; Guam, 13; Hawaii, 17; Palau, 9; Pohnpei, 18; RMI, 2; and Overall, 15. Obesity prevalence (%) differed by jurisdiction (X2 = 96.6, p < 0.001): Alaska, 16; American Samoa 23; CNMI, 16; Guam, 14; Hawaii, 16; Palau, 16; Pohnpei, 4; RMI, 0; and Overall, 16. AN prevalence (%) was higher among 6-8yo (7) than 2-5yo (4, X2 = 23.6, p<0.001), and among Asian (8), Hawaiian and Pacific Islander (6), and among those of more than one race (3), than among Native American/Alaskan (0), Black (0), and White (0) (X2 = 44.5, p < 0.001). AN prevalence (%) was higher among those who were obese (17) compared to other weight categories (3) (X2 = 253, p < 0.001). Presence of AN, and its relationship to obesity, suggests an urgent need for attention to young children in US Affiliated Pacific populations. USDA 2011-68001-30335

Implications of a clinically ignored site of acanthosis nigricans: the knuckles.

The clinical epidemiology of acanthosis nigricans (AN) has not been entirely studied. Most studies mention only its prevalence taking any "typical site" as a whole. These studies were carried out at different ages, races, anthropometries, and skin phototypes without analyzing the comparative clinical connotation of different sites. Furthermore, it has never been explored as a potential early expression of insulin resistance before it becomes clinically evident. The objective was to determine the prevalence and body distribution of AN in easy-access sites to physical examination in a Latin American youth population and its clinical implications as an early marker for obesity. We conducted a prospective, cross-sectional, observational study in 703 randomly selected students. Participants' mean age was 19.1±1.68 years. Overweight and obesity occurred in 23.6% and 6.8%, respectively. 3 observers blindly assessed neck, axillae, elbow and knuckles. AN was identified in any of the examined sites in 47.8% of the participants. Its prevalence increased from 41% to 86% from normal to obese anthropometric categories. AN occurred in 1-4 sites in 23.1%, 10.8%, 6.9% and 7.1% of cases, respectively. The knuckles was the site with the highest prevalence of AN as an overall group (31.3%) and in the normal (24.9%) and overweight body mass index (46.4%) categories and there was a higher prevalence in the cases above the median in the normal body mass index category. In the obese group, AN was slightly more common in the neck but all sites had a very similar high prevalence. AN occurs with a high prevalence in Latin American youths, and its prevalence is much higher in a "non-classical" and ignored location where it is very easy to detect during physical examination: the knuckles. It may also occur earlier in this location in the evolution to obesity. The presence of AN in the knuckles in any patient, even if they have a normal body mass index, might indicate the likelihood of an early clinical manifestation of insulin resistance and metabolic consequences.