Fasting Glucose To Insulin Ratio Research Articles

Insight into the Predictive Power of Surrogate Diagnostic Indices for Identifying Individuals with Metabolic Syndrome.

This study aimed to assess the diagnostic capability of insulin surrogate measurements in identifying individuals with metabolic syndrome (MetS) and propose applicable indices derived from fasting values, particularly in large study populations. Data were collected from the datasets of the Surveillance of Risk Factors of NCDs in Iran Study (STEPS). MetS was defined based on the National Cholesterol Education Program (NCEP) criteria. Various insulin surrogate indices, including Homeostasis Model Assessment (HOMA), Quantitative Insulin Sensitivity Check Index (QUICKI), Fasting glucose to insulin ratio (FGIR), Reynaud, Reciprocal insulin, McAuley, Metabolic Score for Insulin Resistance (METS-IR), Triglyceride-glucose index (TyG), TG/ HDL-C, TG/ BMI, and TG/ WC ratio were assessed. Receiver Operating Characteristic (ROC) curves were used to assess pathologic conditions and determine the optimal cut-off through the highest score of the Youden index. Also, Area Under the Curve (AUC) values were established for each index totally and according to sex, age, and BMI differences. The study population consisted of 373 individuals (49.9% women; 75.1% middle age, 39.1% obese, and 27.3% overweight), of whom 117 (31.4%) had MetS. The METS-IR (AUC: 0.856; 95% CI: 0.817-0.895), TG/ HDL-C (AUC: 0.820; 95% CI: 0.775-0.886), TyG (AUC: 0.808; 95% CI: 0.759-0.857), and McAuley (AUC: 0.804; 95% CI: 0.757-0.852) indices provided the greatest AUC respectively for detection of MetS. The values of AUC for all the indices were higher in men than women. This trend was consistent after data stratification based on BMI categories, middle age, and senile individuals. The present study indicated that indices of insulin, including METS-IR, TG/HDLC, TyG, and McAuley, have an equal or better capacity in determining the risk of MetS than HOMA-IR, are capable of identifying individuals with MetS and may provide a simple approach for identifying populations at risk of insulin resistance.

Evaluation of the Correlation Between Vitamin D Level and Insulin Resistance in Children with Overweight and Obesity

Aim: This study aimed to evaluate the relationship between vitamin D levels and insulin resistance parameters in children with overweight and obesity. Material and Methods: A total of 174 children, 64.4% (n=112) female, and 35.6% (n=62) male, aged between 6-17 years were included in the study. The participants were divided into three groups as normal (29.9%, n=52), overweight (23.6%, n=41), and obesity (46.5%, n=81) based on the criteria of the World Health Organization body mass index (BMI) classification. The insulin resistance status of the participants was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR), fasting glucose to insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI). Results: HOMA-IR was found higher in the obesity group (3.2±2.1) compared to the overweight (2.2±1.0) and the normal weight (1.5±1.0) groups (p<0.001). It was observed that QUICKI values of the overweight (0.34±0.03) and the obesity (0.33±0.03) groups were lower than the normal weight (0.37±0.03) group (p<0.001). FGIR was noticed as higher in the normal weight (16.8±10.4) group compared to the overweight (10.6±6.0) and the obesity (8.5±5.5) groups (p<0.001). The mean serum 25-hydroxyvitamin D [25(OH)D] levels of the children and adolescents were 19.6±10.7 ng/mL, and no statistically significant difference was found between the groups (p=0.153). A significant weak negative correlation between serum 25(OH)D and HOMA-IR values was found (r=-0.170, p=0.025). Additionally, a weak positive statistically significant correlation was found between serum 25(OH)D level and QUICKI and FGIR values (r=0.173, p=0.022, and r=0.173, p=0.023, respectively). Conclusion: Vitamin D levels can affect insulin resistance parameters.

Evaluation of Triglyceride Glucose Index and Homeostasis Model of Insulin Resistance in Patients with Polycystic Ovary Syndrome.

To use the triglyceride glucose (TyG) index to evaluate insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and to explore alternative indicators for early identification of IR. This study included 114 patients with PCOS and 61 healthy volunteers. Pearson or Spearman correlations were calculated to compare the association between the TyG index and triglyceride glucose body mass index (TyG-BMI) with homeostatic model assessment for IR (HOMA-IR), homeostasis model assessment for β-cell function (HOMA-β), quantitative insulin sensitivity check index (QUICKI), and fasting glucose-to-insulinratio (FG-IR). The receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the TyG index and TyG-BMI in identifying IR (defined as HOMA-IR ≥2.5) in patients with PCOS. Correlation analyses revealed that the TyG index of the PCOS group was positively correlated with HOMA-IR (r=0.515, P<0.01) and HOMA-β (r=0.348, P<0.01), but negatively correlated with QUICKI (r=-0.532, P<0.01) and FG-IR (r=-0.394, P<0.01). The ROC curve of IR defined by HOMA-IR showed that the AUC value of TyG-BMI was the highest, at 0.796 (95% confidence interval (CI): 0.710-0.866, P<0.001) when the cut-off point was 191.53, with 85.3% sensitivity and 73.9% specificity values. For the TyG index, the AUC was 0.781 (95% CI: 0.693-0.853, P<0.001) when 8.51 was the cut-off point, with a sensitivity of 63.2% and specificity of 87.0%. This study found that the TyG index and TyG-BMI performed better than traditional lipid ratios, such as triglycerides/high density lipoprotein cholesterol (TG/HDL-C), in predicting IR and may be used as markers of IR in Chinese patients with PCOS.

The effect of Madhumeha Kusumakar Rasa – an Ayurved medicine – in insulin resistance

Madhumeha Kusumakar Rasa (MKR) is an Ayurved formulation having a strong pharmacological base for diabetes management. This study aimed to validate MKR's efficacy in dexamethasone-induced insulin resistance (IR). Albino Wistar rats were divided into four groups. Group 1 served as the normal control, Group 2 received dexamethasone 1.5mg/kg (i.p.), Group 3 received dexamethasone and metformin 200mg/kg (p.o.), and Group 4 received dexamethasone and MKR 236mg/kg (p.o.). Animals were evaluated for serum glucose levels and glucose tolerance, serum insulin, Homeostatic model assessment of insulin resistance (HOMA-IR), Homeostatic model assessment of insulin sensitivity (HOMA-IS), fasting glucose to insulin ratio (FGIR), and lipid parameters. Pancreas, liver, and kidneys were evaluated for reduced Glutathione (GSH) and Malondialdehyde (MDA) levels. These tissues were also evaluated for histopathological changes. MKR showed significant improvement in serum glucose and glucose tolerance, serum insulin and HOMA-IR, HOMA-IS, and FGIR. It also showed a significant improvement in lipid parameters as compared to the dexamethasone-treated group. It prevented depletion of GSH levels and elevation in MDA levels. These effects were supported by histopathological analysis. MKR treatment significantly attenuated dexamethasone-induced IR. This study validates the mechanism of the anti-diabetic potential of MKR.

The waist-height ratio is a potential anthropometric index of insulin resistance: Observations based on oral glucose tolerance test in lean, normo-glycaemic, Asian Indian males from Southern India

AimsTo correlate the waist-to-height ratio (WHt-R) with Matsuda index of the Oral Glucose Tolerance Test (OGTT) and other surrogate indices of fasting insulin resistance/sensitivity and to derive a cut-off value for the WHt-R in lean, normoglycaemic males from Southern India. MethodsA cohort of 105 lean, normoglycaemic males (mean BMI: 19.2 ± 2.6 kg/m2) underwent OGTT. Surrogate indices of insulin resistance viz, the Homeostatic model assessment of Insulin Resistance (HOMA-IR), the Quantitative Insulin sensitivity Check Index (QUICKI), the Fasting glucose to insulin ratio (FG-IR), the McAuley's index and the Triglyceride/HDL-C ratio were correlated with the Matsuda and the Insulinogenic indices. The cut-off value for WHt-R to predict insulin resistance was obtained using Receiver operating characteristics (ROC) with Area under curve (AUC) at 95% confidence interval (CI). The P value < 0.05 was considered statistically significant. ResultsThe ROC analysis at 95% confidence interval (CI), showed an AUC of 0.58 for the WHt-R cut-off value ≥ 0.39 with 69.4% sensitivity and 57.1% specificity. On pooled ROC analysis, significantly higher AUC was observed for the WHt-R (0.90) when compared to BMI (0.83) and waist-to-hip ratio (0.83). Paired wise comparison analysis of ROC curves revealed significant differences for AUC of WHt-R when compared to waist circumference (p < 0.01), but not for BMI and WHR. ConclusionThe WHt-R can be used as a potential anthropometric index to screen for insulin resistance, when compared to BMI and WC in lean, normoglycaemic males from Southern India.

Evaluation of lipid ratios and triglyceride-glucose index as risk markers of insulin resistance in Iranian polycystic ovary syndrome women

BackgroundInsulin resistance has a vital role in the pathophysiology of polycystic ovary syndrome (PCOS). Previous investigations have shown that some lipid ratios could be a simple clinical indicator of insulin resistance (IR) in some disorders and ethnicities. The present study was conducted to evaluate the correlation between triglyceride to HDL-cholesterol (TG/HDL-C), total cholesterol to HDL-cholesterol (TC/HDL-C), as well as fasting triglyceride-glucose (TyG) indices with IR (as measured by homeostasis model assessment of IR (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose to insulin ratio (FGIR)) among the Iranian women diagnosed with PCOS.MethodsIn the current study, a total of 305 women with PCOS were evaluated. TG/HDL-C, TC/HDL-C, and TyG indices were calculated. Fasting insulin level was measured using ELISA technique. IR was defined as a HOMA-IR value of ≥2.63, FG-IR value of < 8.25, and QUICKI value of < 0.33.ResultsThe insulin-resistant (IR) and insulin-sensitive (IS) groups, established by the HOMA-IR, FG-IR, and QUICKI values were different in terms of TG/HDL-C, TC/HDL-C, and TyG indices. These indices were associated with IR even after adjusting for age and BMI. ROC curve analyses showed that TyG, TG/HDL-C, and TC/HDL-C strongly predicted HOMA-IR with area under the curve (AUC) of 0.639, 0.619, and 0.623, respectively (P < 0.05). Further, TC/HDL-C was a good predictor of FG-IR with AUC of 0.614 (P = 0.04).ConclusionTyG, TG/HDL-C, and TC/HDL-C indices might be good indicators of IR among Iranian women diagnosed with PCOS.

The triglyceride/glucose ratio is a reliable index of fasting insulin resistance: Observations from hyperinsulinaemic-euglycaemic clamp studies in young, normoglycaemic males from southern India

Background & aimsNon-obese Asians have a high propensity to develop insulin resistance. Therefore, screening such individuals for insulin resistance using simple surrogate indices is important. In this study, we aimed to validate the triglyceride-glucose (Tg/glu) ratio against the M value of hyperinsulinaemic-euglycaemic clamp (HEC) procedure and other surrogate indices of insulin resistance in normoglycaemic Indian males from Southern India. MethodsA cohort of 105 normoglycaemic males (mean BMI: 19.2 ± 2.6 kg/m2) underwent HEC procedure. Surrogate indices of insulin resistance viz. the triglyceride-glucose (Tg/Glu) ratio, the triglyceride-glucose index, the McAuley’s index, the HOMA-IR, the QUICKI, the fasting glucose to insulin ratio (FG-IR), and the fasting C- peptide index were calculated and correlated with the M value. The cut-off value for the Tg/Glu ratio was obtained using the Receiver Operator Characteristics (ROC) with Area under curve (AUC) analysis at 95% confidence interval (CI). The P value < 0.05 was considered statistically significant. ResultsThe Tg/Glu ratio demonstrated significantly higher AUC (0.81), when compared to the Tg × glu index (0.63), 20/fasting C peptide × fasting plasma glucose index (0.55), HOMA-IR (0.47), QUICKI (0.26), FGIR (0.12) and McAuley’s index (0.18). For the Tg/Glu ratio, a cut-off value ≥ 1.19 had high sensitivity (80%) and specificity (79%) values (PPV: 16%; NPV: 98.8%) respectively. ConclusionThe Tg/Glu ratio can be used as a reliable surrogate index to screen for risk of insulin resistance in lean, normoglycaemic males from Southern India.

Obesity, Dyslipidemia and Insulin Resistance in Survivors of Childhood Cancer

Abstract&#x0D; Background: With the increased survival rates following the treatment of childhood cancer, it becomes equally important that the need for evidence based surveillance of long term effects of cancer therapy is addressed. This includes the risk of development of metabolic syndrome features like obesity, altered lipid and sugar profile, which was attempted in the present study.&#x0D; Materials and Methods: In this cross sectional case study, 50 survivors of childhood cancer aged between 5 – 18 years were recruited. Positive history of obesity, diabetes mellitus, dyslipidemia, and stroke in family were recorded and their anthropometry was noted with calculation of their Body Mass Index (BMI). Fasting lipid profile, blood sugar, and serum insulin levels were tested; the Homeostatic model assessment of Insulin Resistance (HOMA IR) value and the Fasting Glucose to Insulin Ratio(FGIR) were derived as markers of insulin sensitivity. The data were analyzed using SPSS (version 17.0).&#x0D; Results: In these fifty children, the risk factors studied for dyslipidemia and insulin resistance due to chemotherapy were: age at diagnosis, sex, radiation exposure, steroid, and L-asparaginase use during the treatment for cancer. Among the fifty survivors, 7 were found obese, 32 normal, and 11 underweight as per the age specific BMI charts. Their metabolic parameters showed that 12 had raised cholesterol levels, 8 had raised triglyceride levels, and 4 had lowered HDL-C levels. Nine survivors also had raised HOMA-IR levels. However, these metabolic derangements were not found to be statistically significant (p value&gt;0.05) and no correlation was found between the risk factors and obesity, dyslipidemia, or insulin resistance.&#x0D; Conclusion: As against the prior evidence, there was no risk of developing obesity, dyslipidemia, and insulin resistance in survivors of childhood cancers.&#x0D; Keywords: Dyslipidemias, Insulin Resistance, Obesity, Survivors of childhood cancer

Insulin resistance indexes in women with premature ovarian insufficiency - a pilot study.

Premature ovarian insufficiency (POI) is associated with hypoestrogenism and an increased risk of metabolic disorders. In many clinics, a variety of insulin resistance (IR) tests are used during routine clinical assessments. To date, there is no clear opinion about which of these tests should be applied in women with premature ovarian insufficiency (POI). Therefore, our preliminarily aim was to compare the most frequently used insulin resistance indexes in the clinical assessment of a group of POI women and a control group. Our retrospective study included 98 women with karyotypically normal spontaneous POI aged 18-39 years and a control group of 78 healthy women. Each patient was given an oral glucose tolerance test (OGTT) to evaluate their insulin release and insulin resistance. In addition, each woman's insulin resistance (IR) was evaluated us-ing the homeostasis model assessment for insulin resistance (HOMA-IR), the quantitative insulin sensitivity check index (QUICKI), the fasting glucose-to-insulin ratio (FGIR), and Matsuda and McAuley indexes. The two groups' glucose levels were compared at 0, 60 and 120 min of the OGTT. At 0 and 60 min of the OGTT, the insulin levels of the POI women were significantly higher than those of the control group. The number of women in whom IR was detected using the various kits was comparable between the two groups. In conclusion, only the OGTT evaluation revealed a significant difference in insulin concentrations between the two study groups. The indexes most commonly used to detect IR did not detect differences in IR between the POI women and the members of the healthy control group. QUICKI detected significantly more women with IR within both study groups than other tests did.

Evaluation of vitamin D status and its correlation with oxidative stress markers in women with polycystic ovary syndrome

There is little evidence about antioxidant properties of vitamin D. Recent studies suggest that oxidative stress may play a major role in the pathophysiology of polycystic ovary syndrome (PCOS), but the association of vitamin D with oxidative stress is still not known in PCOS. The goal of the present study was to evaluate the correlation between serum 25-hydroxy vitamin D and oxidative stress markers in PCOS group compared to control group. 60 PCOS women (20-40 yr old) and 90 healthy women as control group were participated in this case-control study. Fasting serum level of 25(OH) D, glucose, insulin, calcium, malondialdehyde (MDA), protein carbonyl (PC), also homeostasis model assessment for insulin resistance (HOMA-IR) and fasting glucose to insulin ratio (FGIR) were measured. It was found that the mean of serum 25(OH)D was lower in the PCOS group (10.76±4.17) than in the control group (12.07±6.26) but this difference was not statistically significant (p=0.125). Fasting insulin, HOMA-IR and MDA were significantly higher in the PCOS patients as compared to the controls, whereas PC level did not differ for the two groups (p=0.156). No significant correlations were found between 25(OH)D levels and oxidative stress markers (MDA and PC). The findings indicated no significant differences in the serum 25(OH)D levels between the PCOS patients and the matched controls. Also, no correlation was found between the serum vitamin D levels and oxidative stress markers in both groups.

Prediction of insulin resistance in type 2 diabetes mellitus using routinely available clinical parameters

AimsTo determine if insulin resistance (IR), an important predictor of cardiovascular risk in the general population and in type 2 diabetes mellitus, can be assessed using simple parameters which are readily available in clinical practice. MethodsThis cross-sectional study included 194 patients with type 2 diabetes. Body mass index, waist index (WI), triglyceride levels, 1/HDL, triglyceride/HDL, uric acid and urine albumin:creatinine ratio were investigated as possible predictors of IR. ResultsWI correlated more strongly than any other parameter with log insulin levels, log fasting glucose to insulin ratio (FGIR), log fasting glucose to insulin product (FGIP), homeostatic model assessment (HOMA-IR) and quantitative insulin check index (QUICKI). WI also emerged as the strongest independent predictor of IR indices studied in regression as well as in ROC analyses. At a cut-off of 1.115, WI had a 78% sensitivity and 65% specificity for predicting IR when HOMA-IR was used as indicator of IR, and 74% sensitivity and specificity when QUICKI was used as indicator of IR. Combining WI with other variables did not improve performance significantly. ConclusionsIn our cohort of patients with type 2 diabetes, WI was the parameter with the strongest association with, and the best predictor of, IR.

HMGB1 Is Increased by CFTR Loss of Function, Is Lowered by Insulin, and Increases In Vivo at Onset of CFRD.

Cystic fibrosis-related diabetes (CFRD) is associated with worsening of inflammation and infections, and the beginning of insulin treatment is debated. To verify high-mobility group box 1 protein (HMGB1) levels in CF patients according to glucose tolerance state, and analyze relationships with insulin secretion and resistance. To verify, in an in vitro model, whether HMGB1 gene expression and protein content were affected by insulin administration and whether these changes were dependent on CF transmembrane conductance regulator (CFTR) loss of function. Forty-three patients in stable clinical conditions and 35 age- and sex-matched controls were enrolled. Glucose tolerance was established in patients based on a 5 point oral glucose tolerance test (OGTT). Fasting glucose to insulin ratio (FGIR), HOMA-IR index, whole-body insulin sensitivity index (WIBISI), and the areas under the curve for glucose (AUCG) and insulin (AUCI) were calculated. HMGB1 was assayed in serum, in cell lysates and conditioned media using a specific ELISA kit. For the in vitro study we used CFBE41o- cells, homozygous for the F508del mutation, and 16HBE14o- as non-CF control. HMGB1 gene expression was studied by real-time RT-PCR. Cells were stimulated with insulin at 2.5 and 5 ng/mL. The CFTR inhibitor 172 and CFTR gene silencing were used to induce CFTR loss of function in 16HBE14o- cells. HMGB1 levels were increased at onset of CFRD (5.04 ± 1.2 vs 2.7 ± 0.3 ng/mL in controls; P < .05) and correlated with FGIR (R = +0.43; P = .038), and AUCI (R = +0.43; P = .013). CFTR loss of function in the 16HBE14o- cells increased HMGB1 and was lowered by insulin. HMGB1 was increased in CF patients with deranging glucose metabolism and showed relationships with indexes of glucose metabolism. The increase in HMGB1 was related to CFTR loss of function, and insulin lowered HMGB1. Further research is required to verify whether HMGB1 could potentially be a candidate marker of onset of CFRD and to establish when to start insulin treatment.

English

Background: Paediatric obesity is associated with insulin resistance (IR), which increases risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Hyperinsulinaemic-euglycaemic clamp and minimal-model analysis frequently sampled intravenous glucose tolerance test (FSIVGTT) are used to assess IR, which are invasive, complex and expensive. Objective: To assess IR using the derived indices namely, homeostasis model assessment of insulin resistance (HOMAIR), fasting glucose-to-insulin ratio (FGIR), quantitative insulin-sensitivity check index (QUICKI), in obese children. Methods: Fifty obese children (cases) and 50 apparently healthy age-and gendermatched nonobese children (controls) were studied. Obese children with body mass index (BMI; Kg/m2) greater than 95th percentile and nonobese children with BMI between 5th to 95th percentile were included in the study. Results: Obese children had higher fasting insulin levels, HOMA-IR (p<0.001), FGIR (p<0.001) and QUICKI (p<0.001) when compared to controls; fasting blood glucose levels were comparable (p=0.170). A statistically significant correlation was observed between serum insulin and BMI, between insulin and all the derived indices and between the derived indices and BMI (p<0.001). HOMA-IR had more area under the curve (0.760) followed by FGIR (0.721) when compared to QUICKI (0.240). Conclusions: Obese children were normoglycaemic with IR. HOMA-IR was found to be a stronger predictor of IR when compared to FGIR and QUICKI in obese children.

Normal pregnancy- a state of insulin resistance.

Purpose of insulin resistance (IR) adapted by mother is to deliver enough quantity of nutrients to the growing fetus. Many maternal hormones and factors play role in causation of IR during pregnancy. The study aims at evaluating IR at different trimesters of pregnancy. Pregnant women at 1(st), 2(nd) and 3(rd) trimester were grouped into groups I, II and III respectively (n=20 in each group). Healthy non-pregnant women were taken as controls (n=30). Fasting plasma glucose (FPG) and fasting serum insulin (FSI) were measured and IR indices such as fasting glucose to insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), log FSI and log HOMA1-IR were calculated. The student's t-test and one way Analysis of variance (ANOVA) were used for data analysis. The mean FSI, log FSI and log HOMA 1-IR were significantly higher in 2(nd) and 3(rd) trimesters while QUICKI was significantly lower in 2(nd) and 3(rd) trimesters of pregnancy when compared with controls. Also, mean FGIR was found to be significantly lower in 3rd trimester when compared with controls. As pregnancy advances, IR increases. Increased IR is associated with poor maternal and fetal outcome. Screening of all pregnancy for IR and early intervention may help to reduce the associated complications.

Neck circumference: a useful screening tool of cardiovascular risk in children

Early identification of cardiovascular risk factors consists an essential target for public health. The current study aims to examine the association between neck circumference and several cardiovascular risk factors and to compare it with well-established anthropometric indices. Demographic, anthropometric (body weight and height, waist, hip and neck circumference [WC, HC and NC, respectively]), biochemical (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, triglycerides [TG], fasting plasma glucose and serum insulin), clinical (pubertal stage, systolic and diastolic blood pressure [SBP and DBP, respectively]) and lifestyle (dietary intake, physical activity level) data were collected from 324 children (51.5% boys; 48.5% girls) aged 9-13 in Greece. Body mass index z-score (BMI z-score), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose to insulin ratio (FGIR) were calculated. All indices (BMI z-score, NC, WC, HC, WHR and WHtR) were correlated with SBP, HDL and insulin-related indices (insulin, HOMA-IR, QUICKI and FGIR) and all indices except WHR with TG. LDL was correlated with BMI z-score, WC, WHR and WHtR, whereas DBP was correlated with BMI z-score, WC, HC and WHtR. In multivariate analysis, HDL, TG, SBP, insulin, HOMA-IR, QUICKI and FGIR were associated with all anthropometric indices; DBP with WC, HC, NC and WHtR; LDL with BMI z-score, WC, HC and WHtR. NC is associated with most cardiovascular disease risk factors. These associations are comparable with those observed for BMI z-score, WC, HC, WHR and WHtR. NC could be a simple, alternative screening tool of cardiovascular risk in children.

The Relationship Between Metabolic Syndrome and Left Ventricular Mass Index in Obese Children-

Objective: To investigate the relationships between metabolic syndrome (MS), other metabolic features and left ventricular mass index (LVMI) in a population of obese children and adolescents with MS. Methods: Two hundred and eight obese children and adolescents (119 females and 89 males, mean age: 11.9±2.7 years) and control subjects (24 females and 26 males, mean age: 11.4±2.9 years) were enrolled in the study. The insulin sensitivity index and LVMI were determined. The International Diabetes Federation criteria were used to diagnose MS.Results: The obese patients were divided into MS group (n=55) and non-MS (n=153) group. The values of LVMI in the MS group were significantly higher than those in the non-MS group (p=0.014). The present LVMI cut-off point of 33g/m2 for the diagnosis of MS yielded a sensitivity of 97% and a specificity of 98%. LVMI was found to be positively correlated in univariate analysis with height, weight, body mass index (BMI) SDS, fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR) and fasting glucose to insulin ratio (FGIR) and negatively correlated with quantitative insulin sensitivity check index (QUICK-I). Conclusions: We suggest that our optimal LVMI cut-off value for identifying MS may be considered as a sensitive index in screening obese children and adolescents for pediatric MS. Assessment of LVMI in obese children and adolescents may be used as a tool in predicting the presence of MS and its associated cardiovascular risks. Conflict of interest:None declared.

Apelin, vaspin, visfatin and adiponectin in large for gestational age infants with insulin resistance

ObjectiveTo investigate the relation of circulating four adipokines (apelin, vaspin, visfatin, adiponectin) with markers of insulin sensitivity in large for gestational age (LGA) infants. Patients and methodsForty LGA infants (20 LGA born from diabetic mothers and 20 LGA born from non-diabetic mothers) and 34 appropriate for gestational age (AGA) infants were recruited. Hyperinsulinism and insulin resistance was evaluated using the homeostasis model assessment (HOMA-IR), fasting glucose-to-insulin ratio (FGIR), quantitative insulin-sensitivity check index (QUICK-I) from fasting samples. Plasma adiponectin and vaspin levels were determined by radioimmunoassay. Determination of visfatin and apelin levels was performed by enzyme immunoassay. ResultsHOMA-IR, apelin and visfatin levels (p<0.001, p<0.001, p<0.001, respectively) were significantly elevated and adiponectin levels, FGIR and QUICK-I values. (p<0.001, p<0.001, p<0.05, respectively) were significantly lower in the LGA group. Vaspin levels were higher in the LGA group than AGA neonates without a significance. The LGA infants with diabetic mother had significantly higher visfatin, apelin, HOMA-IR values, fasting insulin levels and significantly lower adiponectin, FGIR, QUICK-I values. Apelin and visfatin were correlated positively, and adiponectin was correlated negatively with birthweight, HOMA-IR values and fasting insulin levels. ConclusionBased on the findings of this study, it is too difficult to explain relation between birthweight and these adipocytokines, but findings of high insulin, HOMA-IR, visfatin, apelin and low adiponectin levels in the LGA neonates showed that these adipocytokines can be used as a good predictor for metabolic syndrome.

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance

The aim of this study was to evaluate ischemia-modified albumin levels (IMA) in polycystic ovary syndrome (PCOS) cases with and without insulin resistance and the correlation of IMA with carotid intima media thickness, homocysteine, and high-sensitivity C-reactive protein levels. Significantly higher levels of IMA in young lean PCOS cases, more relevant in insulin resistant cases, indicates chronic hypoxia and oxidative stress which might play a role in the metabolic consequences in PCOS.

Tools for early detection of risk for developing insulin resistance

Insulin resistance (IR) is becoming of increasing concern in pediatric populations, and HIV positive pediatric patients may be at an increased risk for developing IR. We developed novel, multifactorial tools, the GlucIndex (GI), LipidIndex (LI), and Cumulative Indices Assessment (CIA), which incorporate the fasting glucose to insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), computer version of the homeostasis model assessment (HOMA2‐IR), insulin sensitivity index (ISI), and triglyceride to high‐density lipoprotein ratio (TG/HDL). High risk and low risk for developing IR according to each index is indicated by a + or −, respectively. These novel tools were used to assess 46 HIV positive pediatric patients’ risk for developing IR at Shands Hospital in Gainesville, FL. The table indicates risk based on each index. Notably, no patient had impaired fasting glucose values during the study. These tools may be beneficial for detecting risk for developing IR before glucose values become impaired. Index Percent of Patients GI−,LI− (no detectable risk) 61% GI+,LI− (risk for glucose intolerance) 17% GI−,LI+ (risk for dyslipidemia) 13% GI+,LI+ (risk for glucose intolerance and dyslipidemia) 9%

Vaspin and its correlation with insulin sensitivity indices in obese children

Aim The aim of this study was to assess the vaspin and adiponectin concentrations on markers of insulin sensitivity and obesity in pubertal obese children and adolescents. Material and methods Plasma vaspin and adiponectin level and its relationships with body mass index standard deviation score (BMI-SDS), insulin sensitivity and lipids were analyzed in 33 pubertal obese children (19 girls and 14 boys) and 36 healthy control children (18 girls and 18 boys) aged 11–16 years. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) and fasting glucose-to-insulin ratio (FGIR). Plasma vaspin and adiponectin concentrations were determined with radioimmunoassay. Results Mean vaspin levels were found significantly higher and inversely, adiponectin levels were found significantly lower in obese pubertal group than control subjects. Vaspin levels were positively correlated with BMI-SDS, triglycerides, fasting insulin and HOMA-IR and negatively correlated with adiponectin levels and FGIR. Adiponectin levels were positively correlated with high density lipoprotein-chloesterol, FGIR and negatively correlated with vaspin, BMI-SDS, fasting insulin and HOMA-IR. Conclusion We found higher vaspin and lower adiponectin levels in obese children and these adipokines were significantly correlated with insulin sensitivity indices in this age.