Ann Pediatr Endocrinol Metab.  2016 Sep;21(3):143-148. 10.6065/apem.2016.21.3.143.

The cutoff values of indirect indices for measuring insulin resistance for metabolic syndrome in Korean children and adolescents

• Kim JW
• Park SH
• Kim Y
• Im M
• Han HS

• KMID: 2366789
• DOI: http://doi.org/10.6065/apem.2016.21.3.143

Abstract

PURPOSE
The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups.
METHODS
Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10-18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007-2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves.
RESULTS
According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th-75th, 75th, and 75th-90th percentiles of normal HOMA-IR and TyG index levels.
CONCLUSION
This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.

Keyword

Metabolic syndrome; Insulin resistance; Adolescent; Korea

MeSH Terms

Adolescent*
Child*
Female
Glucose
Homeostasis
Humans
Insulin Resistance*
Insulin*
Korea
Male
Nutrition Surveys
Prevalence
Triglycerides
Glucose
Insulin

Figure

• 

  Fig. 1 Age distribution of the participants by weighted sampling.

• 

  Fig. 2 Receiver operation characteristic curves for metabolic syndrome. (A) Using the criteria of Cook et al.25), (B) using the criteria of de Ferranti et al.26), and (C) using the criteria of International Diabetes Federation27). TyG, triglyceride glucose; HOMA-IR, homeostasis model assessment of insulin resistance; AUC, area under the curve.

Reference

1. Pollare T, Lithell H, Berne C. Insulin resistance is a characteristic feature of primary hypertension independent of obesity. Metabolism. 1990; 39:167–174. PMID: 2405235.

2. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005; 112:3066–3072. PMID: 16275870.

3. Perry IJ, Wannamethee SG, Whincup PH, Shaper AG, Walker MK, Alberti KG. Serum insulin and incident coronary heart disease in middle-aged British men. Am J Epidemiol. 1996; 144:224–234. PMID: 8686691.

4. Després JP, Lamarche B, Mauriège P, Cantin B, Dagenais GR, Moorjani S, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996; 334:952–957. PMID: 8596596.

5. Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM, Sullivan LM, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006; 91:2906–2912. PMID: 16735483.

6. Lakka HM, Lakka TA, Tuomilehto J, Sivenius J, Salonen JT. Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Arch Intern Med. 2000; 160:1160–1168. PMID: 10789610.

7. Feskens EJ, Kromhout D. Hyperinsulinemia, risk factors, and coronary heart disease. The Zutphen Elderly Study. Arterioscler Thromb. 1994; 14:1641–1647. PMID: 7918315.

8. Goodarzi MO, Erickson S, Port SC, Jennrich RI, Korenman SG. Relative impact of insulin resistance and obesity on cardiovascular risk factors in polycystic ovary syndrome. Metabolism. 2003; 52:713–719. PMID: 12800096.

9. Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. Hyperinsulinemic microalbuminuria. A new risk indicator for coronary heart disease. Circulation. 1995; 91:831–837. PMID: 7828312.

10. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002; 287:356–359. PMID: 11790215.

11. Chu MA, Choe BH. Obesity and metabolic syndrome among children and adolescents in Korea. J Korean Med Assoc. 2010; 53:142–152.

12. Lim H, Xue H, Wang Y. Association between obesity and metabolic co-morbidities among children and adolescents in South Korea based on national data. BMC Public Health. 2014; 14:279. PMID: 24666605.

13. Morrison JA, Friedman LA, Wang P, Glueck CJ. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr. 2008; 152:201–206. PMID: 18206689.

14. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007; 369:2059–2061. PMID: 17586288.

15. Martin BC, Warram JH, Krolewski AS, Bergman RN, Soeldner JS, Kahn CR. Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet. 1992; 340:925–929. PMID: 1357346.

16. Bergman RN, Phillips LS, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest. 1981; 68:1456–1467. PMID: 7033284.

17. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–419. PMID: 3899825.

18. Pan DA, Lillioja S, Kriketos AD, Milner MR, Baur LA, Bogardus C, et al. Skeletal muscle triglyceride levels are inversely related to insulin action. Diabetes. 1997; 46:983–988. PMID: 9166669.

19. Kelley DE, Goodpaster BH. Skeletal muscle triglyceride: an aspect of regional adiposity and insulin resistance. Diabetes Care. 2001; 24:933–941. PMID: 11347757.

20. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014; 13:146. PMID: 25326814.

21. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL. Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr. 2014; 61:533–540. PMID: 25174769.

22. Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract. 2011; 93:e98–e100. PMID: 21665314.

23. Ministry of Health & Welfare, Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey (KNHANES IV). Cheongju: Ministry of Health & Welfare;Korea Centers for Disease Control and Prevention;2009.

24. Ministry of Health & Welfare. Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey (KNHANES V). Cheongju: Ministry of Health & Welfare;Korea Centers for Disease Control and Prevention;2010.

25. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003; 157:821–827. PMID: 12912790.

26. de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004; 110:2494–2497. PMID: 15477412.

27. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007; 369:2059–2061. PMID: 17586288.

28. Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord. 2013; 11:71–80. PMID: 23249214.

29. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008; 6:299–304. PMID: 19067533.

30. Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C, et al. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index. Int J Clin Pract. 2013; 67:665–672. PMID: 23758445.

31. Moran A, Jacobs DR Jr, Steinberger J, Hong CP, Prineas R, Luepker R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999; 48:2039–2044. PMID: 10512371.

32. Pilia S, Casini MR, Foschini ML, Minerba L, Musiu MC, Marras V, et al. The effect of puberty on insulin resistance in obese children. J Endocrinol Invest. 2009; 32:401–405. PMID: 19794287.