title: Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice.
abstract: We formally evaluated waist circumference (WC) percentile cutoffs for predicting insulin resistance (IR) and whether different cutoffs should be used for adolescents of different race/ethnicities. Analysis was performed for 1575 adolescents aged 12-18 yr from the National Health and Nutrition Examination Survey 1999-2002. Adolescents were classified as having IR if they had a homeostasis model assessment-insulin resistance level, a validated measure of IR, of >4.39, and WC percentile was classified according to previously published universal (all races combined) and race/ethnicity-specific WC percentile cutoffs. Receiver operating characteristic curves for predicting IR were constructed comparing the race/ethnicity-specific vs. universal WC percentile cutoffs, and area under the curve (AUC) was calculated. Comparing universal with race/ethnicity-specific WC percentiles, there were no significant differences in AUC for Black, Mexican-American, or White adolescents. Because race/ethnicity-specific thresholds did not discriminate better than universal WC thresholds, universal WC thresholds may be used effectively to identify adolescents with IR in primary care practices. A WC > or =75th or > or =90th percentile for all race/ethnicities combined would be appropriate to apply in clinical practice for identification of adolescents with IR, a risk factor for development of type 2 diabetes.
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI 48109-5456, USA. joyclee@umich.edu
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Lee
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Woolford
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000208:ethnology; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data; D009749:Nutrition Surveys; D011237:Predictive Value of Tests; D012372:ROC Curve; D012015:Reference Standards; D012307:Risk Factors; D055105:Waist Circumference / Q000208:ethnology / Q000502:physiology*; D044465:White People / Q000706:statistics & numerical data