Body mass index percentile more sensitive than acanthosis nigricans for screening Native American children for diabetes risk.
BACKGROUND
Many Native American tribes use acanthosis nigricans to screen for type 2 diabetes risk. We hypothesized that acanthosis nigricans misses many children at risk for type 2 diabetes.


METHODS
We evaluated 5- to 18-year-old Native American children and youth to assess the sensitivity and specificity of acanthosis nigricans as a marker for insulin resistance.


RESULTS
In a cohort of 161 youth (72 males/89 females), mean age was 10.7 years + 3.9. Mean body mass index (BMI) percentile was 76.8 +/- 23.3, and 54% had a BMI at or above the 85th percentile. Acanthosis nigricans was present in 21.7% of the participants and was more common in 12-to 18-year-olds than in 5 to 11-year-olds (p = .02). Of those with acanthosis nigricans, 82.4% had insulin resistance (homeostatic model assessment of insulin resistance >4), but only 48.3% of those with insulin resistance had acanthosis nigricans. In contrast, BMI at or above the 85th percentile had a high sensitivity (74%) for insulin resistance, even though its specificity was lower (58%).


CONCLUSIONS
The presence of acanthosis nigricans alone was a specific, but not a sensitive, screening tool for identifying youth with insulin resistance. BMI at or above the 85th percentile was a more sensitive screening tool than acanthosis nigricans alone, or acanthosis nigricans and BMI together for identifying children and youth with IR who are at increased risk for type 2 diabetes.
Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-4085, USA. pnkumi@unmc.edu
Phyllis A
PA
Nsiah-Kumi
Jennifer
J
Beals
Sylvia
S
Lasley
Mary
M
Whiting
Connie
C
Brushbreaker
Judi
J
Erickson
Fang
F
Qiu
Fang
F
Yu
Gay
G
Canaris
Jennifer L
JL
Larsen
D000052:Acanthosis Nigricans / Q000208:ethnology* / Q000209:etiology; D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D048909:Diabetes Complications / Q000208:ethnology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000208:ethnology*; D005260:Female; D006801:Humans; D007198:Indians, North American; D007333:Insulin Resistance / Q000208:ethnology*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009329:Nebraska; D013023:South Dakota