title: A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents.
abstract: OBJECTIVE
  Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS.
  
  
  METHODS
  A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model.
  
  
  RESULTS
  Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p p<0.0001) and WC (4.8, p p<0.0001), compared to WHR (3.3, p p<0.0001).
  
  
  CONCLUSIONS
  In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria.
authors.affiliation: International Life Sciences, Scientific Advisor (Projects), New Delhi, India. E-mail: marwaha_ramank@hotmail.com.
authors.forename: Yashpal
authors.initials: Y
authors.lastname: Singh
authors.forename: M K
authors.initials: MK
authors.lastname: Garg
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.forename: Raman Kumar
authors.initials: RK
authors.lastname: Marwaha
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007194:India; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D009765:Obesity / Q000097:blood / Q000503:physiopathology; D050177:Overweight / Q000097:blood / Q000503:physiopathology; D012372:ROC Curve; D012016:Reference Values; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood; D014504:Urban Health / Q000706:statistics & numerical data*; D055105:Waist Circumference / Q000502:physiology; D049629:Waist-Hip Ratio
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008075:Lipoproteins, HDL; D014280:Triglycerides; D002784:Cholesterol