Percentiles of fasting serum insulin, glucose, HbA1c and HOMA-IR in pre-pubertal normal weight European children from the IDEFICS cohort.
OBJECTIVE
The aim of this study is to present age- and sex-specific reference values of insulin, glucose, glycosylated haemoglobin (HbA1c) and the homeostasis model assessment to quantify insulin resistance (HOMA-IR) for pre-pubertal children.


METHODS
The reference population consists of 7074 normal weight 3- to 10.9-year-old pre-pubertal children from eight European countries who participated in at least one wave of the IDEFICS ('identification and prevention of dietary- and lifestyle-induced health effects in children and infants') surveys (2007-2010) and for whom standardised laboratory measurements were obtained. Percentile curves of insulin (measured by an electrochemiluminescence immunoassay), glucose, HbA1c and HOMA-IR were calculated as a function of age stratified by sex using the general additive model for location scale and shape (GAMLSS) method.


RESULTS
Levels of insulin, fasting glucose and HOMA-IR continuously show an increasing trend with age, whereas HbA1c shows an upward trend only beyond the age of 8 years. Insulin and HOMA-IR values are higher in girls of all age groups, whereas glucose values are slightly higher in boys. Median serum levels of insulin range from 17.4 and 13.2 pmol l(-1) in 3-<3.5-year-old girls and boys, respectively, to 53.5 and 43.0 pmol l(-1) in 10.5-<11-year-old girls and boys. Median values of glucose are 4.3 and 4.5 mmol l(-1) in the youngest age group and 49.3 and 50.6 mmol l(-1) in the oldest girls and boys. For HOMA-IR, median values range from 0.5 and 0.4 in 3-<3.5-year-old girls and boys to 1.7 and 1.4 in 10.5-<11-year-old girls and boys, respectively.


CONCLUSIONS
Our study provides the first standardised reference values for an international European children's population and provides the, up to now, largest data set of healthy pre-pubertal children to model reference percentiles for markers of insulin resistance. Our cohort shows higher values of Hb1Ac as compared with a single Swedish study while our percentiles for the other glucose metabolic markers are in good accordance with previous studies.
Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
J
J
Peplies
GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
D
D
Jiménez-Pavón
Research & Education Institute of Child Health, Strovolos, Cyprus.
S C
SC
Savva
Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
C
C
Buck
Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
K
K
Günther
Medizinisches Versorgungszentrum (MVZ), Dr Eberhard und Partner Dortmund, Dortmund, Germany.
A
A
Fraterman
Epidemiology and Population Genetics, Institute of Food Science, CNR, Avellino, Italy.
P
P
Russo
Centre for High Technology Research and Education in Biomedical Sciences, Universita Cattolica del Sacro Cuore, Campobasso, Italy.
L
L
Iacoviello
National Institute for Health Development (NIHD), Tallinn, Estonia.
T
T
Veidebaum
Research & Education Institute of Child Health, Strovolos, Cyprus.
M
M
Tornaritis
Department of Public Health, Ghent University, Ghent, Belgium.
S
S
De Henauw
Department of Paedriatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
S
S
Mårild
Chronic Diseases Department, National Institute of Health Promotion, University of Pécs, Pécs, Hungary.
D
D
Molnár
GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
L A
LA
Moreno
1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany.
W
W
Ahrens
D017677:Age Distribution; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D005060:Europe / Q000453:epidemiology; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006306:Health Surveys; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D008019:Life Style; D008297:Male; D012016:Reference Values; D017678:Sex Distribution; D012741:Sexual Maturation / Q000502:physiology; D044465:White People
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human