title: Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children.
abstract: BACKGROUND
  It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management.
  
  
  METHODS
  Baseline data from 7- to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) <2.6 was used to define insulin-sensitive and HOMA-IR ≥2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated.
  
  
  RESULTS
  Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6±1.6 vs. 9.9±1.7; p<0.001) and had a higher BMI z-score (1.89±0.42 vs. 2.04±0.42; p=0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p=0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p=0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p=0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p=0.403).
  
  
  CONCLUSIONS
  Using a HOMA-IR value of ≥2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health.
authors.affiliation: 1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.|2Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Unab I
authors.initials: UI
authors.lastname: Khan
authors.affiliation: 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Aileen P
authors.initials: AP
authors.lastname: McGinn
authors.affiliation: 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Carmen R
authors.initials: CR
authors.lastname: Isasi
authors.affiliation: 4Department of Pediatrics, Jacobi Hospital, Bronx, NY.
authors.forename: Adriana
authors.initials: A
authors.lastname: Groisman-Perelstein
authors.affiliation: 4Department of Pediatrics, Jacobi Hospital, Bronx, NY.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Diamantis
authors.affiliation: 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Mindy
authors.initials: M
authors.lastname: Ginsberg
authors.affiliation: 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Judith
authors.initials: J
authors.lastname: Wylie-Rosett
mesh_terms: D001786:Blood Glucose; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D002648:Child; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D009518:New York / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D010641:Phenotype; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D061217:Weight Reduction Programs / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose