Hypertriglyceridemic Waist Phenotype Indicates Insulin Resistance in Adolescents According to the Clamp Technique in the BRAMS Study.
This study aimed to identify cutoff points for detecting hypertriglyceridemic waist phenotype (HTWP) in adolescents and to investigate the association of the HTWP with insulin resistance (IR) and metabolic syndrome components.



A multicentric cross-sectional study of 861 adolescents (10-19 years of age, 504 girls) was conducted. Pubertal stage, anthropometric, and laboratory parameters were assessed. IR was assessed by Homeostasis Model Assessment for Insulin Resistance (HOMA1-IR) index and hyperglycemic clamp (n = 80). HTWP was defined by the presence of increased plasma triglycerides (TGs) and increased waist circumference (WC) according to cutoff points obtained in ROC curve analysis given the HOMA1-IR index as a reference method.



Cutoffs for WC and TGs, with a higher sum of sensitivity (S) and specificity (E), were, respectively: >84 cm (S:65.1%, E:71.9%) and >87 mg/dL (S:65.1%, E:73.4%) in pubertal girls; >88.5 cm (S:80.2%, E:60.2%) and >78 mg/dL (S:60.5%, E:53.2%) in postpubertal girls; >94 cm (S:73.1%, E:83.1%) and >79 mg/dL (S:61.5%, E:60.2%) in pubertal boys; and >99 cm (S:81.3%, E:78.7%) and >86 mg/dL in postpubertal boys (S:68.1%, E:60.7%). HTWP frequency was 27.5%. In the phenotype presence, after adjustment for age and pubertal stage, blood pressure and fasting glucose levels were elevated and high-density lipoprotein cholesterol was lower (p < 0.001). Adolescents with the HTWP showed more IR, evaluated both by the HOMA1-IR and by the clamp test (p < 0.003).



The findings suggest HTWP as an IR status in adolescents. Cutoff point standardization for gender and pubertal stage, combined with the ease of application of the method, may allow their use for screening adolescents who would most benefit from lifestyle changes.
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|2 Post-Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .
Francieli
F
Barreiro-Ribeiro
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|2 Post-Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|3 School of Applied Sciences, University of Campinas (UNICAMP) , Limeira, Sao Paulo, Brazil .
Ana Carolina Junqueira
AC
Vasques
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|2 Post-Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .
Cleliani de Cassia
CC
da Silva
4 Department of Pediatrics, University of Campinas (UNICAMP) , Sao Paulo, Brazil .
Mariana Porto
MP
Zambon
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .
Ana Maria De Bernardi
AM
Rodrigues
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|2 Post-Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .
Daniella Fernandes
DF
Camilo
4 Department of Pediatrics, University of Campinas (UNICAMP) , Sao Paulo, Brazil .
Maria Ângela Reis de Góes Monteiro
MÂ
Antonio
5 Post-Graduate Program in Nutrition, Federal University of Sao Paulo (UNIFESP) , Sao Paulo, Brazil .
Ana Raimunda
AR
Dâmaso
6 Department of Physiotherapy, Therapeutic Resources Laboratory, Federal University of Sao Carlos (UFSCar) , Sao Carlos, SP, Brazil .
Raquel Munhoz da Silveira
RM
Campos
7 Department of Psychobiology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo, Brazil .
Sergio
S
Tufik
7 Department of Psychobiology, Federal University of Sao Paulo (UNIFESP) , Sao Paulo, Brazil .
Marco Túlio
MT
de Mello
1 LIMED-Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .|2 Post-Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, Sao Paulo, Brazil .
Bruno
B
Geloneze
D000293:Adolescent; D001794:Blood Pressure; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D064250:Hypertriglyceridemic Waist / Q000097:blood / Q000453:epidemiology; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D063766:Pediatric Obesity / Q000097:blood / Q000453:epidemiology; D010641:Phenotype; D011627:Puberty / Q000502:physiology; D012307:Risk Factors