European Journal of Pediatrics

, Volume 171, Issue 9, pp 1331–1337

The absence of insulin resistance in metabolic syndrome definition leads to underdiagnosing of metabolic risk in obese patients

  • Selim Kurtoglu
  • Leyla Akin
  • Mustafa Kendirci
  • Nihal Hatipoglu
  • Ferhan Elmali
  • Mümtaz Mazicioglu
Original Article

DOI: 10.1007/s00431-012-1724-6

Cite this article as:
Kurtoglu, S., Akin, L., Kendirci, M. et al. Eur J Pediatr (2012) 171: 1331. doi:10.1007/s00431-012-1724-6


This study explores in a group of obese children and adolescents aged 10 to16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.


Metabolic syndromeInsulin resistanceIDF definitionChildrenAdolescent



Metabolic syndrome


International Diabetes Federation


Insulin resistance


Oral glucose tolerance test


Homeostasis model assessment of insulin resistance


Quantitative insulin sensitivity check index


Fasting glucose/insulin ratio


Waist circumference


Insulin sensitivity index


High-density lipoprotein cholesterol


Post-load glucose


Impaired glucose tolerance


Impaired fasting glucose

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Selim Kurtoglu
    • 1
  • Leyla Akin
    • 1
  • Mustafa Kendirci
    • 1
  • Nihal Hatipoglu
    • 1
  • Ferhan Elmali
    • 2
  • Mümtaz Mazicioglu
    • 3
  1. 1.Department of Pediatric Endocrinology, Faculty of MedicineErciyes UniversityKayseriTurkey
  2. 2.Department of Biostatistics, Faculty of MedicineErciyes UniversityKayseriTurkey
  3. 3.Department of Family Medicine, Faculty of MedicineErciyes UniversityKayseriTurkey