European Journal of Pediatrics

, Volume 178, Issue 12, pp 1813–1822 | Cite as

Homeostasis Model Assessment cut-off points related to metabolic syndrome in children and adolescents: a systematic review and meta-analysis

  • Paola Arellano-Ruiz
  • Antonio García-HermosoEmail author
  • Iván Cavero-Redondo
  • Diana Pozuelo-Carrascosa
  • Vicente Martínez-Vizcaíno
  • Monserrat Solera-Martinez


The aim of this study was to perform a systematic review and meta-analysis of cut-off points of Homeostasis Model Assessment (HOMA-IR) to determine metabolic syndrome (MetS) in children and adolescents. A literature search was conducted in MEDLINE (via PubMed), EMBASE, Web of Science, Proquest, and Scopus databases from their inception to June 2018. Random effects models for the diagnostic odds ratio (dOR) value computed by Moses’ constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the overall test performance. Six published studies were included in the meta-analysis that included 8732 children and adolescents. The region of HOMA-IR (i.e., dOR) associated with MetS range from 2.30 to 3.54. The pooled accuracy parameters from the studies that evaluated the diagnostic odds ratio of HOMA-IR ranged from 4.39 to 37.67.

Conclusion: the HOMA-IR test may be useful for early evaluating children and adolescents with insulin resistance (IR). Furthermore, they present a good diagnostic accuracy independently of the definition of MetS used. According to the studies, the HOMA-IR cut point to avoid MetS risk ranged from 2.30 to 3.59.

What is Known:

There is no consensus to define the optimal cut-off point of Homeostasis Model Assessment–Insulin Resistance in children and adolescents associated with Metabolic Syndrome.

What is New:

• The Homeostasis Model Assessment–Insulin Resistance test may be useful for early evaluations in children and adolescents with insulin resistance and presents a good diagnostic accuracy independently of the definition of Metabolic Syndrome used.

• The Homeostasis Model Assessment–Insulin Resistance cut point to avoid Metabolic Syndrome risk ranged from 2.30 to 3.59


Insulin resistance Cardiometabolic risk HOMA-IR Youth 



Adult Treatment Panel III


Area under the curve


Fasted glucose/insulin ratio


International Diabetes Federation


Insulin resistance


Hierarchical summary receiver operating characteristic curves


Homeostasis Model Assessment–Insulin Resistance


Metabolic syndrome


Receiver operating characteristic curves


Quality Assessment of Diagnostic Accuracy Studies-2


Quantitative insulin-sensitivity check index


Meta-analysis of Observational Studies in Epidemiology.


Authors’ contribution

A-R conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.

C-R, P-C, and S-M designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.

G-H and M-V conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centro de estudios Socio-SanitariosUniversidad de Castilla La ManchaCuencaSpain
  2. 2.Navarrabiomed, Complejo Hospitalario de Navarra (CHN), IdiSNAUniversidad Pública de Navarra (UPNA)PamplonaSpain
  3. 3.Laboratorio de Ciencias de la Actividad Física, el Deporte y la SaludUniversidad de Santiago de Chile, USACHSantiagoChile
  4. 4.Universidad Politécnica y artística del ParaguayAsunciónParaguay
  5. 5.Facultad de EnfermeríaUniversidad de Castilla La ManchaCuencaSpain
  6. 6.Facultad de Ciencias de la SaludUniversidad Autónoma de ChileTalcaChile

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