Homeostasis Model Assessment cut-off points related to metabolic syndrome in children and adolescents: a systematic review and meta-analysis
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.
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
KeywordsInsulin resistance Cardiometabolic risk HOMA-IR Youth
- ATP III
Adult Treatment Panel III
Area under the curve
Fasted glucose/insulin ratio
International Diabetes Federation
Hierarchical summary receiver operating characteristic curves
Homeostasis Model Assessment–Insulin Resistance
Receiver operating characteristic curves
Quality Assessment of Diagnostic Accuracy Studies-2
Quantitative insulin-sensitivity check index
Meta-analysis of Observational Studies in Epidemiology.
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.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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