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Reference ranges of HOMA-IR in normal-weight and obese young Caucasians

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Insulin resistance (IR) may develop very early in life being associated with occurrence of cardiometabolic risk factors (CMRFs). Aim of the present study was to identify in young Caucasians normative values of IR as estimated by the homeostasis model assessment (HOMA-IR) and cutoffs diagnostic of CMRFs.


Anthropometrics and biochemical parameters were assessed in 2753 Caucasians (age 2–17.8 years; 1204 F). Reference ranges of HOMA-IR were defined for the whole population and for samples of normal-weight and overweight/obese individuals. The receiver operator characteristic analysis was used to find cutoffs of HOMA-IR accurately identifying individuals with any CMRF among total cholesterol and/or triglycerides higher than the 95th percentile and/or HDL cholesterol lower than the 5th for age and sex, impaired glucose tolerance, and alanine aminotransferase levels ≥40 U/l.


Overweight/obese individuals had higher HOMA-IR levels compared with normal-weight peers (p < 0.0001) at any age. HOMA-IR index rose progressively with age, plateaued between age 13 and 15 years and started decreasing afterward. HOMA-IR peaked at age 13 years in girls and at 15 years in boys. The 75th percentile of HOMA-IR in the whole population (3.02; AUROC = 0.73, 95 % CI = 0.70–0.75), in normal-weight (1.68; AUROC = 0.76, 95 % CI = 0.74–0.79), and obese (3.42; AUROC = 0.71, 95 % CI = 0.69–0.72) individuals identified the cutoffs best classifying individuals with any CMRF.


Percentiles of HOMA-IR varied significantly in young Caucasians depending on sex, age, and BMI category. The 75th percentile may represent an accurate cutoff point to suspect the occurrence of one or more CMRFs among high total cholesterol and triglycerides, low HDL cholesterol, and ALT ≥ 40 UI/l.

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Body mass index


High-density lipoprotein cholesterol


Low-density lipoprotein cholesterol


International Obesity Task Force


Alanine aminotransferase


Aspartate aminotransferase


Impaired fasting glucose


Impaired glucose tolerance




Oral glucose tolerance test


Insulin resistance


Homeostasis model assessment for insulin resistance


Waist circumference


Cardiometabolic risk factors


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The work was supported by grants from the Italian Ministry of Health (RF-OPG-2008-1142374 to MM; RC 201302R003008 to MM; “Sviluppare profili genetici e trasferirli alla sanità pubblica, in Italia” To BD) and from the EC to MM and BD (FP7-ICT-2012-600932 MD PAEDIGREE). BS was supported by the Grant FP7-ICT-2012-600932 MD PAEDIGREE. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was performed in accordance with the Declaration of Helsinki as revised in 2008 and approved by the Ethical Committee of the Bambino Gesù Children’s Hospital.

Human and Animal Rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all parents or responsible guardians.

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Correspondence to Melania Manco.

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Managed by Massimo Federici.

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Shashaj, B., Luciano, R., Contoli, B. et al. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians. Acta Diabetol 53, 251–260 (2016).

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