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Early testing of insulin resistance: a tale of two lipid ratios in a group of 5th graders screened by the Coronary Artery Risk Detection in Appalachian Communities Project (CARDIAC Project)

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Abstract

Background

In West Virginia (WV), 47% of fifth-grade children are either overweight or obese. There is no clear consensus regarding the definition of insulin resistance in children, and directly measuring insulin on the population level is costly. Two proposed measures examined further in this study include triglyceride (TRIG)/high-density lipoprotein cholesterol (HDL-C) ratio and TRIG/low-density lipoprotein (LDL-C) ratio. The purpose of this study is to examine the relationship between TRIG/HDL-C ratio, TRIG/LDL-C ratio and insulin resistance in fifth-graders with acanthosis nigricans (AN).

Methods

Between 2007 and 2016, 52,545 fifth-grade students in WV were assessed for AN. Fasting glucose and insulin levels were collected only for a sub-group of students who were AN-positive and was used to determine insulin resistance using the Homeostatic Model for Insulin Resistance (HOMA-IR) equation. Statistical analysis included t tests and logistic regression with receiver operating characteristic curves.

Results

Of the students assessed for AN, 4.5% (n = 2360) tested positive. The prevalence of insulin resistance was 79% (n = 814) among 1030 with AN and complete HOMA-IR. TRIG/HDL-C ratio and TRIG/LDL-C ratio were significantly associated with insulin resistance (TRIG/HDL-C:Est. = 0.36, P < 0.0001, AUC = 0.68; TRIG/LDL-C: Est. = 0.87, P < 0.0001, AUC = 0.69). Multivariate analysis showed that increased body mass index (Est. = 0.05, P < 0.0001), gender (Est. = 0.49, p < 0.0001) and TRIG/HDL-C ratio (Est. = 0.21, P < 0.0001) were significantly associated with insulin resistance.

Conclusions

TRIG/HDL-C is a better surrogate marker of insulin resistance in AN-positive children compared to TRIG/LDL-C ratio; so, on a population-level, cholesterol rather than insulin may be obtained for preliminary testing of early insulin resistance in children.

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Acknowledgements

The project described was supported by the National Institute of General Medical Sciences, (IDeA CTR support—NIH/NIGMS Award Number, 5U54GM104942-03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.”

Funding

West Virginia, Bureau of Public Health, Benedum Foundation, Robert Wood Johnson Foundation (Grant no. G120407)

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Authors and Affiliations

  1. West Virginia University, Morgantown, USA

    Charles Ituka Mosimah, Christa Lilly, Pamela J. Murray, Lee Pyles, Elloise Elliot & William Neal

  2. University of Yaounde I, Yaounde, Cameroon

    Awung-Njia Forbin

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  1. Charles Ituka Mosimah
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  2. Christa Lilly
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  3. Awung-Njia Forbin
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  4. Pamela J. Murray
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Contributions

CIM: Aided in the concept and design, analysis and interpretation of data; drafting the article, and revising it critically for important intellectual content; and final approval of the version to be published. CL: Aided in acquisition of data, supervision of data analysis and interpretation; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published. A-NF: Aided in drafting the article, revising it critically for important intellectual content and final approval of the version to be published. PM: Aided in the design and concept, and revised the article critically for important intellectual content, and final approval of the version to be published. LP, EE and WN: Aided in the concept and design, and acquisition of data; revised the article critically for important intellectual content; and final approval of the version to be published. All authors have read and approved the submitted manuscript.

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Correspondence to Christa Lilly.

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Mosimah, C.I., Lilly, C., Forbin, AN. et al. Early testing of insulin resistance: a tale of two lipid ratios in a group of 5th graders screened by the Coronary Artery Risk Detection in Appalachian Communities Project (CARDIAC Project). World J Pediatr 15, 398–404 (2019). https://doi.org/10.1007/s12519-018-00225-z

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