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Prevalence and Determinants of Insulin Resistance Among U.S. Adolescents

A population-based study

¹ Pediatric Endocrinology Unit, University of Michigan, Ann Arbor, Michigan
² Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan
³ Division of General Pediatrics, University of California, San Francisco, San Francisco, California
⁴ Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
⁵ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
⁶ Department of Epidemiology, University of Michigan, Ann Arbor, Michigan

Address correspondence and reprint requests to Joyce M. Lee, MD, MPH, 300 NIB, Room 6E05, Campus Box 0456, Ann Arbor, MI 48109-0456. E-mail: joyclee{at}umich.edu

OBJECTIVE—We sought to examine the distribution of insulin and homeostasis model assessment of insulin resistance (HOMA-IR) and associations of HOMA-IR with sex, race/ethnicity, age, and weight status, as measured by BMI, among U.S. adolescents.

RESEARCH DESIGN AND METHODS—Of 4,902 adolescents aged 12–19 years who participated in the National Health and Nutrition Examination Survey 1999–2002, analysis was performed for a nationally representative subsample of 1,802 adolescents without diabetes who had fasting laboratory measurements. The main outcome measure was HOMA-IR, calculated from fasting insulin and glucose and log transformed for multiple linear regression analyses.

RESULTS—In adjusted regression models that included age and weight status, girls had higher HOMA-IR than boys and Mexican-American children had higher HOMA-IR levels than white children. There were no significant differences in adjusted HOMA-IR between black and white children. Obese children (BMI 95th percentile) had significantly higher levels of HOMA-IR compared with children of normal weight (BMI <85th percentile) in adjusted comparisons (mean HOMA-IR 4.93 [95% CI 4.56–5.35] vs. 2.30 [2.21–2.39], respectively). Weight status was by far the most important determinant of insulin resistance, accounting for 29.1% of the variance in HOMA-IR. The prevalence of insulin resistance in obese adolescents was 52.1% (95% CI 44.5–59.8).

CONCLUSIONS—Obesity in U.S. adolescents represents the most important risk factor for insulin resistance, independent of sex, age, or race/ethnicity. The prevalence of insulin resistance in obese children foreshadows a worrisome trend for the burden of type 2 diabetes in the U.S.

Abbreviations: FSIVGTT, frequently sampled intravenous glucose tolerance test • HOMA-IR, homeostasis model assessment of insulin resistance • NFG, normal fasting glucose • NHANES, National Health and Nutrition Examination Survey

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