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Published online January 17, 2008
Diabetes Care 31:802-804, 2008
DOI: 10.2337/dc07-1655
© 2008 by the American Diabetes Association
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Cardiovascular and Metabolic Risk
Original Research

Alternative Methods of Insulin Sensitivity Assessment in Obese Children and Adolescents

Sophia M. Rössner, MD1, Martin Neovius, PHD2, Scott M. Montgomery, PHD3,4,5, Claude Marcus, MD, PHD6 and Svante Norgren, MD, PHD1

1 Division of Pediatrics, Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
2 Department of Medicine, Karolinska Institute, Stockholm, Sweden
3 Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
4 Clinical Research Centre, Örebro University Hospital, Örebro, Sweden
5 Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, U.K.
6 National Childhood Obesity Centre, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institute, Stockholm, Sweden

Address correspondence and reprint requests to Dr. Sophia Rössner, B57, Karolinska Universitetssjukhuset Huddinge, SE-141 86 Stockholm, Sweden. E-mail: sophia.rossner{at}karolinska.se

OBJECTIVE—To validate fasting indexes against minimal model analysis (MMOD) of the frequently sampled intravenous glucose tolerance test (FSIVGTT) in an obese pediatric population.

RESEARCH DESIGN AND METHODS—FSIVGTT-MMOD results were compared with homeostasis model assessment of insulin resistance (HOMA-IR) and fasting insulin with the sample stratified by sex, puberty, and sensitivity index (Si) median in 191 children (82 males and 109 females, 13.9 ± 2.9 years of age, BMI 36.9 ± 6.2 kg/m2, BMI SD score 6.1 ± 1.6).

RESULTS—Across pubertal groups, correlation coefficients between Si and HOMA-IR ranged from –0.43 to –0.78 in males and from –0.53 to –0.57 in females (age and BMI adjusted, P < 0.05 in all instances). Similar results were seen for fasting insulin. In females, the relationship was significantly weaker in more-insulin-resistant subjects.

CONCLUSIONS—The validity of fasting indexes in explaining Si was sex dependent, varied with pubertal stage, and in females was influenced by degree of insulin sensitivity. In obese pediatric populations, we generally discourage the use of fasting indexes, although the validity varies within subgroups.

Abbreviations: DEXA, dual-energy X-ray absorptiometry • FSIVGTT, frequently sampled intravenous glucose tolerance test • HOMA-IR, homeostasis model assessment of insulin resistance • MMOD, minimal model analysis • QUICKI, quantitative insulin-sensitivity check index


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