PREVALENCE OF INSULIN RESISTANCE AND ASSOCIATION WITH METABOLIC RISK FACTORS AND FOOD CONSUMPTION IN ADOLESCENTS - RECIFE/BRAZIL

Andrade, Maria Izabel Siqueira de; Oliveira, Juliana Souza; Leal, Vanessa Sá; Lima, Niedja Maria da Silva; Bezerra, Phelipe Bibiano; Santiago, Emerson Rogério Costa; Lira, Pedro Israel Cabral de

doi:10.1590/1984-0462/2020/38/2019016

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2019016 copy

PREVALENCE OF INSULIN RESISTANCE AND ASSOCIATION WITH METABOLIC RISK FACTORS AND FOOD CONSUMPTION IN ADOLESCENTS - RECIFE/BRAZIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the prevalence of insulin resistance in adolescents and its associations with metabolic factors and food intake.

Methods:

Cross-sectional study conducted with a stratified, complex, school-based sample. The subjects were adolescents (n=1,081) who participated in the Study of Cardiovascular Risk in Adolescents in the city of Recife (Pernambuco, Brazil). We analyzed demographic, socioeconomic, behavioral, anthropometric, biochemical, and dietary variables. Insulin resistance was defined as HOMA-IR>75^th percentile. A Poisson multivariate regression model with robust variance adjustment was used, and variables with p≤0.05 in the final model were considered statistically associated with insulin resistance.

Results:

Median age was 14 years (interquartile range: 13-16 years), and 25.3% of the sample showed insulin resistance. The variables associated with insulin resistance in the final model were age, body mass index-for-age (BMI/A), biochemical markers (triglycerides and high-density lipoprotein cholesterol) and saturated fat intake, with insulin resistance being more prevalent in individuals whose consumption of this type of fat was below the median of the sample distribution.

Conclusions:

Insulin resistance was prevalent in the adolescents analyzed and was significantly associated with metabolic variables and saturated fat intake.

Keywords:
Insulin resistance; Overweight; Food consumption; Adolescent

Variables	Insulin Resistance			PR (95%CI)	p-value
Variables	n_observed	n_estimated	%	PR (95%CI)	p-value
Level 1 - Demographic/socioeconomic
Gender
Male	89	11498	23.0	Ref.	0.156*
Female	182	13668	27.8	1.21 (0.92, 1.57)	0.156*
Age range
15-17 years	100	9730	20.0	Ref.	0.001†
12-14 years	171	15435	30.6	1.53 (1.21, 1.93)	0.001†
Ethnicity
White	67	6353	23.8	Ref.	0.393
Others	201	19151	26.4	1.10 (0.87, 1.40)	0.393
Sexual maturation
Post-puberty	86	7668	23.8	Ref.	0.597
Puberty	184	17445	26.0	1.09 (0.78, 1.52)	0.597
Maternal schooling
>8 years	140	17045	24.3	Ref.	0.677
≤8 years	65	7593	26.2	1.08 (0.74, 1.57)	0.677
Socioeconomic status
High	49	6608	23.9	Ref.	0.956
Low	136	17210	24.1	1.01 (0.73, 1.38)	0.956
Level 2 - Behavioral
Smoking
Yes	3	487	22.5	Ref.	0.827
No	268	24782	25.5	1.13 (0.35, 3.59)	0.827
Alcohol consumption
Yes	9	529	12.6	Ref.	0.121*
No	240	23939	25.2	1.98 (0.82, 4.79)	0.121*
Physical activity level
Active	118	12345	22.7	Ref.	0.178*
Inactive	137	12542	28.0	1.23 (0.90, 1.68)	0.178*

Variables	Insulin Resistance			PR (95%CI)	p-value
Variables	n_observed	n_estimated	%	PR (95%CI)	p-value
Level 3 - Anthropometric/Biochemical
BMI/A
Non-overweight	122	10935	15.5	Ref.	<0.001‡
Overweight	73	6536	35.4	2.28 (1.65, 3.15)
Obesity	76	7695	73.7	4.74 (3.53, 6.36)
WC
Normal	202	17776	20.1	Ref.	<0.001‡
High	69	7433	68.5	3.40 (2.61, 4.43)	<0.001‡
WHtR
Normal	176	16074	19.0	Ref.	<0.001‡
Abdominal obesity	95	9135	62.3	3.27 (2.37, 4.52)	<0.001‡
Total cholesterol
Desirable	122	11906	21.8	Ref.	0.077*
Borderline	73	6996	28.2	1.29 (0.92, 1.79)
High	76	6264	31.6	1.45 (1.03, 2.01)
LDL-C
Desirable	184	17525	24.1	Ref.	0.542
Borderline	74	6497	29.7	1.23 (0.84, 1.80)
High	13	1150	24.5	1.01 (0.61, 1.68)
HDL-C
Desirable	105	8526	17.1	Ref.	<0.001‡
Low	166	16639	33.7	1.97 (1.54, 2.50)	<0.001‡
TG
Desirable	171	15127	18.6	Ref.	<0.001‡
Borderline	41	4201	44.7	2.39 (1.79, 3.20)
High	59	5837	67.3	3.61 (2.84, 4.58)

Variables	Insulin Resistance			PR (95%CI)	p-value
Variables	n_observed	n_estimated	%	PR (95%CI)	p-value
Level 4 - Food consumption
Energy intake (kcal)
<1761.44	89	8953	38.3	2.17 (1.56, 3.01)	<0.001†
1761.44-2422.74	71	5755	24.7	1.40 (0.93, 2.11)
2422.74-3237.17	63	5713	22.3	1.26 (0.91, 1.73)
>3237.17	48	4744	17.6	Ref.
Carbohydrates (g)
<230.8	90	8417	34.9	1.88 (1.33, 2.67)	<0.001†
230.8-320.8	72	6303	27.1	1.46 (0.93, 2.28)
320.8-434.5	51	4798	18.5	Ref.
>434.5	58	5647	21.7	1.17 (0.76, 1.79)
Refined sugar (g)
<86.1	76	7495	29.3	1.46 (0.97, 2.21)	0.097*
86.1-137.3	83	7272	28.5	1.42 (0.99, 2.03)
137.3-195.4	59	5383	23.4	1.17 (0.67, 2.03)
>195.4	53	5015	20.0	Ref.
Added sugar (g)
<60.8	80	8308	32.9	1.61 (1.07, 2.40)	0.126*
60.8-104.4	68	6188	24.7	1.21 (0.85, 1.72)
104.4-163.0	71	5646	23.2	1.13 (0.70, 1.82)
>163.0	52	5024	20.4	Ref.

Variables	Insulin Resistance			PR (95%CI)	p-value
Variables	n_observed	n_estimated	%	PR (95%CI)	p-value
Level 4 - Food consumption
Total lipids (g)
<54.5	83	8369	35.6	1.76 (1.20, 2.57)	0.028†
54.5-80.3	79	6320	26.4	1.30 (0.89, 1.92)
80.3-115.9	55	5371	20.3	1.01 (0.65, 1.55)
>115.9	54	5105	20.2	Ref.
Saturated fat (g)
<18.8	82	8015	34.5	1.83 (1.21, 2.78)	0.032†
18.8-27.9	71	6384	25.9	1.37 (0.86, 2.21)
27.9-42.9	67	5892	23.2	1.23 (0.80, 1.89)
>42.9	51	4874	18.7	Ref.
Polyunsaturated fat (g)
<8.7	82	7726	33.8	1.53 (1.01, 2.30)	0.199*
8.7-13.5	70	5523	23.3	1.05 (0.69, 1.60)
13.5-22.0	63	6229	23.1	1.04 (0.72, 1.50)
>22.0	56	5687	22.1	Ref.
Omega-6 (g)
<7.6	81	7601	33.3	1.51 (0.98, 2.32)	0.235
7.6-11.8	70	5651	23.7	1.07 (0.75, 1.51)
11.8-19.2	63	5916	22.1	Ref.
>19.2	57	5997	23.3	1.05 (0.71, 1.55)
Omega-3 (g)
<0,9	78	7331	32.8	1.52 (1.01, 2.29)	0.221
0.9-1.4	64	5284	21.5	Ref.
1.4-2.3	73	6771	24.7	1.14 (0.73, 1.79)
>2.3	56	5779	23.1	1.07 (0.70, 1.62)
Monounsaturated fat (g)
<17.5	87	8346	35.7	1.86 (1.27, 2.71)	0.027†
17.5-26.4	72	5989	24.9	1.29 (0.91, 1.85)
26.4-38.9	62	5878	22.6	1.17 (0.77, 1.77)
>38.9	50	4951	19.2	Ref.
Dietary cholesterol (g)
<140.1	69	6920	30.0	1.35 (0.81, 2.26)	0.484
140.1-228.3	76	6799	27.3	1.23 (0.88, 1.71)
228.3-396.4	58	5723	22.5	1.01 (0.71, 1.43)
>396.4	68	5724	22.1	Ref.
Trans fat (g)
<1.0	74	7290	28.6	1.33 (0.96, 1.84)	0.353
1.0-1.7	69	6137	25.3	1.18 (0.92, 1.52)
1.7-3.1	68	6393	26.0	1.21 (0.82, 1.79)
>3.1	60	5345	21.4	Ref.

Levels/variables	Insulin resistance				p-value
	Crude analysis		Adjusted analysis
	PR	95%CI	PR	95%CI
Level 1 - Demographic/socioeconomic
Age range
15-17 years	Ref.		Ref.
12-14 years	1.53	(1.21, 1.93)	1.54	(1.23, 1.95)	0.001*
Level 3 - Anthropometric/biochemical
BMI/A
Non-overweight	Ref.		Ref.
Overweight	2.28	(1.65, 3.15)	1.92	(1.34, 2.75)	0.001*
Obesity	4.74	(3.53, 6.36)	3.14	(2.22, 4.46)	<0.001†
TG
Desirable	Ref.		Ref.
Borderline	2.39	(1.79, 3.20)	1.67	(1.23, 2.26)	0.002*
High	3.61	(2.84, 4.58)	2.13	(1.71, 2.67)	<0.001†
HDL-C
Desirable	Ref.		Ref.
Low	1.97	(1.54, 2.50)	1.51	(1.0, 2.28)	0.050*
Level 3 - Food consumption
Energy intake (kcal)
<1761.44	2.17	(1.56, 3.01)	4.23	(1.32, 13.5)	0.016*
1761.44-2422.74	1.40	(0.93, 2.11)	2.79	(0.93, 8.29)	0.064
2422.74-3237.17	1.26	(0.91, 1.73)	2.35	(1.11, 4.99)	0.027*
>3237.17	Ref.		Ref.
Total lipids (g)
<54.5	1.76	(1.20, 2.57)	0.53	(0.17, 1.61)	0.256
54.5-80.3	1.30	(0.89, 1.92)	0.71	(0.28, 1.78)	0.463
80.3-115.9	1.01	(0.65, 1.55)	0.40	(0.17, 0.91)	0.032*
>115.9	Ref.		Ref.
Polyunsaturated fat (g)
<8.7	1.53	(1.01, 2.30)	0.66	(0.38, 1.15)	0.144
8.7-13.5	1.05	(0.69, 1.60)	0.57	(0.37, 0.87)	0.012*
13.5-22.0	1.04	(0.72, 1.50)	0.92	(0.60, 1.42)	0.718
>22.0	Ref.		Ref.
Monounsaturated fat (g)
<17.5	1.86	(1.27, 2.71)	1.40	(0.52, 3.78)	0.488
17.5-26.4	1.29	(0.91, 1.85)	1.05	(0.40, 2.73)	0.914
26.4-38.9	1.17	(0.77, 1.77)	1.78	(1.02, 3.08)	0.040*
>38.9	Ref.		Ref.

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[1] *Corresponding author. E-mail: izabelandradee@hotmail.com (M.I.S. Andrade).