Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance

Alvim, Rafael de Oliveira; Zaniqueli, Divanei; Neves, Felipe Silva; Pani, Virgilia Oliveira; Martins, Caroline Resende; Peçanha, Marcos Alves de Souza; Barbosa, Míriam Carmo Rodrigues; Faria, Eliane Rodrigues de; Mill, José Geraldo

doi:10.1016/j.jped.2018.04.004

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Original articles • J. Pediatr. (Rio J.) 95 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.jped.2018.04.004 copy

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance^☆ ☆ Please cite this article as: Alvim RO, Zaniqueli D, Neves FS, Pani VO, Martins CR, Peçanha MA, et al. Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance. J Pediatr (Rio J). 2019;95:428 -34.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents.

Methods:

This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8 -14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16.

Results:

Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers.

Conclusion:

The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

KEYWORDS
Children; Adolescents; Insulin resistance; Triglycerides/glucose index; Triglycerides-to-HDL-C ratio; Waist-height ratio

	All	Girls	Boys
n	296	161	135
Age (years)	10.7 ± 2.0	10.7 ± 2.0	10.7 ± 2.0
Pubertal status (%)
Prepubescent	72 (24.3)	35 (21.7)	37 (27.4)
Pubescent	204 (68.9)	114 (70.8)	90 (66.7)
Post-pubescent	20 (6.8)	12 (7.5)	8 (5.9)
Weight (kg)	42.5 ± 15.1	42.6 ± 14.6	42.3 ± 15.8
Height (cm)	145.0 ± 0.1	145.1 ± 0.1	146.3 ± 0.1
BMI Z-score	0.68 ± 1.41	0.64 ± 1.40	0.71 ± 1.42
Overweight (%)	62 (20.9)	35 (21.7)	27 (20.0)
WC (cm)	66.7 ± 10.9	66.7 ± 11.0	66.7 ± 10.8
WHtR	0.45 ± 0.06	0.46 ± 0.06	0.46 ± 0.06
SBP (mmHg)	104 ± 8	103 ± 7	106 ± 8^a a p < 0.05 for girls vs . boys.
DBP (mmHg)	64 ± 6	64 ± 6	64 ± 6
Insulin (mcIU/mL)	12.2 ± 7.9	13.4 ± 8.2^a a p < 0.05 for girls vs . boys.	10.7 ± 7.3
Glucose (mg/dL)	87.0 ± 8.4	86.5 ± 8.2	87.7 ± 8.7
HOMA-IR	2.65 ± 1.86	2.91 ± 1.94^a a p < 0.05 for girls vs . boys.	2.35 ± 1.71
Insulin resistance (%)	78 (26.4)	53 (32.9)^a a p < 0.05 for girls vs . boys.	25 (18.5)
TG (mg/dL)	80.5 ± 40.7	86.5 ± 44.1^a a p < 0.05 for girls vs . boys.	73.3 ± 34.9
TyG index	8.05 ± 0.43	8.11 ± 0.44^a a p < 0.05 for girls vs . boys.	7.98 ± 0.41
HDL-C (mg/dL)	50.9 ± 9.1	49.9 ± 9.3	52.0 ± 8.8
TG/HDL-C	1.69 ± 1.15	1.89 ± 1.33^a a p < 0.05 for girls vs . boys.	1.46 ± 0.82
Uric acid (mg/dL)	3.9 ± 1.0	3.8 ± 0.9	4.0 ± 1.2

	Girls		Boys
	Without IR	With IR	Without IR	With IR
n	108	53	110	25
Age (years)	10.4 ± 1.9	11.5 ± 2.0^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	10.5 ± 1.9	11.7 ± 2.2^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
BMI Z	0.30 ± 1.22	1.35 ± 1.55^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	0.41 ± 1.27	2.07 ± 1.50^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
Overweight (%)	14 (13.0)	21 (39.6)^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	14 (12.7)	13 (52.0)^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
WC (cm)	63.6 ± 8.5	72.9 ± 12.1^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	64.1 ± 6.7	78.6 ± 15.2^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
WHtR	0.44 ± 0.05	0.50 ± 0.08^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	0.44 ± 0.04	0.53 ± 0.09^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
SBP (mmHg)	103 ± 7	105 ± 8	105 ± 8	111 ± 9^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
DBP (mmHg)	64 ± 6	65 ± 7	64 ± 5	65 ± 7
Insulin (mcIU/mL)	8.9 ± 3.5	22.3 ± 7.6^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	8.3 ± 3.4	21.4 ± 9.4^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
Glucose (mg/dL)	84.4 ± 8	90.8 ± 7^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	86.7 ± 9	92.1 ± 7^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
HOMA-IR	1.87 ± 0.7	5.4 ± 1.9^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	1.78 ± 0.8	4.9 ± 2.2^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
TG (mg/dL)	78.7 ± 39.5	102.4 ± 49.2^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	67.2 ± 32.8	100.1 ± 34.8^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
TyG index	8.01 ± 0.41	8.34 ± 0.45^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	7.90 ± 0.38	8.38 ± 0.34^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
HDL-C (mg/dL)	51.7 ± 9.2	46.4 ± 8.4^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	52.5 ± 8.7	49.9 ± 8.8
TG/HDL-C	1.65 ± 1.15	2.40 ± 1.54^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	1.34 ± 0.80	2.01 ± 0.71^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .
Uric acid (mg/dL)	3.6 ± 0.8	4.3 ± 0.9^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .	3.9 ± 1.0	4.6 ± 1.5^a a p < 0.05 for without insulin resistance vs . with insulin resistance. Comparisons adjusted for age, except for BMI Z .

	HOMA-IR	TyG index	TG/HDL-C	WHtR
Girls
HOMA-IR	1	0.42	0.39	0.60
TyG	0.42	1	0.87	0.31
TG/HDL-C	0.39	0.88	1	0.40
WHtR	0.60	0.35	0.40	1
Boys
HOMA-IR	1	0.50	0.42	0.56
TyG	0.50	1	0.82	0.33
TG/HDL-C	0.42	0.82	1	0.37
WHtR	0.56	0.33	0.38	1

		Sensitivity	Specificity	PPV	NPV	AUC	p
Girls	TyG index	0.83	0.63	11.7	47.6	0.76	<0.001
	TG/HDL-C	0.94	0.48	5.5	52.8	0.74	<0.001
	WHtR	0.72	0.74	15.8	42.4	0.78	<0.001
Boys	TyG index	0.84	0.81	4.3	50.0	0.86	<0.001
	TG/HDL-C	0.68	0.86	7.8	48.5	0.81	<0.001
	WHtR	0.80	0.83	5.2	48.7	0.85	<0.001

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[1] * Corresponding author. E-mail:r.alvim@hotmail.com (R.O. Alvim).