Insulin resistance index (HOMA-IR) levels in a general adult population: Curves percentile by gender and age. The EPIRCE study

      Abstract

      Aims

      To describe the distribution of HOMA-IR levels in a general nondiabetic population and its relationships with metabolic and lifestyles characteristics.

      Methods

      Cross-sectional study. Data from 2246 nondiabetic adults in a random Spanish population sample, stratified by age and gender, were analyzed. Assessments included a structured interview, physical examination, and blood sampling. Generalized additive models (GAMs) were used to assess the effect of lifestyle habits and clinical and demographic measurements on HOMA-IR. Multivariate GAMs and quantile regression analyses of HOMA-IR were carried out separately in men and women.

      Results

      This study shows refined estimations of HOMA-IR levels by age, body mass index, and waist circumference in men and women. HOMA-IR levels were higher in men (2.06) than women (1.95) (P = 0.047). In women, but not men, HOMA-IR and age showed a significant nonlinear association (P = 0.006), with increased levels above fifty years of age. We estimated HOMA-IR curves percentile in men and women.

      Conclusions

      Age- and gender-adjusted HOMA-IR levels are reported in a representative Spanish adult non-diabetic population. There are gender-specific differences, with increased levels in women over fifty years of age that may be related with changes in body fat distribution after menopause.

      Keywords

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      References

        • Bunt J.C.
        • Krakoff J.
        • Ortega E.
        • Knowler W.C.
        • Bogardus C.
        Acute insulin response is an independent predictor of type 2 diabetes mellitus in individuals with both normal fasting and 2-h plasma glucose concentrations.
        Diab Metab Res Rev. 2007; 23: 304-310
        • Martin B.C.
        • Warram J.H.
        • Krolewski A.S.
        • Bergman R.N.
        • Soeldner J.S.
        • Kahn C.R.
        Role of glucose and insulin resistance in development of type 2 diabetes mellitus.
        Lancet. 1992; 340: 925-929
        • Ginsberg H.N.
        Insulin resistance and cardiovascular disease.
        J Clin Invest. 2000; 106: 453-458
        • Bertoni A.G.
        • Wong N.D.
        • Shea S.
        • Ma S.
        • Liu K.
        • Preethi S.
        • et al.
        Insulin resistance, metabolic syndrome and subclinical atherosclerosis.
        Diabetes Care. 2007; 30: 2951-2956
        • Li C.L.
        • Tsai S.T.
        • Chou P.
        Relative role of insulin resistance and beta-cell dysfunction in the progression to type 2 diabetes – the Kinmen Study.
        Diab Metab Res Rev. 2003; 59: 225-232
        • Hanley A.J.
        • Williams K.
        • Stern M.P.
        • Haffner S.M.
        Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio Heart Study.
        Diabetes Care. 2002; 25: 1177-1184
        • Geloneze B.
        • Repetto E.M.
        • Geloneze S.R.
        • Tambascia M.A.
        • Ermetice M.N.
        The threshold value for insulin resistance (HOMA-IR) in an admixture population. IR in the Brazilian Metabolic Syndrome Study.
        Diabetes Res Clin Pract. 2006; 72: 219-220
        • Bonora E.
        • Kiechl S.
        • Willeit J.
        • Oberhollenzer F.
        • Egger G.
        • Meigs J.B.
        • et al.
        Insulin resistance as estimated by Homeostasis Model Assessment predicts incident symptomatic cardiovascular disease in Caucasian subjects from the general population. The Bruneck Study.
        Diabetes Care. 2007; 30: 318-324
        • National Committee for Clinical Laboratory Standards (NCCLS)
        How to define and determine reference intervals in the clinical laboratory; approved guideline.
        in: NCCLS document C-28-A2. 2nd ed. NCCLS, Wayne, PA2000
        • Balkau B.
        • Mhamdi L.
        • Oppert J.M.
        • Nolan J.
        • Golay A.
        • Porcellati F.
        • et al.
        Physical activity and insulin sensitivity. The RISC study.
        Diabetes. 2008; 57: 2613-2618
        • Rimm E.B.
        • Williams P.
        • Fosher K.
        • Criqui M.
        • Stampfer M.J.
        Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors.
        BMJ. 1999; 319: 1523-1528
        • Lann D.
        • LeRoith D.
        Insulin resistance as the underlying cause for the metabolic syndrome.
        Med Clin North Am. 2007; 91: 1063-1077
        • Ryder E.
        • Gomez M.E.
        • Fernandez V.
        • Campos G.
        • Morales L.M.
        • Valbuena H.
        • et al.
        Presence of impaired insulin secretion and insulin resistance in normoglycemic male subjects with family history of type 2 diabetes.
        Diabetes Res Clin Pract. 2003; 60: 95-103
        • Chen J.
        • Wildman R.P.
        • Hamm L.L.
        • Muntner P.
        • Reynolds K.
        • Whelton P.K.
        • et al.
        Third National Health and Nutrition Examination Survey. Association between inflammation and insulin resistance in U.S. nondiabetic adults: results from the Third National Health and Nutrition Examination Survey.
        Diabetes Care. 2004; 27: 2960-2965
        • Eckel R.H.
        • Kahn R.
        • Robertson R.M.
        • Rizza R.A.
        Preventing cardiovascular disease and diabetes: a call for action from the American Diabetes Association and the American Heart Association.
        Circulation. 2006; 113: 2943-2946
        • Otero A.
        • Gayoso P.
        • Garcia F.
        • De Francisco A.L.
        Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study.
        Kidney Int. 2005; 99: S16-S19
        • Otero A.
        • De Francisco A.
        • Gayoso P.
        • Garcia F.
        Prevalence of chronic renal disease in Spain: results of the EPIRCE Study.
        Nefrologia. 2010; 30: 78-86
      1. The expert committee on the diagnosis and classification of diabetes mellitus: report of the expert committee on the diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2002; 25: S5-S20
        • Gual A.
        • Martos A.R.
        • Lligona A.
        • Llopis J.J.
        Does the concept of a standard drink apply to viticultural societies?.
        Alcohol Alcohol. 1999; 34: 153-160
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure.
        JAMA. 2003; 289: 2560-2571
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentration in man.
        Diabetologia. 1985; 28: 412-419
        • Hastie T.J.
        • Tibshirani R.J.
        Generalized additive models.
        Chapman and Hall, London1990
        • Wood S.N.
        Generalized additive models: an introduction with R.
        Chapman and Hall/CRC Press, 2006
        • Rigby R.A.
        • Stasinopoulos D.M.
        Generalized additive models for location, scale and shape (with discussion).
        Appl Stat. 2005; 54: 507-554
        • R Development Core Team
        R: a language and environment for statistical computing [article online].
        3-900051-07-0 R Foundation for Statistical Computing, Vienna, Austria2009 (Available from http://www.R-project.org [accessed 23.03.2010])
        • Kahn R.
        The metabolic syndrome (emperor) wears no clothes.
        Diabetes Care. 2006; 29: 1693-1696
        • DeFronzo R.A.
        • Ferrannini E.
        Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic vascular disease.
        Diabetes Care. 1991; 14: 173-194
        • Ferrannini E.
        • Vichi S.
        • Beck-Nielsen H.
        • Laakso M.
        • Paolisso G.
        • Smith U.
        Insulin action and age.
        Diabetes. 1996; 45: 947-953
        • Esteghamati A.
        • Ashraf H.
        • Esteghamati A.R.
        • Meysamie A.
        • Khalilzadeh O.
        • Nakhjavani M.
        • et al.
        Optimal threshold of homeostasis model assessment for insulina resistance in an Iranian population: the implication of the metabolic syndrome to detect insulin resistance.
        Diab Res Clin Pract. 2009; 84: 279-287
        • Kim S.H.
        • Abbasi F.
        • Reaven G.M.
        Impact of degree of obesity on surrogate estimates of insulin resistance.
        Diabetes Care. 2004; 27: 1998-2002
        • Ritchie S.A.
        • Connell J.M.
        The link between abdominal obesity, metabolic syndrome and cardiovascular disease.
        Nutr Metab Cardiovasc Dis. 2007; 17: 319-326
        • Moreno B.
        • Casanueva F.
        Identification, diagnosis and control of patients with abdominal obesity and cardiovascular and metabolic risk factors.
        Med Clin (Barc). 2007; 128: 429-437
        • Geer E.B.
        • Shen W.
        Gender differences in insulin resistance, body composition and energy balance.
        Gend Med. 2009; 6: 60-75
        • Do H.D.
        • Lohsoonthorn V.
        • Jiamjarasrangsi W.
        • Lertmaharit S.
        • Williams M.A.
        Prevalence of insulin resistance and its relationship with cardiovascular disease risk factors among Thai adults over 35 years old.
        Diabetes Res Clin Pract. 2010; 89: 303-308
        • Chung B.-H.
        • Doran S.
        • Liang P.
        • Osterlund L.
        • Cho B.H.
        • Oster R.A.
        • et al.
        Alcohol mediated enhancement of postprandial lipemia: a contributing factor to an increase in plasma HDL and a decrease in risk of cardiovascular disease.
        Am J Clin Nutr. 2003; 78: 391-399
        • Bonora E.
        • Targher G.
        • Alberiche M.
        • Bonadonna R.
        • Saggiani F.
        • Zenere M.
        • et al.
        Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity.
        Diabetes Care. 2000; 23: 57-63
        • Esteghamati A.
        • Ashraf H.
        • Khalilzadeh O.
        • Zandieh A.
        • Nakhjavani M.
        • Rashidi A.
        • et al.
        Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007).
        Nutr Metab. 2010; 7: 26
        • Matsumoto J.K.
        • Miyake S.
        • Yano M.
        • Ueki Y.
        • Yamaguchi Y.
        • Akazawa S.
        • et al.
        Glucose tolerance, insulin secretion and insulin sensitivity in nonobese and obese Japanese subjects.
        Diabetes Care. 1997; 20: 1562-1568
        • Nakai Y.
        • Fukushima M.
        • Nakaishi S.
        • Kishimoto H.
        • Seino Y.
        • Nagasaka S.
        • et al.
        The threshold value for insulin resistance on homeostasis model assessment of insulin sensitivity.
        Diabetic Med. 2002; 9: 344-348
        • De Luis D.A.
        • Gonzalez Sagrado M.
        • Conde R.
        • Aller R.
        • Izazola O.
        • Perez Castrillon J.L.
        • et al.
        Relation of resistin levels with cardiovascular risk factors and insulin resistance in non-diabetes obese patients.
        Diabetes Res Clin Pract. 2009; 84: 174-178
        • Rojo-Martinez G.
        • Esteva I.
        • Ruiz de Adana S.
        • Catala M.
        • Merelo M.J.
        • Tinahones F.
        Patterns of insulin resistance in the general population of southeast Spain.
        Diab Res Clin Pract. 2004; 65: 247-256
        • Ascaso J.F.
        • Romero P.
        • Real J.T.
        • Priego A.
        • Valdecabres C.
        • Carmena R.
        Insulin resistance quantification by fasting insulin plasma values and HOMA index in a non-diabetic population.
        Med Clin (Barc). 2001; 117: 530-533
        • Tomé M.A.
        • Botana M.A.
        • Cadarso-Suarez C.
        • Rego-Irateta A.
        • Fernandez-Mariño A.
        • Mato J.A.
        • et al.
        Prevalence of metabolic syndrome in Galicia (NW Spain) on four alternative definitions and association with insulina resistance.
        J Endocrinol Invest. 2009; 32: 505-511
        • Hedblad B.
        • Nilsson P.
        • Jnazon L.
        • Berglund G.
        Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmo, Sweden.
        Diabetic Med. 2000; 17: 299-307
        • Bonora E.
        • Kiechl S.
        • Willeit J.
        • Oberhollenzer F.
        • Egger G.
        • Targher G.
        • et al.
        Prevalence of insulin resistance in metabolic disorders. The Bruneck Study.
        Diabetes. 1998; 47: 1643-1649
        • Marques-Vidal P.
        • Mazoyer E.
        • Bongard V.
        • Gourdy P.
        • Ruidavets J.B.
        • Drouet L.
        • et al.
        Prevalence of insulin resistance syndrome in southwestern France and its relationship with inflammatory and hemostatic markers.
        Diabetes Care. 2002; 25: 1371-1377
        • Sumner A.E.
        • Cowie C.C.
        Ethnic differences in the ability of triglyceride levels to identify insulin resistance.
        Atherosclerosis. 2008; 196: 696-703
        • Hayes L.
        • Pearce M.S.
        • Firbank M.J.
        • Walker M.
        • Taylor R.
        • Unwin N.C.
        Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study.
        BMC Public Health. 2010; 10: 723