Distribution of HOMA-IR in a population-based cohort and proposal for reference intervals

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Bassel Matli ◽  
Andreas Schulz ◽  
Thomas Koeck ◽  
Tanja Falter ◽  
Johannes Lotz ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Fasting Glucose ◽  
Reference Group ◽  
Reference Interval ◽  
Population Based ◽  
Reference Intervals ◽  
Health Study ◽  
Specific Reference ◽  
Model Assessment ◽  
Significant Difference

Abstract Objectives Insulin resistance (IR) is a hallmark of type 2 diabetes mellitus (DM). The homeostatic model assessment of insulin resistance (HOMA-IR) provides an estimate for IR from fasting glucose and insulin serum concentrations. The aim of this study was to obtain a reference interval for HOMA-IR for a specific insulin immunoassay. Methods The Gutenberg Health Study (GHS) is a population-based, prospective, single-center cohort study in Germany with 15,030 participants aged 35–74 years. Fasting glucose, insulin, and C-peptide were available in 10,340 participants. HOMA-IR was calculated in this group and three reference subgroups with increasingly more stringent inclusion criteria. Age- and sex-dependent distributions of HOMA-IR and reference intervals were obtained. In a substudy three insulin assays were compared and HOMA-IR estimated for each assay. Results Among the 10,340 participants analyzed there were 6,590 non-diabetic, 2,901 prediabetic, and 849 diabetic individuals. Median (interquartile range [IQR]) HOMA-IR was 1.54 (1.13/2.19), 2.00 (1.39/2.99), and 4.00 (2.52/6.51), respectively. The most stringently selected reference group consisted of 1,065 persons. Median (IQR) HOMA-IR was 1.09 (0.85/1.42) with no significant difference between men and women. The 97.5th percentile was 2.35. There was a non-significant trend towards higher values with older age. Comparison of three immunoassays for insulin showed an unsatisfactory correlation among the assays and systematic differences in calculated HOMA-IR. Conclusions We present HOMA-IR reference intervals for adults derived by more or less stringent selection criteria for the reference cohort. In addition we show that assay specific reference intervals for HOMA-IR are required.

scholarly journals Physical Activity, Measures of Obesity, and Cardiometabolic Risk: The Multi-Ethnic Study of Atherosclerosis (MESA)

2014 ◽  
Vol 11 (4) ◽  
pp. 831-837 ◽  
Author(s):  
Paul A. McAuley ◽  
Haiying Chen ◽  
Duck-chul Lee ◽  
Enrique Garcia Artero ◽  
David A. Bluemke ◽  
...  
Keyword(s):  
Physical Activity ◽  
Insulin Resistance ◽  
Waist Circumference ◽  
Impaired Fasting Glucose ◽  
Central Obesity ◽  
Cardiometabolic Risk ◽  
Fasting Glucose ◽  
Reference Group ◽  
Model Assessment ◽  
Ethnic Study

Background:The influence of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.Methods:Between 2000–2002, data were collected on 6795 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Self-reported intentional physical activity in the lowest quartile (0–105 MET-minutes/week) was categorized as inactive and the upper three quartiles (123–37,260 MET-minutes/week) as active. Associations of body mass index (BMI) and waist circumference categories, stratified by physical activity status (inactive or active) with cardiometabolic risk factors (dyslipidemia, hypertension, upper quartile of homeostasis model assessment of insulin resistance [HOMA-IR] for population, and impaired fasting glucose or diabetes) were assessed using logistic regression analysis adjusting for age, gender, race/ethnicity, and current smoking.Results:Among obese participants, those who were physically active had reduced odds of insulin resistance (47% lower; P < .001) and impaired fasting glucose/diabetes (23% lower; P = .04). These associations were weaker for central obesity. However, among participants with a normal waist circumference, those who were inactive were 63% more likely to have insulin resistance (OR [95% CI] 1.63 [1.24–2.15]) compared with the active reference group.Conclusions:Physical activity was inversely related to the cardiometabolic risk associated with obesity and central obesity.

Influence of Insulin Resistance on the Association Between Physical Activity and Heart Rate Variability: The Toon Health Study

2020 ◽  
Vol 17 (11) ◽  
pp. 1075-1082
Author(s):  
Isao Saito ◽  
Koutatsu Maruyama ◽  
Tadahiro Kato ◽  
Yasunori Takata ◽  
Kiyohide Tomooka ◽  
...  
Keyword(s):  
Physical Activity ◽  
Insulin Resistance ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Frequency Standard ◽  
Population Based ◽  
Health Study ◽  
Model Assessment ◽  
Partial Regression Coefficient ◽  
Validated Questionnaire

Background: Autonomic activity is possibly influenced by physical activity (PA). However, it remains unclear whether this association is modified by insulin resistance. Methods: This population-based study between 2009 and 2012 included 2016 men and women aged 30–79 years. The PA was assessed using a validated questionnaire based on sleep, occupation, transportation, household characteristics, and leisure-time PA. Heart rate (HR) and heart rate variability (HRV) in the sitting position were determined from 5-minute recordings of pulse waves detected by a fingertip sensor. The HRV was calculated as frequency (standard deviation of normal-to-normal [NN] intervals [SDNN]), root mean square of successive differences (RMSSD), and percentage differences between normal NN intervals >50 milliseconds [pNN50]) and time domains. Insulin resistance was evaluated using the homeostasis model assessment index (HOMA-IR). Results: HR, RMSSD, and pNN50 were related to the total and moderate/vigorous PA tertiles in models that included HOMA-IR. The partial regression coefficient of total PA per 1-SD increase was .05 (P = .019) for log-transformed RMSSD and 1.86 (P = .001) for pNN50. No interactive associations were observed between PA and HOMA-IR. Conclusions: Low total PA was associated with increased HR and low levels of RMSSD and pNN50, reflecting parasympathetic modulation that was not modified by insulin resistance.

scholarly journals Screening of Undiagnosed Hypothyroidism in Elderly Persons with Diabetes according to Age-Specific Reference Intervals for Serum Thyroid Stimulating Hormone and the Impact of Antidiabetes Drugs

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Rosita Fontes ◽  
Patricia de Fatima dos Santos Teixeira ◽  
Mario Vaisman
Keyword(s):  
Fasting Glucose ◽  
Reference Interval ◽  
The Elderly ◽  
Reference Intervals ◽  
Thyroid Stimulating Hormone ◽  
Specific Reference ◽  
Elderly Persons ◽  
Patients With Diabetes ◽  
The Impact ◽  
Tsh Levels

Background. Studies have suggested that hypothyroidism is more frequent in the elderly with diabetes mellitus. However, an adaptation of TSH levels to age should be considered in this assessment. Some antidiabetes drugs reportedly interfere with TSH levels. The objectives of this study were to evaluate the prevalence of undiagnosed hypothyroidism in patients with diabetes and the influence of antidiabetes drugs.Material and Methods. 1160 subjects, 60 years and older (751 with diabetes), were studied; results were compared according to diabetes treatment and with persons without diabetes. TSH, FT4, antithyroperoxidase, fasting glucose, and HbA1c were measured.Results and Discussion. 6.4% of patients with diabetes had hypothyroidism, a higher prevalence compared with persons without diabetes (5.1%), but lower than observed in many studies. The use of age-specific TSH reference interval (RI) could explain this difference. Patients taking metformin (MTF) had TSH (showed in medians) slightly lower (2.8 mU/L) than those not on MTF (3.3 mU/L),p<0.05. MTF doses influenced TSH levels.Conclusions. The use of specific TSH RI could avoid the misdiagnosis of hypothyroidism in elderly with diabetes. Patients in use of MTF as single drug had lower TSH than those using other medications and persons without diabetes.

scholarly journals Distribution of the homeostasis model assessment of insulin resistance in Mexican children and adolescents

2012 ◽  
Vol 166 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Celia Aradillas-García ◽  
Martha Rodríguez-Morán ◽  
María Eugenia Garay-Sevilla ◽  
Juan Manuel Malacara ◽  
Ramón Alberto Rascon-Pacheco ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Children And Adolescents ◽  
Fasting Glucose ◽  
Population Based ◽  
Healthy Children ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Mexican Children

ObjectiveSeveral cutoff points of the homeostasis model assessment of insulin resistance (HOMA-IR; varying from 2.5 to 4.0) have been suggested for diagnosing IR in youth. In this study, we determined the distribution of the HOMA-IR in Mexican children and adolescents.Design and methodsA total of 6132 children and adolescents from San Luis Potosi, León, Queretaro, and Durango, which are cities in central and northern Mexico, were enrolled in a population-based cross-sectional study. Eligible participants were apparently healthy children and adolescents aged 6–18 years. Pregnancy and the presence of chronic illnesses were exclusion criteria.ResultsA total of 3701 (60.3%) girls and 2431 (39.7%) boys were included in this study. In the overall population, the mean body mass index, insulin levels, and fasting glucose levels were 21.8±1.3 kg/m2, 7.1±3.2 μU/ml, and 86.2±10.0 mg/dl respectively. The concentrations of insulin and fasting glucose gradually increased from 6 to 12 years of age, whereas the concentrations tended to plateau in the 13- to 18-year-old population. The absolute mean of the HOMA-IR was 2.89±0.7. The HOMA-IR gradually increased with age and reached a plateau at 13 years of age.ConclusionsBecause the insulin concentrations, glucose levels, and HOMA-IR exhibited a gradual increase with age that was not related to obesity, our results suggested that the evaluation of IR in children should be based on percentiles of the HOMA-IR rather than a dichotomous value derived from a single cutoff point.

scholarly journals Serum vaspin levels in hypothyroid patients

2011 ◽  
Vol 165 (4) ◽  
pp. 563-569 ◽  
Author(s):  
Neşe Çinar ◽  
Neşe Ersöz Gülçelik ◽  
Kadriye Aydín ◽  
Şafak Akín ◽  
Aydan Usman ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Animal Studies ◽  
Fasting Glucose ◽  
Resistance Index ◽  
The Body ◽  
Model Assessment ◽  
Free Triiodothyronine ◽  
Significant Difference ◽  
Before And After ◽  
Hypothyroid Patients

ObjectiveTo elucidate the link between TSH and obesity, the relationship between TSH and adipocytokines were previously studied. Animal studies demonstrated a possible relationship between vaspin levels and thyroid functions. In this study, we aimed to investigate vaspin levels in hypothyroid states and its relationship with insulin resistance parameters in humans.DesignProspective observational study.MethodsWe enrolled 27 overt hypothyroid, 33 subclinical hypothyroid and 41 euthyroid patients. We measured the body mass index (BMI), fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), lipid profile, TSH, free triiodothyronine, free thyroxine and vaspin levels. The change in vaspin levels in 12 overt hypothyroid patients after establishment of euthyroidism was analysed.ResultsAll groups were age-matched. Overt hypothyroid group had higher BMI values (P<0.05) than other groups. No significant difference was observed in insulin levels and HOMA-IR among the groups (P>0.05). Adjusted vaspin levels for BMI and age were similar among the groups. Mean vaspin levels in overt, subclinical and euthyroid patients were 1.20±1.17, 1.48±0.93 and 0.95±0.75 ng/ml respectively (P>0.05). There was no significant association between vaspin levels and BMI, fasting glucose, insulin and HOMA-IR (P>0.05). Establishing euthyroidism in hypothyroid patients did not result in a significant change in vaspin levels (before and after treatment, 1.35±1.06 and 1.25±0.68 ng/ml, respectively; P>0.05).ConclusionWe herein present novel data indicating vaspin levels are neither altered in overt and subclinical hypothyroidism nor have a relationship with features of insulin resistance in hypothyroid patients.

scholarly journals Rice and noodle consumption is associated with insulin resistance and hyperglycaemia in an Asian population

2013 ◽  
Vol 111 (6) ◽  
pp. 1118-1128 ◽  
Author(s):  
Yasmin L. M. Zuñiga ◽  
Salome A. Rebello ◽  
Puay Leng Oi ◽  
Huili Zheng ◽  
Jeannette Lee ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Cell Function ◽  
Fasting Glucose ◽  
Asian Population ◽  
Hdl Cholesterol ◽  
Population Based ◽  
Model Assessment ◽  
Homa Index ◽  
Cross Sectional ◽  
High Consumption

High consumption of refined grains, particularly white rice, has been reported to be associated with a higher risk of type 2 diabetes. Therefore, in the present study, we evaluated the association between rice and noodle consumption and markers of glucose homeostasis, inflammation and dyslipidaemia in an Asian population. We carried out a population-based cross-sectional study in 2728 Singaporean Chinese men and women aged between 24 and 92 years. Rice and noodle intake was assessed using a validated FFQ and studied in relation to glycaemic (fasting glucose, glycated Hb, homeostasis model assessment (HOMA) index for insulin resistance (HOMA-IR) and HOMA index for β-cell function (HOMA-β)), inflammatory (plasma adiponectin and C-reactive protein (CRP)) and lipid (fasting TAG and HDL-cholesterol (HDL-C)) markers. We used multiple linear regression analyses with adjustment for total energy intake and sociodemographic, anthropometric (BMI and waist:hip ratio) and lifestyle factors. Higher rice consumption was found to be associated with higher fasting glucose concentrations (0·81 % higher values per portion increment; 95 % CI 0·09, 1·54) and HOMA-IR (4·62 %; 95 % CI 1·29, 8·07). Higher noodle consumption was also found to be significantly associated with higher fasting glucose concentrations (1·67 %; 95 % CI 0·44, 2·92), HOMA-IR (6·17 %; 95 % CI 0·49, 12·16) and fasting TAG concentrations (9·17 %; 95 % CI 3·44, 15·22). No significant association was observed between rice and noodle consumption and adiponectin, CRP and HDL-C concentrations or HOMA-β in the fully adjusted model. These results suggest that high consumption of rice and noodles may contribute to hyperglycaemia through greater insulin resistance and that this relationship is independent of adiposity and systemic inflammation.

scholarly journals Case–control study of markers of insulin resistance and endometrial cancer risk

2012 ◽  
Vol 19 (6) ◽  
pp. 785-792 ◽  
Author(s):  
Christine M Friedenreich ◽  
Annie R Langley ◽  
Thomas P Speidel ◽  
David C W Lau ◽  
Kerry S Courneya ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Endometrial Cancer ◽  
Cancer Risk ◽  
Case Control Study ◽  
Fasting Glucose ◽  
Population Based ◽  
Case Control ◽  
Model Assessment ◽  
Endometrial Cancer Risk ◽  
Control Study

Markers of insulin resistance such as the adiponectin:leptin ratio (A:L) and the homeostasis model assessment ratio (HOMA-IR) are associated with obesity and hyperinsulinemia, both established risk factors for endometrial cancer, and may therefore be informative regarding endometrial cancer risk. This study investigated the association between endometrial cancer risk and markers of insulin resistance, namely adiponectin, leptin, the A:L ratio, insulin, fasting glucose, and the HOMA-IR. We analyzed data from 541 incident endometrial cancer cases and 961 frequency age-matched controls in a population-based case–control study in Alberta, Canada from 2002 to 2006. Participants completed interview-administered questionnaires were assessed for anthropometric measures, and provided 8-h fasting blood samples either pre- or postoperatively. Blood was analyzed for concentrations of leptin, adiponectin, and insulin by immunoassay, and fasting plasma glucose levels were determined by fluorimetric quantitative determination. Compared with the lowest quartile, the highest quartile of insulin and HOMA-IR was associated with 64% (95% confidence intervals (CI): 1.12–2.40) and 72% (95% CI: 1.17–2.53) increased risks of endometrial cancer, respectively, and the highest quartile of adiponectin was associated with a 45% (95% CI: 0.37–0.80) decreased risk after multivariable adjustments. Null associations were observed between fasting glucose, leptin and A:L, and endometrial cancer risk. This population-based study provides evidence for a role of insulin resistance in endometrial cancer etiology and may provide one possible pathway whereby obesity increases the risk of this common cancer. Interventions aimed at decreasing both obesity and insulin resistance may decrease endometrial cancer risk.

scholarly journals A comparative study of insulin resistance in acne vulgaris

2017 ◽  
Vol 3 (3) ◽  
pp. 403
Author(s):  
Prathima Munichandrappa ◽  
Manjunath K. G. ◽  
Kiran C. ◽  
Anirudh Variyar
Keyword(s):  
Insulin Resistance ◽  
Fasting Glucose ◽  
Acne Vulgaris ◽  
Model Assessment ◽  
Fasting Insulin ◽  
Homeostasis Model Assessment ◽  
Insulin Levels ◽  
Glucose Levels ◽  
Significant Difference

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Acne is common skin problem among adolescents and young adults. Recently the role of insulin resistance in acne is being widely researched.</span>The o<span lang="EN-IN">bjectives of the study were to evaluate insulin resistance in acne, to compare the insulin resistance among cases and controls using homeostasis model assessment of insulin resistance</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">45 cases and 45 controls were recruited. Acne severity was graded using the global acne grading system(GAGS). Fasting glucose, fasting insulin levels were done and insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA-IR)</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We did not find any statistically significant difference in fasting insulin levels between cases and controls. However, a weak positive correlation between acne severity and fasting insulin levels (r =0.3, p=0.04) were observed. Fasting glucose levels and HOMA-IR values observed between cases and controls were not statistically significant (p=0.05, p=0.59 respectively). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Our study did not suggest a major role of insulin resistance in acne.</span></p>

EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

2021 ◽  
pp. 000456322110269
Author(s):  
O E Okosieme ◽  
Medha Agrawal ◽  
Danyal Usman ◽  
Carol Evans
Keyword(s):  
Systematic Review ◽  
Reference Interval ◽  
First Trimester ◽  
Reference Intervals ◽  
Assay Method ◽  
Specific Reference ◽  
Upper Limits ◽  
Wide Range ◽  
Assay Methods ◽  
In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5–97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40–13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

2021 ◽  
Author(s):  
K Aaron Geno ◽  
Matthew S Reed ◽  
Mark A Cervinski ◽  
Robert D Nerenz
Keyword(s):  
Pregnant Women ◽  
Equilibrium Dialysis ◽  
Reference Interval ◽  
First Trimester ◽  
Reference Intervals ◽  
Free Thyroxine ◽  
Specific Reference ◽  
Childbearing Age ◽  
Thyroid Autoantibody ◽  
The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

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