한국 청소년의 HOMA-IR과 대사 위험 요소와의 연관성
HOMA-IR and Its Association with Metabolic Risk Factors among Korean Adolescents
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study was performed to evaluate the distribution of homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance, and its association with metabolic risk factors among Korean adolescents. Methods: This study was based on data from Korean National Health and Nutrition Examination Survey (KNHANES) 2008∼2009. Data from 2,035 adolescents (1,053 boys, 982 girls; aged 10∼19 years) were analyzed. We classified all subjects into four groups, based on the quartiles of HOMA-IR, and the highest quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis to determine the independent risk factors for insulin resistance. Results: The highest quartile values of HOMA-IR representing insulin resistance were 3.4 for boys and 3.6 for girls. Mean body mass index, waist circumference, systolic blood pressure, serum triglyceride, alanine aminotransferase (ALT), fasting glucose and insulin increased, whereas HDL cholesterol decreased with increased HOMA-IR. We found HOMA-IR has significant positive correlation with waist circumference, triglyceride, ALT level and systolic/diastolic blood pressure, while it has negative correlation with HDL-cholesterol level (p<0.005). Independent predictors (odds ratio) for insulin resistance were elevated ALT (3.53 for boys; 4.04 for girls), central obesity (3.01 for boys; 3.20 for girls), and hypertriglyceridemia (3.03 for boys; 1.94 for girls). Conclusion: Metabolic risk factors were strongly associated with insulin resistance, defined as highest quartile values of HOMA-IR (≥3.4 for boys and ≥3.6 for girls). These values could be useful as a marker of insulin resistance and metabolic risk in Korean adolescents. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 376∼384)
Abstract
Purpose: This study was performed to evaluate the distribution of homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance, and its association with metabolic risk factors among Korean adolescents. Methods: This study was based on data from Korean National Health and Nutrition Examination Survey (KNHANES) 2008∼2009. Data from 2,035 adolescents (1,053 boys, 982 girls; aged 10∼19 years) were analyzed. We classified all subjects into four groups, based on the quartiles of HOMA-IR, and the highest quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis to determine the independent risk factors for insulin resistance. Results: The highest quartile values of HOMA-IR representing insulin resistance were 3.4 for boys and 3.6 for girls. Mean body mass index, waist circumference, systolic blood pressure, serum triglyceride, alanine aminotransferase (ALT), fasting glucose and insulin increased, whereas HDL cholesterol decreased with increased HOMA-IR. We found HOMA-IR has significant positive correlation with waist circumference, triglyceride, ALT level and systolic/diastolic blood pressure, while it has negative correlation with HDL-cholesterol level (p<0.005). Independent predictors (odds ratio) for insulin resistance were elevated ALT (3.53 for boys; 4.04 for girls), central obesity (3.01 for boys; 3.20 for girls), and hypertriglyceridemia (3.03 for boys; 1.94 for girls). Conclusion: Metabolic risk factors were strongly associated with insulin resistance, defined as highest quartile values of HOMA-IR (≥3.4 for boys and ≥3.6 for girls). These values could be useful as a marker of insulin resistance and metabolic risk in Korean adolescents. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 376∼384)
참고문헌 (40)
- 추미애, "의학강좌", 한국 소아청소년 비만과 대사 증후군, 2010, pp.53(2), 142~152[DOI]
- 오경원, "한국 소아청소년의 비만 유병률 추이: 1997년과 2005년 비교", Korean Journal of Pediatrics, 51(9), pp.950~955 (2008), 대한소아과학회
- Park MJ, "Prevalence and Trends of Metabolic Syndrome Among Korean Adolescents: From the Korean NHANES Survey, 1998-2005", Journal Of Pediatrics, 155, pp.529~534 (2009), MOSBY-ELSEVIER
- Groop L, "Orho-Melander M. The dysmetabolic syndrome", J Intern Med, 250, pp.105~120 (2001)
- Reaven GM, "Banting Lecture 1988. Role of insulin resistance in human disease", Diabetes, 37, pp.1597~1607 (1988)
- 박미정, "소아청소년에서의 대사증후군 역학", Korean Journal of Pediatrics, 51(6), pp.564~568 (2008), 대한소아과학회
- Song Y, "Secular trends in dietary patterns and obesity-related risk factors in Korean adolescents aged 10-19 years", Int J Obes, 34, pp.48~56 (2010)
- Long SD, "Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study", Diabetes Care, 17, pp.372~375 (1994)
- Bergman RN, "Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose", J Clin Invest, 68, pp.1456~1467 (1981)
- Matthews DR, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Kenskin M, "Homeostasis model assessment is more reliable than the fasting glucose", insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents, 2005, pp.115, 500~503
- "Korean National Health and Nutrition Examination Survey (KNHANES) IV progress report"[URL]
- 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망", Korean Journal of Pediatrics, 51(1), pp.1~25 (2008), 대한소아과학회
- Zimmet P, "IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report", Pediatr Diabetes, 8, pp.299~306 (2007)
- Cook S, "Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994", Arch Pediatr Adolesc Med, 15, pp.821~827 (2003)
- Kang HS, "Healthy range for serum ALT and the clinical significance of “unhealthy” normal ALT levels in the Korean population", J Gastroenterol Hepatol, 26, pp.292~299 (2011)
- McAuley KA, "Diagnosing insulin resistance in the general population", Diabetes Care, 24, pp.460~464 (2001)
- Goran MI, "Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents", J Clin Endocrinol Metab, 88, pp.1417~1427 (2003)
- Moran A, "Insulin resistance during puberty: results from clamp studies in 357 children", Diabetes, 48, pp.2039~2044 (1999)
- Goran MI, "Longitudinal study on pubertal insulin resistance", Diabetes, 50, pp.2444~2450 (2001)
- Hirschler V, "Are girls more insulin-resistant than boys", Clin Biochem, 42, pp.1051~1056 (2009)
- Lee JM, "Prevalence and determinants of insulin resistance among U.S. adolescents: a population based study", Diabetes Care, 29, pp.2427~2432 (2006)
- Bao W, "Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. The Bogalusa Heart Study", Circulation, 93, pp.54~59 (1996)
- Balkau B, "Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR)", Diabet Med, 16, pp.442~443 (1999)
- Kang HT, "The association between the ratio of triglyceride to HDL-C and insulin resistance according to waist circumference in a rural Korean population", Nutr Metab Cardiovasc Dis, 14 (2011)
- Kim CS, "Hyperinsulinemia and homeostasis model assessment of insulin resistance as predictors of hypertension: a 5-year follow-up study of Korean sample", Am J Hypertens, 24, pp.1041~1045 (2011)
- Ausk KJ, "Insulin resistance predicts mortality in nondiabetic individuals in the U.S", Diabetes Care, 33, pp.1179~1185 (2010)
- Pande RL, "Association of insulin resistance and inflammation with peripheral arterial disease: the National Health and Nutrition Examination Survey, 1999 to 2004", Circulation, 118, pp.33~41 (2008)
- Cha BS, "Pathophysiology of insulin resistence, in Metabolic syndrome 2009. 2nd ed", pp.39~50 (2009), in publishing Co
- Sadur CN, "Insulin responsiveness of adipose tissue lipoprotein lipase is delayed but preserved in obesity", J Clin Endocrinol Metab, 59, pp.1176~1182 (1984)
- Golay A, "High density lipoprotein (HDL) metabolism in noninsulin-dependent diabetes mellitus: measurement of HDL turnover using titrated HDL", J Clin Endocrinol Metab, 65, pp.512~515 (1987)
- 김세영, "소아와 청소년에서 Adiponectin과 인슐린 저항성에 관한 연구", 대한소아내분비학회지, 12(1), pp.63~70 (2007), 대한소아내분비학회
- Ahn JG, "Factors related to complications of childhood obesity", J Korean Soc Pediatr Endocrinol, 11, pp.76~84 (2006)
- Sihoon Lee, "Cutoff Values of Surrogate Measures of Insulin Resistance for Metabolic Syndrome in Korean Non-diabetic Adults", Journal of Korean Medical Science, 21(4), pp.695~700 (2006), 대한의학회
- Choi HJ, "Predictors of insulin resistance in postmenopausal women", J Korean Soc Menopause, 16, pp.93~98 (2010)
- Amiel SA, "Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes", N Engl J Med, 315, pp.215~219 (1986)
- Steinberger J, "Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism)", Circulation, 107, pp.1148~1453 (2003)
- Clark JM, "The prevalence and etiology of elevated aminotransferase levels in the United States", Am J Gastroenterol, 98, pp.960~967 (2003)
- Vozarova B, "High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes", Diabetes, 51, pp.1889~1895 (2002)
- Hanley AJ, "Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study", Diabetes, 54, pp.3140~3147 (2005)
