Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice

Authors

  • Joyce M Lee,

    Corresponding author
    1. Department of Pediatrics, Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
    2. Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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  • Matthew M Davis,

    1. Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
    2. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA
    3. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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  • Susan J Woolford,

    1. Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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  • James G Gurney

    1. Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Joyce M Lee, MD, MPH, University of Michigan, 300 NIB, Room 6E08, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
Tel: 734-615-3508;
fax: 734-764-2599;
e-mail: joyclee@umich.edu

Abstract

Abstract: We formally evaluated waist circumference (WC) percentile cutoffs for predicting insulin resistance (IR) and whether different cutoffs should be used for adolescents of different race/ethnicities. Analysis was performed for 1575 adolescents aged 12–18 yr from the National Health and Nutrition Examination Survey 1999–2002. Adolescents were classified as having IR if they had a homeostasis model assessment-insulin resistance level, a validated measure of IR, of >4.39, and WC percentile was classified according to previously published universal (all races combined) and race/ethnicity-specific WC percentile cutoffs. Receiver operating characteristic curves for predicting IR were constructed comparing the race/ethnicity-specific vs. universal WC percentile cutoffs, and area under the curve (AUC) was calculated. Comparing universal with race/ethnicity-specific WC percentiles, there were no significant differences in AUC for Black, Mexican-American, or White adolescents. Because race/ethnicity-specific thresholds did not discriminate better than universal WC thresholds, universal WC thresholds may be used effectively to identify adolescents with IR in primary care practices. A WC ≥75th or ≥90th percentile for all race/ethnicities combined would be appropriate to apply in clinical practice for identification of adolescents with IR, a risk factor for development of type 2 diabetes.

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