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Homeostasis Model Assessment cut-off points related to metabolic syndrome in children and adolescents: a systematic review and meta-analysis

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Abstract

The aim of this study was to perform a systematic review and meta-analysis of cut-off points of Homeostasis Model Assessment (HOMA-IR) to determine metabolic syndrome (MetS) in children and adolescents. A literature search was conducted in MEDLINE (via PubMed), EMBASE, Web of Science, Proquest, and Scopus databases from their inception to June 2018. Random effects models for the diagnostic odds ratio (dOR) value computed by Moses’ constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the overall test performance. Six published studies were included in the meta-analysis that included 8732 children and adolescents. The region of HOMA-IR (i.e., dOR) associated with MetS range from 2.30 to 3.54. The pooled accuracy parameters from the studies that evaluated the diagnostic odds ratio of HOMA-IR ranged from 4.39 to 37.67.

Conclusion: the HOMA-IR test may be useful for early evaluating children and adolescents with insulin resistance (IR). Furthermore, they present a good diagnostic accuracy independently of the definition of MetS used. According to the studies, the HOMA-IR cut point to avoid MetS risk ranged from 2.30 to 3.59.

What is Known:

• There is no consensus to define the optimal cut-off point of Homeostasis Model Assessment–Insulin Resistance in children and adolescents associated with Metabolic Syndrome.

What is New:

• The Homeostasis Model Assessment–Insulin Resistance test may be useful for early evaluations in children and adolescents with insulin resistance and presents a good diagnostic accuracy independently of the definition of Metabolic Syndrome used.

• The Homeostasis Model Assessment–Insulin Resistance cut point to avoid Metabolic Syndrome risk ranged from 2.30 to 3.59

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Abbreviations

ATP III:

Adult Treatment Panel III

AUC:

Area under the curve

FGIR:

Fasted glucose/insulin ratio

IDF:

International Diabetes Federation

IR:

Insulin resistance

HSROC:

Hierarchical summary receiver operating characteristic curves

HOMA-IR:

Homeostasis Model Assessment–Insulin Resistance

MetS:

Metabolic syndrome

ROC:

Receiver operating characteristic curves

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies-2

QUICKI:

Quantitative insulin-sensitivity check index

MOOSE:

Meta-analysis of Observational Studies in Epidemiology.

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Author information

Authors and Affiliations

  1. Centro de estudios Socio-Sanitarios, Universidad de Castilla La Mancha, Cuenca, Spain

    Paola Arellano-Ruiz, Iván Cavero-Redondo, Diana Pozuelo-Carrascosa, Vicente Martínez-Vizcaíno & Monserrat Solera-Martinez

  2. Navarrabiomed, Complejo Hospitalario de Navarra (CHN), IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Navarra, Spain

    Antonio García-Hermoso

  3. Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile

    Antonio García-Hermoso

  4. Universidad Politécnica y artística del Paraguay, Asunción, Paraguay

    Iván Cavero-Redondo

  5. Facultad de Enfermería, Universidad de Castilla La Mancha, Cuenca, Spain

    Diana Pozuelo-Carrascosa

  6. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile

    Vicente Martínez-Vizcaíno

Authors
  1. Paola Arellano-Ruiz
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  2. Antonio García-Hermoso
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  3. Iván Cavero-Redondo
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  4. Diana Pozuelo-Carrascosa
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  5. Vicente Martínez-Vizcaíno
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  6. Monserrat Solera-Martinez
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Contributions

A-R conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.

C-R, P-C, and S-M designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.

G-H and M-V conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Antonio García-Hermoso.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

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Arellano-Ruiz, P., García-Hermoso, A., Cavero-Redondo, I. et al. Homeostasis Model Assessment cut-off points related to metabolic syndrome in children and adolescents: a systematic review and meta-analysis. Eur J Pediatr 178, 1813–1822 (2019). https://doi.org/10.1007/s00431-019-03464-y

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  • DOI: https://doi.org/10.1007/s00431-019-03464-y

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