Metabolic Profiles in Obese Children and Adolescents with Insulin Resistance


  • Marko Kostovski Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Viktor Simeonovski Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Kristina Mironska Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Velibor Tasic Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Zoran Gucev Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia



Childhood obesity, Obesity in adolescents, Insulin resistance, Homeostatic model assessment of insulin resistance, Metabolic parameters


BACKGROUND: In the past several decades, the increasing frequency of overweight and obese children and adolescents in the world has become a public health problem. It has contributed significantly to the already high tide of diabetes, cardiovascular and cerebrovascular diseases.

AIM: To investigate the frequency of insulin resistance and to evaluate the metabolic profile of insulin resistant and non-insulin resistant obese children and adolescents.

SUBJECTS AND METHODS: The study included 96 (45 boys, 51 girls) obese children and adolescents aged     4-17 years old (10.50 ± 2.87 years). Only participants with Body Mass Index ≥ 95 percentile were included.  We analysed sera for fasting insulin levels (FI), fasting serum triglycerides (TG), total serum cholesterol (TC), fasting plasma glucose (FPG) and plasma glucose 2 hours after the performance of the oral glucose tolerance test        (2-h G). Homeostatic model assessment for insulin resistance (HOMA-IR) index was calculated as fasting insulin concentration (microunits per millilitre) x fasting glucose concentration (millimolar)/22.5. The value of HOMA-IR above 3.16 was used as a cut-off value for both genders.

RESULTS: Insulin resistance was determined in 58.33% of study participants. Insulin resistant participants had significantly higher level of 2-h G (p = 0.02), FI level (p = 0.000) as well as TG levels (p = 0.01), compared to non-insulin resistant group. Strikingly, 70.73% of the pubertal adolescents were insulin resistant in comparison to 49.09% of the preadolescents (p = 0.03). Significantly higher percentage of insulin-resistant participants were girls (p = 0.009). Moreover, a higher percentage of the girls (70.59%) than boys (44.44%) had HOMA-IR above 3.16 and had elevated FI levels (70.59% vs 48.89%). The difference in the frequency of insulin resistance among obese versus severely obese children and adolescents was not significant (p = 0.73, p > 0.05). Our study results also showed positive, but weak, correlation of HOMA-IR with age, FPG, TG and BMI of the participants (p < 0.05).

CONCLUSION: Higher percentage of insulin-resistant participants was of female gender and was adolescents. In general, insulin resistant obese children and adolescents tend to have a worse metabolic profile in comparison to individuals without insulin resistance. It is of note that the highest insulin resistance was also linked with the highest concentrations of triglycerides.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


McMorrow AM, Connaughton RM, Lithander FE, et al. Adipose tissue dysregulation and metabolic consequences in childhood and adolescent obesity: potential impact of dietary fat quality. Proc Nutr Soc. 2015; 74(1):67-82. PMid:25497038

Morandi A, Maffeis C. Predictors of metabolic risk in childhood obesity. Horm Res Paediatr. 2014; 82(1):3-11. PMid:24923289

Lewandowska E, Zieliński A. White adipose tissue dysfunction observed in obesity. Pol Merkur Lekarski. 2016; 40(239):333-6. PMid: 27234867

Berenson GS. Obesity--a critical issue in preventive cardiology: the Bogalusa Heart Study. Prev Cardiol. 2005; 8(4):234-41; quiz 242-. PMid:16230878

Marcovecchio ML, Mohn A, Chiarelli F. Obesity and insulin resistance in children. J Pediatr Gastroenterol Nutr. 2010; 51(Suppl 3):S149-50. PMid:21088543

Ng M, Fleming T, Robinson M, et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: A systematic analysis. Lancet. 2014; 30; 384(9945):766-81.

Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc. 2017; 92: 251–65. PMid:28065514

Livingstone MBE. Epidemiology of childhood obesity in Europe. Eur J Pediatr 2000; 159(Suppl.1): S14–S34. PMid:11011953

Cunningham SA, Kramer MR, Narayan KM. Incidence of childhood obesity in the United States. N Engl J Med. 2014; 370(17):1660-1.

Cheung PC, Cunningham SA, Naryan KMV, et al. Childhood Obesity Incidence in the United States: A Systematic Review. Childhood Obesity. 2016; 12(1):1-11. PMid:26618249 PMCid:PMC4753627

Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017; 390(10113): 2627-2642.

Chiarelli F, Marcovecchio ML. Insulin resistance and obesity in childhood. Eur J Endocrinol. 2008; 159 (Suppl 1):S67-74. PMid:18805916

Levy-Marchal C, Arslanian S, Cutfield W, et al. Insulin Resistance in Children: Consensus, Perspective, and Future Directions. J Clin Endocrinol Metab. 2010; 95(12):5189-5198. PMid:20829185 PMCid:PMC3206517

Weiss R, Kaufman FR. Metabolic complications of childhood obesity: identifying and mitigating the risk. Diabetes Care. 2008; 31(Suppl 2):S310-6. PMid:18227502

Antuna-Puente B, Disse E, Rabasa-Lhoret R, et. al. How can we measure insulin sensitivity/resistance?. Diabetes Metab. 2011; 37(3):179-88. PMid:21435930

Gutch M, Kumar S, Razi SM, et al. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015; 19(1):160-164. PMid:25593845 PMCid:PMC4287763

Morrison JA, Glueck CJ, Horn PS, et. al. Homeostasis model assessment of insulin resistance*body mass index interactions at ages 9 to 10 years predict metabolic syndrome risk factor aggregate score at ages 18 to 19 years: a 10-year prospective study of black and white girls. Metabolism. 2009; 58(3):290-5. PMid:19217441

Morrison JA, Friedman LA, Wang P, et al. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr. 2008; 152(2):201-6. PMid:18206689

Morrison JA, Glueck CJ, Horn PS, et al. Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18-19 y: a 10-y prospective study of black and white girls. Am J Clin Nutr. 2008; 88(3):778-88. PMid:18779296

Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013; 13:47. PMid:24131857 PMCid:PMC4016563

Patel DA, Srinivasan SR, Chen W, et al. Serum Alanine Aminotransferase and Its Association with Metabolic Syndrome in Children: The Bogalusa Heart Study. Metabolic Syndrome and Related Disorders. 2011; 9(3):211-216. PMid:21476865 PMCid:PMC3125570

Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007; 120(Suppl 4):S164-92. PMid:18055651

Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013; 128(15):1689-712. PMid:24016455

Alberti KG, Zimmet PZ. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications Part 1 : Diagnosis and Classification of Diabetes Mellitus Provisional Report of a WHO Consultation. 1998; 15(7):539-553.

Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment:insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–419. PMid:3899825

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report. Pediatrics. 2011; 128(Suppl 5):S213–S256. PMid:22084329 PMCid:PMC4536582

American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care. 2016; 39(Suppl 1):S13-22. PMid:26696675

Reaven GM, Brand RJ, Chen YD, et. al. Insulin resistance and insulin secretion are determinants of oral glucose tolerance in normal individuals. Diabetes. 1993; 42(9):1324-32. PMid:8349044

Keskin M, Kurtoglu S, Kendirci M, et al. 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. Pediatrics. 2005; 115(4):500-503. PMid:15741351

Thota P, Perez-Lopez FR, Benites-Zapata VA et al. Obesity-related insulin resistance in adolescents: a systematic review and meta-analysis of observational studies. Gynecol Endocrinol. 2017; 33(3):179-184. PMid:28102091

Yin J, Li M, Xu L, et al. Insulin resistance determined by Homeostasis Model Assessment (HOMA) and associations with metabolic syndrome among Chinese children and teenagers. Diabetology & Metabolic Syndrome. 2013; 5:71. PMid:24228769 PMCid:PMC3833654

Ling JCY, Mohamed MNA, Jalaludin MY, et al. Determinants of High Fasting Insulin and Insulin Resistance Among Overweight/Obese Adolescents. Sci Rep. 2016; 6:36270. PMid:27824069 PMCid:PMC5099955

Romualdo MC, Nóbrega FJ, Escrivão MA. Insulin resistance in obese children and adolescents. J Pediatr (Rio J). 2014; 90(6):600-7. PMid:25019650

Nogueira-de-Almeida CA, Mello ED. Correlation of BMI Z-scores with glucose and lipid profiles among overweightand obese children and adolescents. J Pediatr (Rio J). 2017. PMid:28881179

Hrafnkelsson H, Magnusson KT, Sigurdsson EL, et al. Association of BMI and fasting insulin with cardiovascular disease risk factors in seven-year-old Icelandic children. Scand J Prim Health Care. 2009; 27(3):186-191. PMid:19731182 PMCid:PMC3413192

Murphy MJ, Metcalf BS, Voss LD, Jeffery et al. Girls at five are intrinsically more insulin resistant than boys: The Programming Hypotheses Revisited – The EarlyBird Study (EarlyBird 6). Pediatrics. 2004; 113(1):82-86. PMid:14702453

Moran A, Jacobs DR Jr, Steinberger J, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999; 48(10):2039-44. PMid:10512371

Libman IM, Barinas-Mitchell E, Bartucci A, et al. Fasting and 2-Hour Plasma Glucose and Insulin: Relationship with risk factors for cardiovascular disease in overweight nondiabetic children. Diabetes Care. 2010; 33(12):2674-2676. PMid:21115769 PMCid:PMC2992211

Bao W, Srinivasan SR, Berenson GS. Persistant elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. The Bogalusa Heart Study. Circulation. 1996; 93:54-9. PMid:8616941

Atabek ME, Pirgon O, Kurtoglu S. Assessment of abnormal glucose homeostasis and insulin resistance in Turkish obese children and adolescents. Diabetes Obes Metab. 2007; 9(3):304-10. PMid:17391156

Lentferink YE, Elst MAJ, Knibbe CAJ, et al. Predictors of Insulin Resistance in Children versus Adolescents with Obesity. J Obes. 2017; 2017:3793868. PMid:29375912 PMCid:PMC5742469

Kelsey MM, Zeitler PS. Insulin Resistance of Puberty. Curr Diab Rep. 2016; 16(7):64. PMid:27179965

Pilia S, Casini MR, Foschini ML, et al. The effect of puberty on insulin resistance in obese children. J Endocrinol Invest. 2009; 32(5):401-5. PMid:19794287

Manco M, Spreghini MR, Luciano R, et al. Insulin Sensitivity from Preschool to School Age in Patients with Severe Obesity. PLoS ONE. 2013;8(7):e68628. PMid:23935878 PMCid:PMC3729946

Lee JM. Insulin resistance in children and adolescents. Rev Endocr Metab Disord. 2006;7(3):141-7. PMid:17165145

Burt SCM, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction. 2010; 140(3):399-410. PMid:20802107 PMCid:PMC2931339

Onal ZE, Atasayan V, Gürbüz T, et al. Association of glycosylated hemoglobin (HbA1c) levels with Iinsulin resistance in obese children. Afr Health Sci. 2014; 14(3):533-8. PMid:25352869 PMCid:PMC4209635

Guerrero-Romero F, Aradillas-García C, Simental-Mendía LE, et al. Biochemical characteristics and risk factors for insulin resistance at different levels of obesity. Pediatrics. 2013; 131(4):e1211-7. PMid:23478864

Esteghamati A, Khalilzadeh O, Anvari M, et al. Metabolic syndrome and insulin resistance significantly correlate with body mass index. Arch Med Res. 2008; 39(8):803-8. PMid:18996295

Panag KMDS, Kaur N, Goyal G. Correlation of insulin resistance by various methods with fasting insulin in obese. Int J Appl Basic Med Res. 2014; 4(Suppl 1):S41-S45. PMid:25298942 PMCid:PMC4181131

Valerio G, Licenziati MR, Iannuzzi A, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis. 2006; 16(4):279-84. PMid:16679220

Viner R, Segal T, Lichtarowicz-Krynska E, Hindmarsh P. Prevalence of the insulin resistance syndrome in obesity. Arch Dis Child. 2005; 90(1):10-14. PMid:15613503 PMCid:PMC1720077

Hagman E, Arani PI, Fischer M, et. al. Blood sugar levels are higher in obese young children in Sweden than in Poland. Acta Paediatr. 2014; 103(11):1174-8. PMid:25060480

Hagman Е, Reinehr Т, J Kowalski Ј, et. al. Impaired fasting glucose prevalence in two nationwide cohorts of obese children and adolescents. Int J Obes (Lond). 2014; 38(1): 40–45. PMid:23828099 PMCid:PMC3884136

Yuri YPM, Pateda V, Tirtamulya K, et al. Profile of fasting blood glucose in obese children with insulin resistance. International Journal of Pediatric Endocrinology. 2013; 2013(Suppl 1):P100. PMCid:PMC3890975

Grandone A, Amato A, Luongo C, et. al. High-normal fasting glucose levels are associated with increased prevalence of impaired glucose tolerance in obese children. J Endocrinol Invest. 2008; 31(12):1098-102. PMid:19246977

Pulgaron ER, Delamater AM. Obesity and Type 2 Diabetes in Children: Epidemiology and Treatment. Curr Diab Rep. 2014; 14(8):508. PMid:24919749 PMCid:PMC4099943

Guglielmi V, Cardellini M, Cinti F et al. Omental adipose tissue fibrosis and insulin resistance in severe obesity. Nutr Diabetes. 2015; 10;5:e175.

Ricco RC, Ricco RG, Almeida CA, et al. Comparative study of risk factors among children and adolescents with an anthropometric diagnosis of overweight or obesity. Rev Paul Pediatr. 2010; 28(4):320-5.



How to Cite

Kostovski M, Simeonovski V, Mironska K, Tasic V, Gucev Z. Metabolic Profiles in Obese Children and Adolescents with Insulin Resistance. Open Access Maced J Med Sci [Internet]. 2018 Mar. 14 [cited 2022 Aug. 14];6(3):511-8. Available from:



B - Clinical Sciences

Most read articles by the same author(s)