Pediatr Gastroenterol Hepatol Nutr.  2016 Dec;19(4):251-258. 10.5223/pghn.2016.19.4.251.

Acanthosis Nigricans as a Clinical Predictor of Insulin Resistance in Obese Children

Affiliations
  • 1Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea. krmoon@chosun.ac.kr

Abstract

PURPOSE
This study aimed to evaluate the utility of acanthosis nigricans (AN) severity as an index for predicting insulin resistance in obese children.
METHODS
The subjects comprised 74 obese pediatric patients who attended the Department of Pediatrics at Chosun University Hospital between January 2013 and March 2016. Waist circumference; body mass index; blood pressure; fasting glucose and fasting insulin levels; lipid profile; aspartate transaminase, alanine transaminase, glycated hemoglobin, C-peptide, and uric acid levels; and homeostatic model assessment insulin resistance (HOMA-IR) and quantitative insulin check sensitivity index (QUICKI) scores were compared between subjects with AN and those without AN. Receiver operating characteristic curves were used to investigate the utility of the AN score in predicting insulin resistance. HOMA-IR and QUICKI were compared according to AN severity.
RESULTS
The With AN group had higher fasting insulin levels (24.1±21.0 mU/L vs. 9.8±3.6 mU/L, p<0.001) and HOMA-IR score (5.74±4.71 vs. 2.14±0.86, p<0.001) than the Without AN group. The AN score used to predict insulin resistance was 3 points or more (sensitivity 56.8%, specificity 83.9%). HOMA-IR scores increased with AN severity, from the Without AN group (mean, 2.15; 95% confidence interval [CI], 1.72-2.57) to the Mild AN (mean, 4.15; 95% CI, 3.04-5.25) and Severe AN groups (mean, 7.22; 95% CI, 5.08-9.35; p<0.001).
CONCLUSION
Insulin resistance worsens with increasing AN severity, and patients with Severe AN (AN score ≥3) are at increased risk of insulin resistance.

Keyword

Acanthosis nigricans; Insulin resistance; Hyperinsulinism; Pediatric obesity

MeSH Terms

Acanthosis Nigricans*
Alanine Transaminase
Aspartate Aminotransferases
Blood Pressure
Body Mass Index
C-Peptide
Child*
Fasting
Glucose
Hemoglobin A, Glycosylated
Humans
Hyperinsulinism
Insulin Resistance*
Insulin*
Pediatric Obesity
Pediatrics
ROC Curve
Sensitivity and Specificity
Uric Acid
Waist Circumference
Alanine Transaminase
Aspartate Aminotransferases
C-Peptide
Glucose
Insulin
Uric Acid

Figure

  • Fig. 1 Receiver operating characteristic curves for prediction of insulin resistance. ROC: receiver operating characteristic, AUC: area under curve, CI: confidence interval, AN: acanthosis nigricans, BMI: body mass index, WHtR: waist-to-height ratio. *p<0.05.

  • Fig. 2 Comparison of acanthosis nigricans (AN) severity in terms of homeostatic model assessment insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). The p-value from (A) one-way ANOVA and (B) Kruskal-Wallis test is given. AN: acanthosis nigricans.


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