Abstract
Acantosis Nigricans (AN) has been proposed as an insulin resistance marker and an independent risk factor for type 2 diabetes (T2DM) in obese adolescents. The purpose of this study was to determine the association between AN and: a) Several insulin resistance markers (HOMA-IR, IGFBP1 levels, basal insulinemia), b) BMI (% body fat), c) HDL cholesterol, triglycerides and other risk factors for insulin resistance or T2DM. Study design: 1250 Hispanic adolescents (mean age 12.4 ± 1.4 years) who consulted the adolescent department for routine check-up between April and November 2001, were evaluated. 288 were obese (BMI > percentile 95); from this sample we took a randomized sample of 74 obese adolescents (40 females). Data for birth weight, positive family history for obesity and/or T2DM, BMI, presence of AN, blood pressure and Tanner stage, were obtained. OGTT test, lipid profile, insulinemia and IGF1BP1 test were performed. Statistical analysis: 95% CI of AN relative range was calculated according to Fleiss. X2 was used for statistically significant differences, and multiple regression analysis for non parametric correlations. Results: Of 74 obese adolescents, 41 had AN (55.4%); all of them were Tanner ≥ 2, and had a positive family history for obesity or T2DM. No statistically significant differences were observed for age and sex between the group with (41+) and without AN (33-). In the group with vs without AN, 4 vs 2 were glucose intolerant. None of the adolescents presented T2DM. A t test was used to compare adolescents with and without AN. There was no difference for all insulin index: HOMA IR (6.6 vs 4.9; p=0.19), basal insulinemia (27.3 vs 21.5; p=0.27), IGFBP1 (8.2 vs 8.3; p= 0.98) between the 2 groups. There was statistically signficant difference between the group with AN vs the group without AN in BMI (30.6 vs 27.3; p=0.00039), basal glucose( 5.3 vs 5; p=0.01), HDL cholesterol (39.2 vs 45.1; p=0.02), and birth weight (3.23 vs 3.61; p=0.0021). In the univariate analysis, there was association between AN and BMI (rS 0.45; p=0.00038), birth weight (rS -0.37; p=0.0021), basal glucose (rS 0.30; p=0.009), and HDL-C (rS -0.25; p=0.03). There was neither univariate nor multivariate association between AN and markers of insulin resistance: basal insulinemia (rS 016; p=0.16), HOMA IR (rS 0.2; p=0.06), and IGF1BP1 (rS 0.07; p=0.69). The presence of AN showed a positive correlation with BMI (OR:1.30; p=0.018) and a negative one with birth weight ( OR:0.23; p=0.03) in the multivariate analysis. Conclusions: There was a high rate of AN in our population (55.4%) of obese adolescents. There was no statistical difference in insulin resistance between obese adolescents with or without AN. There was a positive correlation between AN and BMI, suggesting that AN is a clinical sign for severe obesity, but not a reliable marker for insulin resistance in our population.
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Hirschler, V., Aranda, C., Oneto, A. et al. Is Acantosis Nigricans a Clinical Sign of Insulin Resistance in Obese Adolescents?. Pediatr Res 53, 872 (2003). https://doi.org/10.1203/00006450-200305000-00046
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DOI: https://doi.org/10.1203/00006450-200305000-00046