http://dx.doi.org/10.4082/kjfm.2016.37.3.188 • Korean J Fam Med 2016;37:188-196
Original Article eISSN: 2092-6715
Comparison of Surrogate Markers as Measures of Uncomplicated Insulin Resistance in Korean Adults Tae Jong Kim1, Hye Jung Kim1, Young Bae Kim2, Jee Yon Lee1, Hye Sun Lee3, Jung Hwa Hong3, Ji Won Lee1,* 1
Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Family Medicine, Seoul Red Cross Hospital, Seoul, Korea 3 Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea 2
Background: Metabolic syndrome (MS) is known to increase the risk of various cardiometabolic diseases and insulin resistance (IR) has known to have central role in the development of MS. Many surrogate indices of IR have been proposed and the detection of MS might be a suitable model for assessing the accuracy of surrogate indices. The aims of our study are to invest the most appropriate index by assessment of the diagnostic capacity of IR among each surrogate index and identifying cut-off values for discriminating uncomplicated MS in Korean adults. Methods: A cross-sectional study was performed, assessing 294 Korean adults, 85 of whom were diagnosed with uncomplicated MS. The sensitivities and specificities of five surrogate IR indices were compared to discriminate MS from healthy subjects; these included fasting serum insulin, homeostasis model assessment–insulin resistance index, quantitative insulin sensitivity check index, McAuley index, and Disse index. Correlations between each index value were assessed using Pearson’s and Spearman’s correlation methods. Results: The McAuley index showed the highest area under the curve (0.85), specificity (86.12%), accuracy (82.31%), positive predictive value (68.13%), and negative predictive value (88.67%) to distinguish MS, with a cut-off point of 5.3 defined. Correlation coefficients of the five indices showed that the McAuley index had the strongest correlation with IR. Conclusion: The McAuley index showed the best accuracy in the detection of MS as a surrogate marker of IR. To establish more effective and accurate standards of measuring IR, comprehensive and multi-scaled studies are required. Keywords: Metabolic Syndrome; Insulin Resistance; McAuley Index; Koreans
Received: August 31, 2014, Revised: January 8, 2016, Accepted: January 11, 2016 *Corresponding Author: Ji Won Lee Tel: +82-2-2228-2338, Fax: +82-2-362-2473, E-mail: [email protected]
Copyright © 2016 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
www.kjfm.or.kr 189
Tae Jong Kim, et al. • Markers of Insulin Resistance in Korean Adults
INTRODUCTION
McAuley index, and Disse index to discriminate uncomplicated MS
Metabolic syndrome (MS) is clinically identified as a cluster of cardio-
metabolic risks among Korean adults was assessed.
from normal controls. The ability of these indices to detect increased
vascular risk factors and metabolic imbalances such as central obesity, dyslipidemia, impaired glucose tolerance and dysregulation of blood pressure.1) MS increases the risk of cardiometabolic diseases, includ-
METHODS
ing type II diabetes and cardiovascular disease.2) Furthermore, the
1. Participants
prevalence of MS is increasing steadily in several Asian countries3) ow-
A total of 492 participants were recruited for this study (79.7% female).
ing to the influence of socioeconomic westernization, resulting in
Participants were recruited from those undergoing a medical check-
problems such as increasing obesity4,5) and reduced physical activity.6)
up at the division of family medicine in Gangnam Severance Hospital,
According to data from the Korean National Health and Nutrition Ex-
between October 2005 and January 2008. Each participant was indi-
amination Survey (1998–2007), the age-adjusted prevalence of MS in
vidually asked to complete a simple questionnaire to evaluate the risk
Korean adults has rapidly increased in recent years, from 24.9% in
of metabolic or cardiovascular disease, including questions regarding
1998 to 31.3% in 2007.5) Although the precise mechanism of MS patho-
past medical history, current medication, and smoking or alcohol con-
genesis is still unknown, many studies have revealed that insulin resis-
sumption. Smokers were defined as participants who currently or pre-
tance (IR) and related factors have a central role in the development of
viously smoked cigarettes daily and those who had smoked ≥5 packs
metabolic dysfunction.7) As IR is a central factor in the development of
(100 cigarettes) of cigarettes during their lifetime before the study
MS, the detection of MS may provide a suitable model to assess the
date.18) Non-smokers were defined as participants who had smoked
Original Article eISSN: 2092-6715
Comparison of Surrogate Markers as Measures of Uncomplicated Insulin Resistance in Korean Adults Tae Jong Kim1, Hye Jung Kim1, Young Bae Kim2, Jee Yon Lee1, Hye Sun Lee3, Jung Hwa Hong3, Ji Won Lee1,* 1
Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Family Medicine, Seoul Red Cross Hospital, Seoul, Korea 3 Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea 2
Background: Metabolic syndrome (MS) is known to increase the risk of various cardiometabolic diseases and insulin resistance (IR) has known to have central role in the development of MS. Many surrogate indices of IR have been proposed and the detection of MS might be a suitable model for assessing the accuracy of surrogate indices. The aims of our study are to invest the most appropriate index by assessment of the diagnostic capacity of IR among each surrogate index and identifying cut-off values for discriminating uncomplicated MS in Korean adults. Methods: A cross-sectional study was performed, assessing 294 Korean adults, 85 of whom were diagnosed with uncomplicated MS. The sensitivities and specificities of five surrogate IR indices were compared to discriminate MS from healthy subjects; these included fasting serum insulin, homeostasis model assessment–insulin resistance index, quantitative insulin sensitivity check index, McAuley index, and Disse index. Correlations between each index value were assessed using Pearson’s and Spearman’s correlation methods. Results: The McAuley index showed the highest area under the curve (0.85), specificity (86.12%), accuracy (82.31%), positive predictive value (68.13%), and negative predictive value (88.67%) to distinguish MS, with a cut-off point of 5.3 defined. Correlation coefficients of the five indices showed that the McAuley index had the strongest correlation with IR. Conclusion: The McAuley index showed the best accuracy in the detection of MS as a surrogate marker of IR. To establish more effective and accurate standards of measuring IR, comprehensive and multi-scaled studies are required. Keywords: Metabolic Syndrome; Insulin Resistance; McAuley Index; Koreans
Received: August 31, 2014, Revised: January 8, 2016, Accepted: January 11, 2016 *Corresponding Author: Ji Won Lee Tel: +82-2-2228-2338, Fax: +82-2-362-2473, E-mail: [email protected]
Copyright © 2016 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
www.kjfm.or.kr 189
Tae Jong Kim, et al. • Markers of Insulin Resistance in Korean Adults
INTRODUCTION
McAuley index, and Disse index to discriminate uncomplicated MS
Metabolic syndrome (MS) is clinically identified as a cluster of cardio-
metabolic risks among Korean adults was assessed.
from normal controls. The ability of these indices to detect increased
vascular risk factors and metabolic imbalances such as central obesity, dyslipidemia, impaired glucose tolerance and dysregulation of blood pressure.1) MS increases the risk of cardiometabolic diseases, includ-
METHODS
ing type II diabetes and cardiovascular disease.2) Furthermore, the
1. Participants
prevalence of MS is increasing steadily in several Asian countries3) ow-
A total of 492 participants were recruited for this study (79.7% female).
ing to the influence of socioeconomic westernization, resulting in
Participants were recruited from those undergoing a medical check-
problems such as increasing obesity4,5) and reduced physical activity.6)
up at the division of family medicine in Gangnam Severance Hospital,
According to data from the Korean National Health and Nutrition Ex-
between October 2005 and January 2008. Each participant was indi-
amination Survey (1998–2007), the age-adjusted prevalence of MS in
vidually asked to complete a simple questionnaire to evaluate the risk
Korean adults has rapidly increased in recent years, from 24.9% in
of metabolic or cardiovascular disease, including questions regarding
1998 to 31.3% in 2007.5) Although the precise mechanism of MS patho-
past medical history, current medication, and smoking or alcohol con-
genesis is still unknown, many studies have revealed that insulin resis-
sumption. Smokers were defined as participants who currently or pre-
tance (IR) and related factors have a central role in the development of
viously smoked cigarettes daily and those who had smoked ≥5 packs
metabolic dysfunction.7) As IR is a central factor in the development of
(100 cigarettes) of cigarettes during their lifetime before the study
MS, the detection of MS may provide a suitable model to assess the
date.18) Non-smokers were defined as participants who had smoked
