Obesity-related insulin resistance in adolescents: a systematic review and meta-analysis of observational studies

Abstract

Insulin resistance is common among obese adolescents; however, the extent of this problem is not clear. We conducted a systematic review of PubMed-Medline, CINAHL, The Web of Science, EMBASE and Scopus for observational studies evaluating components defining insulin resistance (insulin, C-peptide and homeostatic model assessment-insulin resistance [HOMA-IR]) in obese adolescents (12–18 years) versus non-obese adolescents. Our systematic review and meta-analysis followed the PRISMA guidelines. Data were combined using a random-effects model and summary statistics were calculated using the mean differences (MDs). 31 studies were included (n = 8655). In 26 studies, fasting insulin levels were higher in obese adolescents when compared to non-obese adolescents (MD = 64.11 pmol/L, 95%CI 49.48–78.75, p < 0.00001). In three studies, fasting C-peptide levels were higher in obese adolescents when compared to non-obese adolescents (MD = 0.29 nmol/L, 95%CI 0.22–0.36, p < 0.00001). In 24 studies, HOMA-IR values were higher in obese adolescents when compared to non-obese adolescents (MD = 2.22, 95%CI 1.78–2.67, p < 0.00001). Heterogeneity of effects among studies was moderate to high. Subgroup analyses showed similar results to the main analyses. Circulating insulin and C-peptide levels and HOMA-IR values were significantly higher in obese adolescents compared to those non-obese.

Chinese abstract

肥胖青少年中常见胰岛素抵抗；然而这个问题的具体程度仍不甚清楚。我们对PubMed-Medline, CINAHL, The Web of Science, EMBASE 和Scopus 中评估肥胖青少年 (12-18岁) 和非肥胖青少年相比较胰岛素抵抗 (胰岛素水平, C-肽和稳态模型胰岛素抵抗[HOMA-IR]) 的观察性研究进行了系统综述。系统综述和meta分析遵循PRISMA指南, 使用随机模型组合数据, 并使用平均差 (MDs) 计算汇总统计。共纳入31项研究 (n = 8655) 。在26项研究中, 肥胖青少年的空腹胰岛素水平高于非肥胖青少年(MD =64.11 pmol/L, 95%CI 49.48–78.75,p＜0.00001)。在三个研究中, 肥胖青少年的空腹C肽水平高于非肥胖青少年(MD =0.29 nmol/L, 95%CI 0.22–0.36,p＜0.00001)。在24个研究中, 与非肥胖青少年相比, 肥胖青少年的HOMAIR水平更高(MD =2.22, 95%CI 1.78–2.67,p＜0.00001)。各研究间影响的异质性为中至高。亚组分析结果与主要研究结果相类似。与非肥胖青少年相比, 肥胖青少年的循环胰岛素, C肽水平和HOMA-IR值显著升高。

Keywords:

• Adolescence
• C-peptide
• HOMA-IR
• homeostatic model assessment-insulin resistance
• insulin resistance
• insulin
• obesity

Declaration of interest

The authors report no conflicts of interest. All authors wrote the first draft of the paper. All authors critically revised subsequent drafts. All authors read and approved the submitted version.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Supplementary material available online