Clinical biochemistry · 2017
Triglycerides and glycated hemoglobin for screening insulin resistance in obese patients.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Boursier Guilaine, Sultan Ariane, Molinari Nicolas, Maimoun Laurent, Boegner Catherine, Picandet Marion, Kuster Nils, Bargnoux Anne-Sophie, Badiou Stéphanie, Dupuy Anne-Marie, Cristol Jean-Paul, Avignon Antoine
Аннотация
OBJECTIVE: Assessment of insulin resistance (IR) is essential in non-diabetic patients with obesity. Thus study aims to identify the best determinants of IR and to propose an original approach for routine assessment of IR in obesity.
DESIGN AND PATIENTS: All adult with obesity defined by a body mass index ≥30kg/m2, evaluated in the Nutrition Department between January 2010 and January 2015 were included in this cross-sectional study. Patients with diabetes were excluded. IR was diagnosed according to the HOMA-IR. Based on a logistic regression, we determined a composite score of IR. We then tested the variables with a principal component analysis and a hierarchical clustering analysis.
RESULTS: A total of 498 patients with obesity were included. IR was associated with grade III obesity (OR=2.6[1.6-4.4], p<0.001), HbA1c≥5.7% (OR=2.6[1.7-4.0], p<0.001), hypertriglyceridemia >1.7mmol/l (OR=3.0[2.0-4.5], p<0.001) and age (OR=0.98[0.96-0.99], p=0.002). Exploratory visual analysis using factor map and clustering analysis revealed that lipid and carbohydrates metabolism abnormalities were correlated with insulin resistance but not with excessive fat accumulation and low-grade inflammation.
CONCLUSIONS: Our results highlight the interest of simple blood tests such as HbA1c and triglyceride determination, which associated with BMI, may be widely available tools for screening IR in obese patients.
DESIGN AND PATIENTS: All adult with obesity defined by a body mass index ≥30kg/m2, evaluated in the Nutrition Department between January 2010 and January 2015 were included in this cross-sectional study. Patients with diabetes were excluded. IR was diagnosed according to the HOMA-IR. Based on a logistic regression, we determined a composite score of IR. We then tested the variables with a principal component analysis and a hierarchical clustering analysis.
RESULTS: A total of 498 patients with obesity were included. IR was associated with grade III obesity (OR=2.6[1.6-4.4], p<0.001), HbA1c≥5.7% (OR=2.6[1.7-4.0], p<0.001), hypertriglyceridemia >1.7mmol/l (OR=3.0[2.0-4.5], p<0.001) and age (OR=0.98[0.96-0.99], p=0.002). Exploratory visual analysis using factor map and clustering analysis revealed that lipid and carbohydrates metabolism abnormalities were correlated with insulin resistance but not with excessive fat accumulation and low-grade inflammation.
CONCLUSIONS: Our results highlight the interest of simple blood tests such as HbA1c and triglyceride determination, which associated with BMI, may be widely available tools for screening IR in obese patients.