Low HDL-C is a non-fasting marker of insulin resistance in children

Erika L. Zevin; Amy L. Peterson; Ann Dodge; Xiao Zhang; Aaron L. Carrel

doi:10.1515/jpem-2021-0751

Article

Low HDL-C is a non-fasting marker of insulin resistance in children

Erika L. Zevin , Amy L. Peterson , Ann Dodge , Xiao Zhang and Aaron L. Carrel

Published/Copyright: June 2, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 7

Abstract

Objectives

Childhood obesity and associated comorbidities, including insulin resistance, are increasing in the United States. Our objectives were to (1) determine the prevalence of insulin resistance in children seen in dyslipidemia clinic and (2) evaluate which aspects of the lipid profile correlate with insulin resistance.

Methods

Children and adolescents seen in a specialized pediatric dyslipidemia clinic without secondary diagnoses known to alter the lipid panel were included. Simultaneous fasting lipid panel, insulin, and glucose levels were available in 572 children (50.5% male).

Results

Mean patient age was 15.0 ± 3.6 years with the majority being over 10 years of age (92.5%). Mean BMI was 29.8 ± 8.1 kg/m² and BMI standard deviation score was 1.80 ± 0.9. Mean HOMA-IR was 6.2 ± 5.7 with a range of 0.4–49.3, and interquartile range of 2.7–7.6. Triglyceride level had a positive correlation with HOMA-IR (p<0.001). HDL-C negatively correlated with HOMA-IR even controlling for triglyceride level by multivariate analysis (p=0.001) and HDL-C <30 mg/dL predicted IR with 41.5% PPV.

Conclusions

In children and adolescents with dyslipidemia, insulin resistance is common and significantly correlates with reduced HDL-C levels. Non-fasting samples are easier to obtain in children and low HDL-C, which is minimally affected on non-fasting samples, could be an easily obtained indicator of IR. Increasing detection of insulin resistance in children with dyslipidemia may provide greater opportunities for lifestyle interventions and possible pharmacotherapy to modify cardiovascular risk.

Keywords: dyslipidemia; HDL-C; insulin resistance

Corresponding author: Erika L. Zevin, MD, Assistant Professor of Clinical Pediatrics, Division of Pediatric Endocrinology and Diabetes, Indiana University School of Medicine, Riley Hospital 5960, PEND 705 Riley Hospital, Indianapolis, IN, 46202, USA, Phone: 317-944-3889, E-mail: ezevin@iu.edu

Funding source: National Institutes of Health

Award Identifier / Grant number: NIDDK T32 DK077586-11A1

Acknowledgments

We thank Dr. David Allen, Chair of Pediatric Endocrinology and Diabetes at University of Wisconsin-Madison, for his advice and editorial contributions. We also thank the entire Pediatric Preventative Cardiology Clinic at American Family Children’s Hospital in Madison, Wisconsin.

Research funding: Supported by the National Institutes of Health Postdoctoral Fellowship Grant (NIDDK T32 DK077586-11A1).
Author contributions: Conceptualization, design, and construction of the methodology of the project was performed by all authors involved. Formal analysis of the data was performed by Xiao Zhang, with direction from Dr. Zevin. The initial draft of the manuscript was composed by Dr. Zevin. Supervision was provided was Drs. Carrel and Peterson, as well as Ann Dodge. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Stock in Pfizer, Johnson and Johnson, and Merck owned by Ann Dodge MS RN CPNP. No other conflicts identified among other authors.
Informed consent: Not applicable.
Ethical approval: This study protocol was reviewed and approved by the University of Wisconsin Health Sciences Institutional Review Board.

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Received: 2021-12-13

Accepted: 2022-05-13

Published Online: 2022-06-02

Published in Print: 2022-07-26

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Articles in the same Issue

https://doi.org/10.1515/jpem-2021-0751

Keywords for this article

dyslipidemia; HDL-C; insulin resistance