Prevalence and Predictors of Insulin Resistance in Overweight and Obese Children and Adolescents: A Hospital-based Study

Main Article Content

Hebah Kutbi
Abdulmoein Al Agha


insulin resistance, body mass index, children, adolescents, overweight, obesity


Background/Aim: To estimate the prevalence and predictors of insulin resistance (IR) among overweight and obese children and adolescents.

Material and Methods: Data of this cross-sectional study included 62 overweight and obese children and adolescents (8-19 years of age), who visited the pediatric endocrinology clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants’ sociodemographic and health characteristics, dietary habits, physical activity, anthropometric measurements, and values of homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. Multiple regression analyses were conducted with [95% confidence intervals].

Results: Among our sample, 59.7% of the participants (n=37) were insulin resistant. Among the evaluated predictors, physical activity and waist circumference (WC) predicted the risk for IR (B=-0.218 [-0.410 to -0.26] and B=0.127 [0.001, 0.016], respectively). Examining the associations between HOMA-IR values and anthropometric measurements while stratifying by maternal educational status revealed that the associations between WC and waist-hip ratio with IR were mediated by maternal educational status, and those associations were only observed in children of less educated mothers (B=0.014 [0.004, 0.024] and B=2.156 [0.635, 3.676], respectively).

Conclusion: High prevalence of IR was observed among our sample. Future studies are needed to investigate the nationwide prevalence and predictors of IR among overweight and obese children and adolescents. Special attention should be paid to children of low-educated mothers for early detection and management.


Download data is not yet available.
Abstract 22 |


1. Cho N, Shaw J, Karuranga S, Huang Y, da Rocha Fernandes J, Ohlrogge A, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes research and clinical practice. 2018;138:271-81.
2. Abuyassin B, Laher I. Diabetes epidemic sweeping the Arab world. World journal of diabetes. 2016;7(8):165.
3. Al-Agha A, Ocheltree A, Shata N. Prevalence of hyperinsulinism, type 2 diabetes mellitus and metabolic syndrome among Saudi overweight and obese pediatric patients. Minerva Pediatr. 2012;64(6):623-31.
4. Al-Rubeaan K. National surveillance for type 1, type 2 diabetes and prediabetes among children and adolescents: a population-based study (SAUDI-DM). J Epidemiol Community Health. 2015;69(11):1045-51.
5. van Greevenbroek MM, Schalkwijk CG, Stehouwer CD. Obesity-associated low-grade inflammation in type 2 diabetes mellitus: causes and consequences. Neth J Med. 2013;71(4):174-87.
6. Friesen M, Cowan CA. Adipocyte metabolism and insulin signaling perturbations: insights from genetics. Trends Endocrinol Metab. 2019;30(6):396-406.
7. Lee S, Libman I, Hughan K, Kuk JL, Jeong JH, Zhang D, et al. Effects of exercise modality on insulin resistance and ectopic fat in adolescents with overweight and obesity: a randomized clinical trial. J Pediatr. 2019;206:91-8 e1.
8. Kelishadi R, Mirghaffari N, Poursafa P, Gidding SS. Lifestyle and environmental factors associated with inflammation, oxidative stress and insulin resistance in children. Atherosclerosis. 2009;203(1):311-9.
9. Peplies J, Börnhorst C, Günther K, Fraterman A, Russo P, Veidebaum T, et al. Longitudinal associations of lifestyle factors and weight status with insulin resistance (HOMA-IR) in preadolescent children: the large prospective cohort study IDEFICS. International Journal of Behavioral Nutrition and Physical Activity. 2016;13(1):97.
10. Vilela S, Muresan I, Correia D, Severo M, Lopes C. The role of socioeconomic factors in food consumption of Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016. Brit J Nutr. 2020:1-23.
11. Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry. 2012;24(3):176-88.
12. Hills AP, Andersen LB, Byrne NM. Physical activity and obesity in children. Br J Sports Med. 2011;45(11):866-70.
13. Sun Y, Liu B, Snetselaar LG, Wallace RB, Caan BJ, Rohan TE, et al. Association of normal-weight central obesity with all-cause and cause-specific mortality among postmenopausal women. JAMA Netw Open. 2019;2(7):e197337.
14. Cheong KC, Ghazali SM, Hock LK, Subenthiran S, Huey TC, Kuay LK, et al. The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race. Diabetes Metab Syndr. 2015;9(2):74-8.
15. Alotaibi A, Perry L, Gholizadeh L, Al-Ganmi A. Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview. J Epidemiol Glob Health. 2017;7(4):211-8.
16. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. 4th Edition ed. China: Lippincott Williams & Wilkins; 2013.
17. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi journal of anaesthesia. 2017;11(Suppl 1):S80.
18. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303.
19. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45(239):13-23.
20. Vereecken CA, Maes L. A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire. Public health nutrition. 2003;6(6):581-8.
21. Ridgers ND, Timperio A, Crawford D, Salmon J. Validity of a brief self-report instrument for assessing compliance with physical activity guidelines amongst adolescents. Journal of Science and Medicine in Sport. 2012;15(2):136-41.
22. Organization WH. Physical status: The use of and interpretation of anthropometry, Report of a WHO Expert Committee. 1995.
23. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660-7.
24. Garcia Cuartero B, Garcia Lacalle C, Jimenez Lobo C, Gonzalez Vergaz A, Calvo Rey C, Alcazar Villar MJ, et al. The HOMA and QUICKI indexes, and insulin and C-peptide levels in healthy children. Cut off points to identify metabolic syndrome in healthy children. An Pediatr (Barc). 2007;66(5):481-90.
25. Al-Hussaini A, Bashir MS, Khormi M, AlTuraiki M, Alkhamis W, Alrajhi M, et al. Overweight and obesity among Saudi children and adolescents: Where do we stand today? Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2019;25(4):229.
26. Valerio G, Licenziati MR, Iannuzzi A, Franzese A, Siani P, Riccardi G, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis. 2006;16(4):279-84.
27. Romualdo MC, Nobrega FJ, Escrivao MA. Insulin resistance in obese children and adolescents. J Pediatr (Rio J). 2014;90(6):600-7.
28. Taha D, Ahmed O, bin Sadiq B. The prevalence of metabolic syndrome and cardiovascular risk factors in a group of obese Saudi children and adolescents: a hospital-based study. Ann Saudi Med. 2009;29(5):357-60.
29. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes care. 2019;42(Supplement 1):S13-S28.
30. Nasreddine LM, Kassis AN, Ayoub JJ, Naja FA, Hwalla NC. Nutritional status and dietary intakes of children amid the nutrition transition: the case of the Eastern Mediterranean Region. Nutr Res. 2018;57:12-27.
31. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-8.
32. Al-Hazzaa HM. Physical inactivity in Saudi Arabia revisited: a systematic review of inactivity prevalence and perceived barriers to active living. International journal of health sciences. 2018;12(6):50.
33. Lim SM, Choi DP, Rhee Y, Kim HC. Association between obesity indices and insulin resistance among healthy Korean adolescents: the JS High School Study. PLoS One. 2015;10(5):e0125238.
34. Ling JC, Mohamed MN, Jalaludin MY, Rampal S, Zaharan NL, Mohamed Z. Determinants of high fasting insulin and insulin resistance among overweight/obese adolescents. Sci Rep. 2016;6:36270.
35. Wicklow BA, Becker A, Chateau D, Palmer K, Kozyrskij A, Sellers EA. Comparison of anthropometric measurements in children to predict metabolic syndrome in adolescence: analysis of prospective cohort data. Int J Obes (Lond). 2015;39(7):1070-8.
36. Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280(21):1843-8.
37. Lawlor DA, Harro M, Wedderkopp N, Andersen LB, Sardinha LB, Riddoch CJ, et al. Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study. Bmj. 2005;331(7510):183.
38. Rasmussen AR, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, Hagen CP, Tinggaard J, Mouritsen A, et al. Validity of self-assessment of pubertal maturation. Pediatrics. 2015;135(1):86-93.
39. Balzer BWR, Garden FL, Amatoury M, Luscombe GM, Paxton K, Hawke CI, et al. Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes. J Pediatr Endocrinol Metab. 2019;32(6):569-76.
40. Ali M. Adolescent Sexual Reproductive Health (ASRH) education: perspectives of muslims in South Asia and Middle East countries. Journal of Knowledge Globalization. 2018;10(2).

Most read articles by the same author(s)