Full text
| |
| Author(s): |
Brunna Sullara Vilela Rodrigues
Total Authors: 1
|
| Document type: | Master's Dissertation |
| Press: | Campinas, SP. |
| Institution: | Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas |
| Defense date: | 2016-03-23 |
| Examining board members: |
Bruno Geloneze Neto;
Patrícia Feliciano Pereira;
Marcelo Miranda de Oliveira Lima
|
| Advisor: | Bruno Geloneze Neto; Ana Carolina Junqueira Vasques |
| Abstract | |
Background: The major adverse metabolic consequences of obesity are associated with the development of insulin resistance (IR), specially the metabolic syndrome (MS), characterized by a clustering of cardiovascular risk factors in the same individual. The HOMA-AD index has recently been proposed as a surrogate maker for assessing insulin resistance. This index is a modification of HOMA-IR index that adds the serum adiponectin information to its denominator. Until now, no other study has proposed cutoff points for HOMA-AD. Objectives: evaluate the performance of the HOMA-AD index compared with the HOMA-IR as a surrogate marker of IR, as assessed by a hyperglycemic clamp, and to establish the cutoff value of the HOMA-AD. Methods: The Brazilian Metabolic Syndrome Study (BRAMS) is a cross-sectional multicenter survey. The data from 1,808 subjects met the desired criteria: 18-65 years old, BMI: 18.5-49.9 Kg/m² and non-diabetic. The IR was assessed by the surrogate indexes HOMA-IR and HOMA-AD (total sample) and by the hyperglycemic clamp (n=49). Metabolic syndrome was defined using the International Diabetes Federation criteria (2005). Results: For the IR assessed by the hyperglycemic clamp, the HOMA-AD demonstrated a greater coefficient of correlation (r = -0.64) compared with the HOMA-IR (r = -0.56); p < 0.0001. The HOMA-AD index showed greater coefficient correlation with most variables compared to the HOMA-IR for females, which did not occur with men. In the ROC analysis, compared with the HOMA-IR, the HOMA-AD showed higher values of the AUC for the identification of IR based on the clamp test (AUC: 0.844 vs. AUC: 0.804) and on the metabolic syndrome (AUC: 0.703 vs. AUC: 0.689), respectively; p<0.001 for all. However, the pairwise comparison did not suggest superiority for the HOMA-AD in either the comparison with the HOMA-IR in the diagnostic of IR during the clamp (p=0.307) or the metabolic syndrome status (p=0.339). Besides, the AUC for HOMA-AD did not showed superiority compared to HOMA-IR in men (AUC: 0.710 vs. AUC: 0.756), respectively. The optimal cutoff identified for the HOMA-AD for the diagnosis of IR was 0.51 [sensibility (95% CI) = 70.0 (63.5-75.9); specificity (95% CI) = 60.3 (56.8-63.6)] for females and 0.92 [sensibility (95% CI) = 77.5 (66.8 - 86.1); specificity (95% CI) = 54.2 (44.8 - 63.3)] for males. Conclusion: The HOMA-AD was demonstrated to be a useful surrogate marker for detecting IR. In men, the index has not demonstrated superiority compared to the HOMA-IR. However, the HOMA-AD index presented a similar performance as the HOMA-IR between adults women. Finally, adiponectin levels do not enhance accuracy to the HOMA-IR index when added to your denominator (AU) | |
| FAPESP's process: | 13/06195-8 - Validation of HOMA-AD index as a surrogate marker of insulin resistance - Brazilian Metabolic Syndrome Study (BRAMS) |
| Grantee: | Brunna Sullara Vilela Rodrigues |
| Support Opportunities: | Scholarships in Brazil - Master |