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Incorporation of the fasting free fatty acid concentration into QUICKI improves its association with insulin sensitivity in adults, but not in children

R IJzerman, VU University medical center, Amsterdam, 1007 MB, Netherlands
C Stehouwer, Internal Medicine, University Hospital Maastricht, Maastricht, Netherlands
E Serne, VU University medical center, Amsterdam, Netherlands
J Voordouw, VU University medical center, Amsterdam, Netherlands
Y Smulders, VU University medical center, Amsterdam, Netherlands
H Delemarre, VU University medical center, Amsterdam, Netherlands
M van Weissenbruch, VU University medical center, Amsterdam, Netherlands

Correspondence: Richard IJzerman, Email: rg.ijzerman{at}vumc.nl

Abstract

Objective: Based on fasting insulin and glucose, indices of insulin sensitivity have been developed in adults. Recently, it has been demonstrated that incorporation of fasting free fatty acid (FFA) concentration improves the association with insulin sensitivity in adults. We investigated the association of clamp-derived insulin sensitivity with indices of insulin sensitivity derived from fasting blood in prepubertal children and adults, with and without incorporation of FFAs.

Design and Methods: We studied 59 healthy adults and 29 of their prepubertal children. We measured insulin sensitivity with the euglycemic hyperinsulinemic clamp. Based on fasting insulin and glucose, we estimated insulin sensitivity with the homeostasis model assessment (HOMA), the quantitive insulin sensitivity check index (QUICKI), and the revised QUICKI after incorporation of FFAs.

Results: The associations of HOMA and QUICKI with clamp-derived insulin sensitivity in children (r=-0.55 and r=0.54, respectively; P<0.01) were similar to those in adults (r=-0.54 and r=0.53, respectively; P<0.01). However, incorporation of FFAs into the QUICKI model resulted in an increase in the association in adults, but not in children (r=0.68 and r=0.48, respectively; P<0.01). Adding FFA levels to a regression model with glucose and insulin as independent variables resulted in an increase in the explained variance in clamp-derived insulin sensitivity in adults, but not in children (P value 0.004 in adults, 0.3 in children).

Conclusions: HOMA and QUICKI are associated with clamp-derived insulin sensitivity in children and adults. Incorporating fasting FFA levels into the QUICKI model improves its association with clamp-derived insulin sensitivity in adults, but not in children.