Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Acanthosis Nigricans as a Clinical Predictor of Insulin Resistance in Obese Children

  • Koh, Young Kwon (Department of Pediatrics, Chosun University School of Medicine) ;
  • Lee, Jae Hee (Department of Pediatrics, Chosun University School of Medicine) ;
  • Kim, Eun Young (Department of Pediatrics, Chosun University School of Medicine) ;
  • Moon, Kyung Rye (Department of Pediatrics, Chosun University School of Medicine)
  • Received : 2016.09.05
  • Accepted : 2016.10.24
  • Published : 2016.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate the utility of acanthosis nigricans (AN) severity as an index for predicting insulin resistance in obese children. Methods: The subjects comprised 74 obese pediatric patients who attended the Department of Pediatrics at Chosun University Hospital between January 2013 and March 2016. Waist circumference; body mass index; blood pressure; fasting glucose and fasting insulin levels; lipid profile; aspartate transaminase, alanine transaminase, glycated hemoglobin, C-peptide, and uric acid levels; and homeostatic model assessment insulin resistance (HOMA-IR) and quantitative insulin check sensitivity index (QUICKI) scores were compared between subjects with AN and those without AN. Receiver operating characteristic curves were used to investigate the utility of the AN score in predicting insulin resistance. HOMA-IR and QUICKI were compared according to AN severity. Results: The With AN group had higher fasting insulin levels ($24.1{\pm}21.0\;mU/L$ vs. $9.8{\pm}3.6\;mU/L$, p<0.001) and HOMA-IR score ($5.74{\pm}4.71$ vs. $2.14{\pm}0.86$, p<0.001) than the Without AN group. The AN score used to predict insulin resistance was 3 points or more (sensitivity 56.8%, specificity 83.9%). HOMA-IR scores increased with AN severity, from the Without AN group (mean, 2.15; 95% confidence interval [CI], 1.72-2.57) to the Mild AN (mean, 4.15; 95% CI, 3.04-5.25) and Severe AN groups (mean, 7.22; 95% CI, 5.08-9.35; p<0.001). Conclusion: Insulin resistance worsens with increasing AN severity, and patients with Severe AN (AN score ${\geq}3$) are at increased risk of insulin resistance.

Keywords

References

  1. Seo JW. Obesity in children and adolescents. Korean J Pediatr 2009;52:1311-20. https://doi.org/10.3345/kjp.2009.52.12.1311
  2. Weiss R, Kaufman FR. Metabolic complications of childhood obesity: identifying and mitigating the risk. Diabetes Care 2008;31 Suppl 2:S310-6. https://doi.org/10.2337/dc08-s273
  3. Hong YM. Metabolic syndrome in children and adolescents. Korean J Pediatr 2009;52:737-44. https://doi.org/10.3345/kjp.2009.52.7.737
  4. Chueh HW, Cho GR, Yoo JH. Clinical significance of acanthosis nigricans in children and adolescents with obesity induced metabolic complications. Korean J Pediatr 2007;50:987-94. https://doi.org/10.3345/kjp.2007.50.10.987
  5. Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, et al. The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man. N Engl J Med 1976;294:739-45. https://doi.org/10.1056/NEJM197604012941401
  6. Dietz WH. Overweight in childhood and adolescence. N Engl J Med 2004;350:855-7. https://doi.org/10.1056/NEJMp048008
  7. Slyper AH, Kashmer L, Huang WM, Re'em Y. Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents. J Pediatr Endocrinol Metab 2014;27:1107-11.
  8. Patidar PP, Ramachandra P, Philip R, Saran S, Agarwal P, Gutch M, et al. Correlation of acanthosis nigricans with insulin resistance, anthropometric, and other metabolic parameters in diabetic Indians. Indian J Endocrinol Metab 2012;16:S436-7. https://doi.org/10.4103/2230-8210.95706
  9. Centers for Disease Control and Prevention. 2007 Korean National Growth Charts [Internet]. Osong: 2008 [cited 2008 Aug 21]. Available from: http://cdc.go.kr/CDC/notice/CdcKrInfo0201.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU1889&cid=1235.
  10. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500-3. https://doi.org/10.1542/peds.2004-1921
  11. Burke JP, Hale DE, Hazuda HP, Stern MP. A quantitative scale of acanthosis nigricans. Diabetes Care 1999;22:1655-9. https://doi.org/10.2337/diacare.22.10.1655
  12. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37 Suppl 1:S81-90. https://doi.org/10.2337/dc14-S081
  13. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
  14. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol 2007;56:901-16. https://doi.org/10.1016/j.jaad.2006.12.004
  15. Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol 2004;5:199-203. https://doi.org/10.2165/00128071-200405030-00008
  16. Dunaif A, Green G, Phelps RG, Lebwohl M, Futterweit W, Lewy L. Acanthosis nigricans, insulin action, and hyperandrogenism: clinical, histological, and biochemical findings. J Clin Endocrinol Metab 1991;73:590-5. https://doi.org/10.1210/jcem-73-3-590
  17. Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol 1994;31:1-19. https://doi.org/10.1016/S0190-9622(94)70128-8
  18. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med 1993;44:121-31. https://doi.org/10.1146/annurev.me.44.020193.001005
  19. Caprio S, Plewe G, Diamond MP, Simonson DC, Boulware SD, Sherwin RS, et al. Increased insulin secretion in puberty: a compensatory response to reductions in insulin sensitivity. J Pediatr 1989;114:963-7. https://doi.org/10.1016/S0022-3476(89)80438-X
  20. Stuart CA, Smith MM, Gilkison CR, Shaheb S, Stahn RM. Acanthosis nigricans among native Americans: an indicator of high diabetes risk. Am J Public Health 1994;84:1839-42. https://doi.org/10.2105/AJPH.84.11.1839
  21. Stuart CA, Peters EJ, Prince MJ, Richards G, Cavallo A, Meyer WJ 3rd. Insulin resistance with acanthosis nigricans: the roles of obesity and androgen excess. Metabolism 1986;35:197-205. https://doi.org/10.1016/0026-0495(86)90201-5
  22. Venkatswami S, Anandam S. Acanthosis nigricans: a flag for insulin resistance. J Endocrinol Metab Diabetes South Afr 2014;19:68-74. https://doi.org/10.1080/16089677.2014.11073603
  23. Noviarti D, Rini EA, Oenzil F. Association of resistin level with acanthosis nigricans in obese adolescents. Paediatr Indones 2016;56:32-6. https://doi.org/10.14238/pi56.1.2016.32-6
  24. Kong AS, Williams RL, Rhyne R, Urias-Sandoval V, Cardinali G, Weller NF, et al. Acanthosis nigricans: high prevalence and association with diabetes in a practice-based research network consortium--a PRImary care Multi-Ethnic network (PRIME Net) study. J Am Board Fam Med 2010;23:476-85. https://doi.org/10.3122/jabfm.2010.04.090221
  25. Yamazaki H, Ito S, Yoshida H. Acanthosis nigricans is a reliable cutaneous marker of insulin resistance in obese Japanese children. Pediatr Int 2003;45:701-5. https://doi.org/10.1111/j.1442-200X.2003.01812.x

Cited by

  1. Severe insulin resistance: pathologies vol.34, pp.6, 2016, https://doi.org/10.1002/pdi.2116
  2. Insulinoma masquerading as a loss of consciousness in a teenage girl: case report and literature review vol.2017, pp.1, 2016, https://doi.org/10.1186/s13633-017-0049-7
  3. Effectiveness and Safety of Metformin versus Canthex™ in Patients with Acanthosis Nigricans: A Randomized, Double-blind Controlled Trial vol.64, pp.2, 2019, https://doi.org/10.4103/ijd.ijd_417_17
  4. Changes in inflammatory markers correlated with increased testosterone after laparoscopic sleeve gastrectomy in obese Chinese men with acanthosis nigricans vol.46, pp.4, 2016, https://doi.org/10.1111/1346-8138.14783
  5. Acanthosis nigricans as a clinical marker of insulin resistance among overweight adolescents vol.24, pp.2, 2016, https://doi.org/10.6065/apem.2019.24.2.99
  6. Correlation of HOMA-IR with BMI-for-age percentile in children and adolescents from the Soconusco region of Chiapas, Mexico vol.67, pp.4, 2016, https://doi.org/10.15446/revfacmed.v67n4.67159
  7. Association of the Triglyceride/High-Density Lipoprotein Cholesterol Index with Insulin Resistance in a Pediatric Population in Northeast Mexico vol.18, pp.7, 2020, https://doi.org/10.1089/met.2020.0046
  8. Relationship of acanthosis nigricans with metabolic syndrome in obese children vol.33, pp.12, 2020, https://doi.org/10.1515/jpem-2020-0154
  9. Impact of Obesity and Being Overweight on the Immunogenicity to Live Attenuated Hepatitis A Vaccine in Children and Young Adults vol.9, pp.2, 2016, https://doi.org/10.3390/vaccines9020130