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Insulin resistance in school-age children: comparison surrogate diagnostic markers

Pediatric Research (2025)Cite this article

Abstract

Background

This study aimed to identify surrogate markers suitable for evaluating insulin resistance in children and adolescents with overweight and obesity.

Methods

Forty-nine reported surrogate markers of insulin resistance were selected, including 14 insulin-based markers and 35 non-insulin-based markers. The markers were analyzed in 800 children aged 7–12 years. The demographic characteristics, physical measurements, and clinical indicators of these children were obtained through a cross-sectional study.

Results

27 surrogate markers of insulin resistance were associated with overweight and obesity in children. Insulin-based surrogate markers exhibited a strong linear relationship with HOMA-IR (r > 0.85). Markers such as CRP/HDL-C ratio, Castelli’s risk index I, and Castelli’s risk index II, which lack evidence from pediatric studies, showed a low linear correlation with HOMA-IR (r ≥ 0.2). Among non-insulin-based surrogate markers, comprehensive indicators such as TyG-WC, TyG-BMI, lipid accumulation product index (LAP), and METS-IR had better diagnostic value for insulin resistance (AUC > 0.8) than single markers. The ALT/AST ratio not only had a strong linear relationship with other surrogate markers but also had a strong diagnostic value for insulin resistance (AUC = 0.771).

Conclusions

Only some of the published surrogate markers of insulin resistance had good predictive power in school-age children, and the ALT/AST ratio is a good surrogate marker.

Impact

  • This study compared the role of 49 surrogate markers of insulin resistance in Chinese school-age children.

  • The ability of insulin-based surrogate markers to assess insulin resistance was stronger than that of non-insulin-based surrogate markers. Among non-insulin-based surrogate markers, comprehensive indicators such as TyG-WC, TyG-BMI, lipid accumulation product index, and METS-IR had better diagnostic value for insulin resistance than single markers.

  • The results of this study have great public health implications. The diagnostic value of the reported surrogate markers of insulin resistance was clarified, and the ALT/AST ratio was found to have a good evaluation effect on insulin resistance.

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Fig. 1
Fig. 2: Correlation of surrogate markers of insulin resistance in children with overweight and obesity.

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Data availability

The original contributions proposed in the study are included in the paper, further enquiries can be directed to the corresponding author.

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Funding

This work was supported by the key scientific research project plan of Henan Province (No. 24A330001), program for science and technology development in Henan Province (No. 232102310208, No. 252102311118), student innovation and entrepreneurship training program of Henan University (No. XJ2024337, No. XJ2024338).

Author information

Authors and Affiliations

  1. Department of Public Health and Epidemiology, School of Basic Medical Sciences, Henan University, Kaifeng, China

    Lu Zhang, Na Qiu, Tingting Luo, Mingjing Zhang, Jiajia Yang, Yingying Bao & Boran Huang

  2. Henan Provincial Engineering Center for Tumor Molecular Medicine, Kaifeng, China

    Lu Zhang & Yange Wang

  3. Department of Endocrinology, The First Affiliated Hospital of Henan University, Kaifeng, China

    Xiaoping Chen & Lijun Chu

  4. Department of Cell Biology and Genetics, School of Basic Medical Sciences, Henan University, Kaifeng, China

    Yange Wang

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  1. Lu Zhang
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  2. Na Qiu
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  3. Xiaoping Chen
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  5. Mingjing Zhang
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Contributions

L.Z. conceived and designed the study, and analyzed and drafted the manuscript. N.Q. and X.P.C. handled the data and revised the manuscript. T.T.L., M.J.Z., J.J.Y., Y.Y.B., B.R.H., L.J.C., and Y.G.W. collected the epidemiological and clinical data. All authors approved the final version.

Corresponding author

Correspondence to Lu Zhang.

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Informed consent was obtained by the parents or guardians of the participating children.

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Zhang, L., Qiu, N., Chen, X. et al. Insulin resistance in school-age children: comparison surrogate diagnostic markers. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04353-x

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