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

¹ Department of Internal Medicine, Institute for Cardiovascular Research-Vrije Universiteit, VU University Medical Center, PO Box 7057, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands² Department of Paediatrics, Institute for Clinical and Experimental Neurosciences, VU University Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands³ Department of Internal Medicine, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands

(Correspondence should be addressed to R G Ijzerman; Email: rg.ijzerman{at}vumc.nl)

Objective: Based on fasting insulin and glucose, several indices of insulin sensitivity have been developed in adults. Recently, it has been demonstrated that incorporation of the 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 them are 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 quantitative insulin sensitivity check index (QUICKI), and the revised QUICKI after the incorporation of FFAs.

Results: The associations of HOMA and QUICKI with clamp-derived insulin sensitivity in children (r=–0.55 and 0.54 respectively; P<0.01) were similar to those in adults (r=–0.54 and 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 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 and 0.3 in children).

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

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