Cardiometabolic risk stratification in pediatric obesity: evaluating the clinical utility of fasting insulin and BMI standard deviation score (BMI-SDS)
An erratum to this article was published (Cardiovasc Diabetol, 1 Nov 2025 ↗)
Authors' conclusion
In children and adolescents with obesity, fasting insulin provides complementary information to BMI-SDS in identifying those with elevated cardiometabolic risk factors. While neither marker alone offers strong predictive accuracy, incorporating fasting insulin into clinical assessment may help prioritize individuals who require more detailed evaluation. An elevated fasting insulin value may warrant further investigation among children and adolescents with obesity, independent of obesity class based on BMI-SDS.
Study context
- Population
- Children and adolescents aged 3 to 18 years with obesity (712) and lean controls, international cohort712 with obesity
- Exposure
- Fasting insulin vs BMI-SDS for detecting cardiometabolic risk factors
- Lean controlsn = 99reference
- Outcome
- AUC for detecting cardiometabolic risk factors
Methodological detailsinternational cohort, diagnostic accuracy (ROC) analysis
- International cohort
- Diagnostic accuracy (ROC) analysis
Main finding
As reported in the abstract
- Higher AUC with fasting insulin than BMI-SDS for dyslipidemia, dysglycemia, and combined dyslipidemia, dysglycemia and hypertension
- Higher AUC with BMI-SDS than fasting insulin for hypertension
- Fasting insulin had an overall stronger association with cardiometabolic risk factors than BMI-SDS
Observational data: associations, not effects.
Further findings
Prevalence of dyslipidemia, dysglycemia and hypertension
- Elevated prevalence with increasing BMI-SDS classes and increasing fasting insulin quartiles
Logistic regression
- Same patterns as for AUC
Original publication
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