Wrist circumference a marker of insulin resistance in children and adolescents

Wrist circumference is an easily measurable marker of insulin resistance in overweight and obese children and adolescents and could potentially be used to predict cardiovascular disease risk, according to Italian researchers.

The study reported in Circulation provides the first evidence that wrist circumference is highly correlated with insulin resistance measures (fasting insulin and homeostasis model assessment of insulin resistance index [HOMA-IR]) in overweight/obese children and adolescents. Insulin resistance is a metabolic risk factor for future cardiovascular disease.

Excess body fat is associated with insulin resistance and other cardiovascular disease risk factors. Identification of young people at increased risk for obesity-related and insulin resistance−related complications is a clinical priority. Measurement of body fat using the body mass index (BMI) in children is problematic, however. Wrist circumference is an easy-to-detect measure of skeletal frame size that is not severely confounded by body fat variation.

In the current study, the researchers evaluated standard deviation score BMI (SDS-BMI), fasting biochemical parameters, and HOMA-IR in 477 overweight/obese children and adolescents. Wrist circumference was measured manually in all participants and by nuclear magnetic resonance imaging (NMR) in 51 of them. In a second data set of 160 children, waist circumference was also measured.

Fasting insulin and HOMA-IR were significantly associated with manually measured wrist circumference. These associations were stronger than those between SDS-BMI and fasting insulin and HOMA-IR. NMR imaging showed that the association between wrist circumference and insulin parameters reflected the association with transversal wrist bone tissue−related areas but not with adipose tissue areas.

Both wrist and waist circumference were significantly associated with insulin resistance measures. The researchers note, however, that wrist circumference is easily measurable and more reproducible than waist circumference. Wrist circumference could be considered in the classification of obesity for the prediction of insulin resistance and cardiovascular risk, they conclude.

Capizzi M, Leto G, Petrone A, et al. Wrist circumference is a clinical marker of insulin resistance in overweight and obese children and adolescents. Circulation. 2011;123(16):1757-1762.