The association between metabolic syndrome components, low-grade systemic inflammation and insulin resistance in non-diabetic Indonesian adolescent male

Background and aims: Millions of people in Indonesia have diabetes. The cluster of metabolic abnormalities has long been identified as the risk factors for type 2 diabetes and is now commonly described as metabolic syndrome/MetS. Insulin resistance takes a key role in the process of the MetS and has even been hypothesized as its underlying cause. Clinical and epidemiologic studies also indicate that inflammatory factors might be correlated with IR. Prospective studies have proved that metabolic syndrome grows during childhood/adolescence and progresses to adulthood T2DM. The purpose of this study was to investigate relationships between metabolic syndrome components and low-grade systemic inflammation with insulin resistance in non-diabetic Indonesian adolescent male.

Methods: This was a cross-sectional analysis of non-diabetic adolescent male in Indonesian population (n = 128) aged between 18 and 22 years old. MetS components are based on NCEP ATP III (2004) modification for Asia Pacific population. Marker for low-grade systemic inflammation is hsCRP and insulin resistance was determined by HOMA-IR formula. Relevant measures were anthropometry, blood pressure, fasting insulin, serum glucose, lipid profiles and hsCRP.

Results: Of the 128 adolescent male, we found that 16 subjects (12.5%) have central obesity; 3 subjects (2.3%) have hyperglycemia; 26 subjects (20.3%) have low HDL-c; 19 subjects (14.8%) have high triacylglycerol; 45 subjects (35.2%) have hsCRP ≥1.0 mg/dL; 4 subjects (3.1%) have high blood pressure and 39 subjects (30.5%) have insulin resistance. The association of MetS components with the risk of insulin resistance is central obesity and high triacylglycerol with OR of 24.4 (95%CI: 5.19-114.42) and 9.4 (95%CI: 3.09-28.68) consecutively. We also found that low-grade systemic inflammation (hsCRP ≥1.0 mg/dL) was strongly associated with incident of insulin resistance with OR 5.2 (95%CI: 2.31-11.64). Meanwhile, we found that high triacylglycerol level is the solely one of five MetS components which has contribution to the incident of systemic low-grade inflammation with OR 3.9 (95%CI: 1.43-10.92).

Conclusion: Central obesity and high triacylglycerol level are the important MetS components associated with IR. Systemic low-grade inflammation has been associated with insulin resistance. Identification of obesity, high triacylglycerol and high hsCRP should be focused for prevention of type 2 diabetes in non-diabetic Indonesian adolescent male.