Cardiometabolic Risk Clustering and Surrogate Markers of Insulin Resistance in Adolescents.

BACKGROUND: Adolescent obesity is increasingly linked to early insulin resistance (IR) and clustering of cardiometabolic abnormalities, including impaired glucose regulation, dyslipidemia, inflammation, and liver dysfunction. Identifying at-risk adolescents remains challenging due to physiological variability and a lack of standardized definitions. AIM: The aim of this study was to identify simple and reliable surrogate markers of IR and associated cardiometabolic risk in overweight and obese adolescents. MATERIALS AND METHODS: In this cross-sectional study, 182 adolescents aged 10-19 years underwent detailed anthropometric, clinical, and biochemical evaluation, including fasting glucose, insulin, lipid profile, alanine aminotransferase (ALT), uric acid, and high-sensitivity C-reactive protein (hs-CRP). IR was defined as homeostatic model assessment of IR (HOMA-IR) ≥2.5, and associations with demographic, anthropometric, lifestyle, dietary, clinical, and metabolic factors were analyzed. RESULTS: IR was identified in 62.6% of participants and was more common among obese and pubertal adolescents. Central obesity was present not only in the overweight and obese groups but also in 11.2% of normal-weight adolescents, indicating metabolic risk beyond body mass index (BMI). Measures of central adiposity, particularly waist-to-height ratio (WHtR), showed stronger associations with IR than BMI. IR-positive adolescents demonstrated clustering of metabolic, inflammatory, and hepatic abnormalities, including elevated glucose, insulin, triglycerides, triglyceride: high-density lipoprotein cholesterol (TG: HDL-C) ratio, hs-CRP, uric acid, and ALT, with reduced HDL-C. Acanthosis nigricans, low physical activity, poor sleep, and increased screen time were also more frequent. Metabolic syndrome was present in 13.18% of participants. CONCLUSION: IR and cardiometabolic risk are highly prevalent in adolescents with obesity. WHtR, TG: HDL-C ratio, ALT, hs-CRP, and acanthosis nigricans may serve as practical surrogate markers for identifying adolescents with HOMA-IR-defined IR and supporting early preventive strategies.