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Insulin resistance may be misdiagnosed by HOMA-IR in adults with greater fat-free mass: the ELSA-Brasil Study

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Abstract

Aims

Conflicting results have been reported on the association of fat-free mass (FFM) and insulin resistance (IR). This study sought to test the association of FFM and IR by indexing FFM to avoid collinearity with fat mass.

Methods

This cross-sectional study comprised 11,284 volunteers, aged 38–79 years. Body composition was assessed by multi-frequency bioelectrical impedance. FFM indexed to body surface area (FFMbsa) was calculated. IR and impaired glucose tolerance (IGT) were estimated with homeostatic model assessment of insulin resistance index (HOMA-IR) and 2-h oral glucose tolerance test (2h-OGTT), respectively.

Results

Percent body fat decreased from the 1st to the 5th quintile of FFMbsa in both women (Eta2 = 0.166) and men (Eta2 = 0.133). In women, fasting insulin (Eta2 = 0.002), glucose (Eta2 = 0.006), and HOMA-IR (Eta2 = 0.007) increased slightly, but 2-h plasma glucose (2-h PG) was similar across the quintiles of FFMbsa. In men, fasting insulin and HOMA-IR were similar across the quintiles of FFMbsa, whereas fasting glucose increased slightly (Eta2 = 0.002) and 2-h PG decreased (Eta2 = 0.005) toward the highest quintile of FFMbsa. The higher the odds ratio for IR, the greater the FFMbsa in both sexes. Differently, FFMbsa did not affect the odds of IGT in women, while in men the odds ratio for IGT was lower in the 5th quintile compared with the 1st quintile of FFMbsa.

Conclusions

Higher odds of IR associated with greater FFMbsa contrasted with lower odds of IGT associated with greater FFMbsa. IR may be misdiagnosed by HOMA-IR in adults with greater fat-free mass.

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Availability of supporting data

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

FFM:

Fat-free mass

IR:

Insulin resistance

FFMbsa:

Fat-free mass indexed to body surface area

HOMA-IR:

Homeostasis model assessment-insulin resistance

2-h PG:

2-h plasma glucose

IGT:

Impaired glucose tolerance

2h-OGTT:

2-h oral glucose tolerance test

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Acknowledgements

The authors thank all volunteers for their important contribution.

Funding

This study was funded by Brazilian Ministry of Health (Department of Science and Technology) and Ministry of Science, Technology and Innovation (FINEP, Financiadora de Estudos e Projetos), Grants No. 01 06 0010.00, 01 06 0212.00, 01 06 0300.00, 01 06 0278.00, 01 06 0115.00 and 01 06 0071.00 and CNPq (the National Council for Scientific and Technological Development).

Author information

Authors and Affiliations

  1. Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil

    Divanei Zaniqueli & José Geraldo Mill

  2. Department of Physiological Sciences, Federal University of Amazonas, Av. General Rodrigo Octavio Jordão Ramos 1200, Coroado I, Manaus, AM, 69067-005, Brazil

    Rafael de Oliveira Alvim

  3. Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Rosane Harter Griep

  4. Center for Clinical and Epidemiological Research, Medical School, University of São Paulo, São Paulo, SP, Brazil

    Isabela Martins Benseñor

  5. School of Medicine and Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Sandhi Maria Barreto

  6. Department of Internal Medicine, Medical School, University of São Paulo, São Paulo, SP, Brazil

    Paulo Andrade Lotufo

Authors
  1. Divanei Zaniqueli
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  2. Rafael de Oliveira Alvim
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  3. Rosane Harter Griep
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  4. Isabela Martins Benseñor
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  5. Sandhi Maria Barreto
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  6. Paulo Andrade Lotufo
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  7. José Geraldo Mill
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Contributions

DZ and ROA were involved in the conception and drafting of the manuscript. RHG, IMB, and SMB acquired and interpreted the data. PAL and JGM were involved in the final approval of the manuscript.

Corresponding author

Correspondence to Rafael de Oliveira Alvim.

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The authors declare that they have no conflict of interest.

Ethical standard statement

Ethical approval was obtained from the Ethics Committee of the six affiliated institutions. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed written consent was obtained from all volunteers.

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Zaniqueli, D., de Oliveira Alvim, R., Griep, R.H. et al. Insulin resistance may be misdiagnosed by HOMA-IR in adults with greater fat-free mass: the ELSA-Brasil Study. Acta Diabetol 58, 73–80 (2021). https://doi.org/10.1007/s00592-020-01594-6

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  • DOI: https://doi.org/10.1007/s00592-020-01594-6

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