Homeostasis Model Assessment cut-off points related to metabolic syndrome in children and adolescents: a systematic review and meta-analysis

The aim of this study was to perform a systematic review and meta-analysis of cut-off points of Homeostasis Model Assessment (HOMA-IR) to determine metabolic syndrome (MetS) in children and adolescents. A literature search was conducted in MEDLINE (via PubMed), EMBASE, Web of Science, Proquest, and Scopus databases from their inception to June 2018. Random effects models for the diagnostic odds ratio (dOR) value computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the overall test performance. Six published studies were included in the meta-analysis that included 8732 children and adolescents. The region of HOMA-IR (i.e., dOR) associated with MetS range from 2.30 to 3.54. The pooled accuracy parameters from the studies that evaluated the diagnostic odds ratio of HOMA-IR ranged from 4.39 to 37.67. Conclusion: the HOMA-IR test may be useful for early evaluating children and adolescents with insulin resistance (IR). Furthermore, they present a good diagnostic accuracy independently of the definition of MetS used. According to the studies, the HOMA-IR cut point to avoid MetS risk ranged from 2.30 to 3.59.What is Known:center dot There is no consensus to define the optimal cut-off point of Homeostasis Model Assessment-Insulin Resistance in children and adolescents associated with Metabolic Syndrome.What is New:center dot The Homeostasis Model Assessment-Insulin Resistance test may be useful for early evaluations in children and adolescents with insulin resistance and presents a good diagnostic accuracy independently of the definition of Metabolic Syndrome used.center dot The Homeostasis Model Assessment-Insulin Resistance cut point to avoid Metabolic Syndrome risk ranged from 2.30 to 3.59