Original article
Prevalence of acanthosis nigricans and its association with hyperinsulinemia in New Mexico adolescents1

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Abstract

Purpose: To determine whether the association between acanthosis nigricans (AN) and hyperinsulinemia is independent of obesity and other variables.

Methods: A convenience sample of 675 New Mexico middle school students was screened to determine the presence of AN, obesity, and other variables, including: ethnicity, parental history of diabetes, and level of physical activity. Fasting glucose and insulin levels were drawn on 233 students to determine the association between risk factors and hyperinsulinemia.

Results: Acanthosis nigricans (AN) was present in 18.9% of students screened. Twenty-one percent of the subsample had hyperinsulinemia. Based on these results, the estimated prevalence of hyperinsulinemia among all middle school students in New Mexico was 8.9%. Forty-seven percent (47.2%) of students who had AN and were obese had hyperinsulinemia, compared with 2.4% of students who did not have either of these conditions. In multiple logistic regression analysis, AN and obesity were independently and positively associated with hyperinsulinemia, whereas physical activity was protective.

Conclusions: The high prevalence of risk factors in this population makes diabetes prevention a priority for public health action. AN screening is an easily performed, noninvasive method for identifying adolescents at risk for type 2 diabetes.

Section snippets

Study population

The research protocol was approved by the University of New Mexico Human Research Review Committee. Twelve schools (sixth, seventh, and eighth grades), geographically and ethnically representative of New Mexico middle schools, participated in the study. Several weeks before the screening, students were given information about diabetes and the project. An informed consent form which included permission for the student to be screened for AN and fasting insulin and glucose testing, signed by the

Characteristics of participants in AN screening

Of the 675 participants, 52.4% were female. The mean age was 13.5 years; the majority of the students (99.5%) were between 12 and 15 years of age. Forty-six percent (46.5%) of the students were Hispanic and 19% were Native American. More than one in four students (26.8%) were obese and 11.3% reported having a parent with diabetes.

Prevalence of AN

Of the 675 students, 128 (18.9%) had AN. The prevalence varied by ethnicity: 19.7% of Hispanic students and 38.6% of Native American students had AN compared with 4.7%

Discussion

When combined with obesity, AN substantially increased the predictive value for detecting adolescents with hyperinsulinemia. In addition, although obesity is associated with hyperinsulinemia and AN, we demonstrated that the presence of AN is an independent predictor of hyperinsulinemia in adolescents. Almost half of the students who were obese and had AN had hyperinsulinemia. Among Native Americans, more than one-fourth of the students are estimated to have hyperinsulinemia. When these

Acknowledgements

The authors acknowledge the financial support of the New Mexico Department of Health, Public Health Division. The authors particularly thank Charles Stuart, M.D., and Charles Gilkison, M.S.N., University of Texas Medical Branch at Galveston, for generously sharing their medical expertise and materials. Thanks also to David Espey, M.D., Ellen Kaufman, M.D., Susan Scott, M.D., and Pat Boyle, M.D. In addition, the authors thank all of the many New Mexico Public Health Division staff, school

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