Acanthosis Nigricans Identifies Youth at High Risk for Metabolic Abnormalities

• Published in: The Journal of pediatrics Vol. 156; no. 1; pp. 87 - 92
• Main Authors: Brickman, Wendy J., MD, Huang, Jie, ScD, Silverman, Bernard L., MD, Metzger, Boyd E., MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 2010; Elsevier
• Subjects: Acanthosis Nigricans - epidemiology; Acanthosis Nigricans - metabolism; Adolescent; Biological and medical sciences; Blood Glucose - metabolism; Child; Dermatology; Dyskeratosis; Female; General aspects; Homeostasis - physiology; Humans; Insulin Resistance - physiology; Male; Medical sciences; Multivariate Analysis; Obesity - epidemiology; Pediatrics; Pigmentary diseases of the skin; Prevalence; Risk Assessment; Polycystic ovary syndrome; Impaired fasting glucose; Insulin sensitivity; Diabetes mellitus; DM; Glutamic acid decarboxylase; GAD; IFG; AN; With acanthosis nigricans; Body mass index; HDL; HOMA-IR; PCOS; High-density lipoprotein; Homeostasis model assessment of insulin resistance; Without acanthosis nigricans; IGT; Acanthosis nigricans; Impaired glucose tolerance; S i; BMI; Human; High; Dyskeratosis; Pediatrics; Skin disease; Pigmentation disorder; Hyperkeratosis; Adolescent; Anomaly; Metabolism
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2009.07.011

Objective To determine the prevalence of abnormal glucose homeostasis and cardiovascular risk factors in youth with acanthosis nigricans (AN). Study design Youth (8-14 years) were recruited from community pediatric offices. Each subject underwent a questionnaire, a targeted physical examination, and an oral glucose tolerance test. Results Subjects (n = 236) with AN of the neck (AN+) (60% Hispanic, 30% African American, 54% female, body mass index [BMI] z-score 2.3 kg/m2 ) and 51 youth without AN (65% Hispanic, 22% African American, 37% female, BMI z-score 2.1 kg/m2 ) completed the study. Twenty-nine percent of the AN+ group had abnormal glucose homeostasis, 27% had systolic blood pressure > 95th percentile, and 50% had high-density lipoprotein–cholesterol ≤5th percentile. Once corrected for sex, puberty, maternal education, and BMI z-score, AN remained significantly associated with insulin resistance and abnormal glucose homeostasis. For youth in the AN+ group, homeostasis model assessment of insulin resistance, female sex, and positive glutamic acid decarboxylase antibodies remained significantly and independently associated with impaired glucose tolerance. Conclusions Youth in the AN+ group had severe insulin resistance, and more than 1 in 4 already had abnormal glucose homeostasis. AN identified a high-risk population, for whom appropriate interventions have the potential to attenuate or even prevent the development of diabetes and further metabolic abnormalities.