Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice

Joyce M. Lee*, Matthew M. Davis, Susan J. Woolford, James G. Gurney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


We formally evaluated waist circumference (WC) percentile cutoffs for predicting insulin resistance (IR) and whether different cutoffs should be used for adolescents of different race/ethnicities. Analysis was performed for 1575 adolescents aged 12-18 yr from the National Health and Nutrition Examination Survey 1999-2002. Adolescents were classified as having IR if they had a homeostasis model assessment-insulin resistance level, a validated measure of IR, of >4.39, and WC percentile was classified according to previously published universal (all races combined) and race/ethnicity-specific WC percentile cutoffs. Receiver operating characteristic curves for predicting IR were constructed comparing the race/ethnicity-specific vs. universal WC percentile cutoffs, and area under the curve (AUC) was calculated. Comparing universal with race/ethnicity-specific WC percentiles, there were no significant differences in AUC for Black, Mexican-American, or White adolescents. Because race/ethnicity-specific thresholds did not discriminate better than universal WC thresholds, universal WC thresholds may be used effectively to identify adolescents with IR in primary care practices. A WC ≥75th or ≥90th percentile for all race/ethnicities combined would be appropriate to apply in clinical practice for identification of adolescents with IR, a risk factor for development of type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalPediatric Diabetes
Issue number5
StatePublished - 2009


  • IR
  • WC

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism


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