Diabetes Research and Clinical Practice 72 (2006) 219–220
www.elsevier.com/locate/diabres
Letter to the Editor
The threshold value for insulin resistance (HOMA-
IR) in an admixtured population. IR in the Brazilian
Metabolic Syndrome Study
To the Editor,
Insulin resistance is the major finding in several
metabolic disorders, including type 2 diabetes, meta-
bolic syndrome, dyslipidemia, and hypertension [1].
Homeostasis model assessment (HOMA) was proposed
as a simple and inexpensive technique to evaluate
insulin resistance in vivo [2]. Although the HOMA-IR
has been widely used for the study of insulin resistance,
the threshold value for insulin resistance has not been
conclusive.
In the present study, insulin sensitivity was assessed
in normal subjects without any known risk factors for
insulin resistance sampled from those of the Brazilian
Metabolic Syndrome Study (BRAMS), a population-
based survey on metabolic disorders. This study
included 1317 subjects (976 women, 341 men), age:
40  12 years, BMI: 34  10 kg/m2. Normal subjects
were defined as: no family history of diabetes, normal
BMI <25 kg/m2, fasting plasma glucose <6.1 mmol/l,
serum total cholesterol <5.7 mmol/l, HDL-cholesterol
>1.0 mmol/l, triglycerides <1.7 mmol/l, systolic blood
pressure <130 mmHg and diastolic blood pressure
<85 mmHg.
Blood specimens were collected after a 12-h fast.
Plasma glucose was measured by the glucose oxidase
method and serum insulin was measured using a
specific radioimmunoassay kit (Linco Research, St.
Charles, MO). HOMA-IR was calculated with the
formula: fasting serum insulin (uU/ml)  fasting
plasma glucose (mmol/l)/22.5 [2].
Normal subjects (240 women, 72 men; age:
37.2  9.0 years and BMI: 22.6  2.0 kg/m2) showed
a HOMA-IR of 1.66  0.79 (1.65  0.81 in women,
and 1.69  0.72 in men). Researchers assumed different
methods to describe a threshold, such as the top quintile
[3] and 90th percentile [4] of the HOMA in normal
0168-8227/$ – see front matter # 2005 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.diabres.2005.10.017
glucose tolerant non-obese populations. Considering
the patients whose HOMA-IR is above the 90th
percentile as insulin resistant subjects, we found a
threshold value for insulin resistance of 2.71. This
threshold is comparable to that in Bonora’s study (i.e.
2.77), but it is fairly low compared with the recently
published study of Stern et al. (i.e. 4.65 for BMI
>28.9 kg/m2 and 3.60 for BMI >27.5 kg/m2) [5].
Therefore, we calculated the HOMA-IR threshold in
those subjects who fulfilled the criteria of normal
subjects.
Brazilian people form one of the most heterogeneous
population in the world, which is the result of five
centuries of interethnic crosses of peoples from three
continents: the European colonizers, the African slaves,
and the autochthonous Amerindians [6,7]. The recogni-
tion of insulin resistance in the Brazilian admixtured
population using a simple laboratorial assessment has
clinical relevance in identifying subjects at high risk of
metabolic disorders and atherosclerosis.
References
[1] G.M. Reaven, Banting lecture 1988. Role of insulin resistance in
human disease, Diabetes 37 (1988) 1595–1607.
[2] D.R. Matthews, J.P. Hosker, A.S. Rudenski, B.A. Naylor, D.F.
Treacher, R.C. Turner, Homeostasis model assessment: insulin
resistance and beta-cell function from plasma glucose and insulin
concentrations in man, Diabetologia 28 (1985) 412–419.
[3] E. Bonora, S. Kiechi, J. Williet, F. Oberhollenzer, G. Egger, G.
Targher, et al., Prevalence of insulin resistance in metabolic
disorders. The Bruneck study, Diabetes 47 (1998) 1643–1649.
[4] K. Matsumoto, S. Miyake, M. Yano, Y. Ueki, Y. Yamaguchi, S.
Akazawa, et al., Glucose tolerance, insulin secretion, and insulin
sensitivity in non-obese and obese Japanese subjects, Diabetes
Care 20 (1997) 1562–1568.
[5] S.E. Stern, K. Williams, E. Ferrannini, R.A. DeFronzo, C.
Bogardus, M.P. Stern, Identification of individuals with insulin
resistance using routine clinical measurements, Diabetes 54
(2005) 333–339.
[6] F.C. Parra, R.C. Amado, J.R. Lambertucci, J. Rocha, C.M.
Antunes, S.D. Pena, Color and genomic ancestry in Brazilians,
Proc. Natl. Acad. Sci. U.S.A. 100 (2003) 177–182.
[7] S.M. Callegari-Jacques, D. Grattapaglia, F.M. Salzano, S.P. Sal-
amoni, S.G. Crossetti, M.E. Ferreira, et al., Historical genetics:
220 Letter to the Editor / Diabetes Research and Clinical Practice 72 (2006) 219–220

spatiotemporal analysis of the formation of the Brazilian popula- *Corresponding author at: Rua Camargo Paes 251,
tion, Am. J. Hum. Biol. 15 (2003) 824–834. 13073-350 Campinas-SP, Brazil
E-mail address: bgeloneze@aol.com
B. Geloneze* (B. Geloneze)
E.M. Repetto
S.R. Geloneze 27 July 2005
M.A. Tambascia Available online 28 November 2005
M.N. Ermetice
Endocrinology Department,
University of Campinas—UNICAMP,
São Paulo, Brazil