Relation of acanthosis nigricans to hyperinsulinemia and insulin sensitivity in overweight African American and white children

Objectives: Acanthosis nigricans (AN) has been proposed as a reliable marker of hyperinsulinemia but its utility for predicting hyperinsulinism has not been systematically evaluated in overweight children. We examined the relationship of AN to hyperinsulinemia and body adiposity. Study design: One hundred thirty-nine children underwent physical examination for AN, body composition studies, an oral glucose tolerance test, and a hyperglycemic clamp. Results: Thirty-five children (25%) had AN. AN was more prevalent in African Americans (50.1%) than in white subjects (8.2%, P < .001). Independent of race, children with AN had greater body weight and body fat mass (P < .001); greater basal and glucose-stimulated insulin levels during oral glucose tolerance test (P < .001); greater first-phase, second-phase, and steady-state insulin levels (P < .001); and lower insulin sensitivity (P < .001) during the hyperglycemic clamp. After adjusting for body fat mass and age. none of these differences remained significant. When categorized by fasting insulin, 35% with fasting insulin levels >20 muU/mL and 50% with fasting insulin levels >15 muU/mL did not have AN. Eighty-eight percent of children with fasting insulin levels greater than or equal to 15 muU/mL had a body mass index SE score greater than or equal to3.0. Conclusions: AN is not a reliable marker for hyperinsulinemia in over-weight children. Children with a race-, sex-, and age-specific body mass index SD scores greater than or equal to3.0 should be screened for hyperinsulinemia, whether or not they have AN.