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The only exception was the lack of excess risk using the HOMA criterion for the metabolically healthy obese (1.08; 0.67–1.08).
Among the obese, the risk of mortality did not vary as a function of metabolic health apart from when using the HOMA criterion (1.93; 1.93–3.22).
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However, our findings are in contrast with recent data from a U.S. population that suggest increased all-cause mortality in MHO subjects (defined according to the same BMI and HOMA-IR criteria we use here) (7).
Diabetes and MS were diagnosed according to published recommendations and criteria (3, 4); the homeostasis model assessment-insulin resistance (HOMA-IR) index and the HOMA for β-cell (HOMA-B) function were calculated (5).
Metabolically normal was defined using three separate definitions: 1) insulin sensitive by HOMA; 2) one or fewer MetSyn criteria; or 3) absence of all MetSyn criteria and IR.
A HOMA >2.77 as anticipated, was a criterion for inclusion in the study for all patients [ 12].
However, in contrast to our results, Boronat et al. report that individuals newly diagnosed with diabetes who meet the HbA1c criteria for diabetes have higher BMIs, higher HOMA insulin resistance, and lower HDL (high density lipoprotein) cholesterol than individuals fulfilling the OGTT criteria only [ 14].
HOMA-IR, metabolic syndrome criteria numbers, waist circumference, systolic blood pressure, glucose, TG, and HDL cholesterol were included in the metabolic risk factors.
According to the International Diabetes Federation criteria, the HOMA-IR cut-off point to differentiate between low and high insulin resistance is 2.38, and HOMA-IR values range from 0.34 to 1.29 in the lowest quartile, whereas in the 4th quartile these values range from 2.89 to 20.39.
Table 4 shows the correlations of HOMA as a continuous variable with the individual MetS criteria and BMIZ scores also as continuous variables.
We propose the addition of the components of MetS analysis as a criterion to establish the cut-off points of HOMA-IR to define IR instead of using a percentile of the population distribution.
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