Ultrasound hepatic elastography: A non-invasive indicator of insulin resistance in the pediatric population: A systematic review

Table 3 Different methods used to assess insulin resistance in pediatric populations

IR measure	Primary physiological focus	Required inputs	Advantages	Limitations in pediatrics
HOMA-IR	Hepatic IR	Fasting glucose, fasting insulin	Simple, widely used, validated in adults	Overestimates IR during puberty; sensitive to fasting variations; poor reflection of adipose/muscle IR
QUICKI	Peripheral IR	Fasting glucose, fasting insulin	Good for detecting insulin sensitivity changes	Less reliable at extremes of glucose or insulin; limited pediatric validation
Adipo-IR	Adipose lipolysis and FFA flux	Fasting insulin × fasting free fatty acids	Directly reflects adipose dysfunction; links metabolic overflow to hepatic injury	Requires FFA measurement; less available in clinical labs
METS-IR	Systemic metabolic IR	Glucose, triglycerides, HDL-C, BMI (or waist circumference)	Integrates multiple metabolic risk factors; correlates with both CAP and LSM	Newer index; pediatric reference ranges still being standardized
Clamp techniques (e.g., hyperinsulinemic-euglycemic clamp)	Gold standard for IR quantification	Dynamic insulin-glucose infusion study	Direct measure of insulin sensitivity	Invasive, costly, impractical in pediatric studies

HOMA-IR: Homeostatic model assessment for insulin resistance; IR: Insulin resistance; QUICKI: Quantitative insulin sensitivity check index; Adipo-IR: Adipose tissue insulin resistance index; FFA: Free fatty acid; METS-IR: Metabolic score for insulin resistance; HDL-C: High-density lipoprotein cholesterol; BMI: Body mass index; CAP: Controlled attenuation parameter; LSM: Liver stiffness measurement.