Insulin resistance predicts mortality in nondiabetic individuals in the U.S

Diabetes Care. 2010 Jun;33(6):1179-85. doi: 10.2337/dc09-2110. Epub 2010 Mar 3.


Objective: Insulin resistance is a suspected causative factor in a wide variety of diseases. We aimed to determine whether insulin resistance, estimated by the homeostasis model assessment for insulin resistance (HOMA-IR), is associated with all-cause or disease-specific mortality among nondiabetic persons in the U.S.

Research design and methods: We determined the association between HOMA-IR and death certificate-based mortality among 5,511 nondiabetic, adult participants of the third U.S. National Health and Nutrition Examination Survey (1988-1994) during up to 12 years of follow-up, after adjustment for potential confounders (age, sex, BMI, waist-to-hip ratio, alcohol consumption, race/ethnicity, educational attainment, smoking status, physical activity, C-reactive protein, systolic and diastolic blood pressure, plasma total and HDL cholesterol, and triglycerides).

Results: HOMA-IR was significantly associated with all-cause mortality (adjusted hazard ratio 1.16 [95% CI 1.01-1.3], comparing successive quartiles of HOMA-IR in a linear model and 1.64 [1.1-2.5], comparing the top [HOMA-IR >2.8] to the bottom [HOMA-IR <or=1.4] quartile). HOMA-IR was significantly associated with all-cause mortality only in subjects with BMI <25.2 kg/m(2) (the median value) but not in subjects with BMI >or=25.2 kg/m(2). Subjects in the second, third, and fourth quartile of HOMA-IR appeared to have higher cardiovascular mortality than subjects in the lowest quartile of HOMA-IR. HOMA-IR was not associated with cancer-related mortality.

Conclusions: HOMA-IR is associated with all-cause mortality in the nondiabetic U.S. population but only among persons with normal BMI. HOMA-IR is a readily available measure that can be used in the future to predict mortality in clinical or epidemiological settings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Body Mass Index
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / mortality
  • Female
  • Humans
  • Insulin / blood
  • Insulin / metabolism
  • Insulin Resistance / physiology*
  • Male
  • Middle Aged
  • Mortality*
  • Neoplasms / blood
  • Neoplasms / mortality
  • United States


  • Blood Glucose
  • Insulin