Objective: This study examines the impact of body mass index (BMI) on homeostatic model assessment for insulin sensitivity (HOMA-S) and homeostatic model assessment for pancreatic β-cell function (HOMA-B) in adults with obesity but without diabetes. Additionally, the association of key hormones, leptin and gastric inhibitory peptide (GIP), with HOMA indices and BMI has been investigated.
Methods: This cross-sectional study involved 289 adults without diabetes from Hamad General Hospital in Qatar. BMI was analyzed as a predictor of HOMA-S and HOMA-B using adjusted multivariable linear regression. A logistic regression model was used to investigate hormonal predictors of insulin sensitive phenotype (ISP), and results were presented using margins plots, stratified by obesity classes.
Results: We found a strong, linear dose-response relationship between BMI and HOMA indices, with each unit increase in BMI linked to approximately a 2% decline in HOMA-S and a 1% rise in HOMA-B. Subgroup analysis revealed that the effects on ISP were more strongly driven by hormonal variations, particularly leptin and GIP levels, than by BMI alone.
Conclusions: Our findings demonstrate that BMI is a proxy for hormonal variations, particularly in leptin and GIP, which more strongly predict insulin sensitivity. These results support the need for incorporating hormonal markers into obesity-related risk assessment and management strategies.
Keywords: BMI; GIP; HOMA; dose response; insulin sensitivity; leptin; pancreatic β-cell.