Comparative Performance of the Matsuda Index versus HOMA-IR for Detecting Insulin Resistance in Vitamin D-Deficient Prepubertal Children with Obesity: A Systematic Review
Main Article Content
https://orcid.org/0009-0005-7514-8805
Prabhu Vikash Ravichandran
https://orcid.org/0009-0007-2458-6965
Chinnusamy Bhuvaneswari
https://orcid.org/0009-0005-8983-5040
Prasanthi Vishaalini Gunasekaran
https://orcid.org/0009-0001-0670-6667
Rajendran Karupanan
https://orcid.org/0000-0002-2271-6611
Abstract
Background Childhood obesity is strongly associated with insulin resistance (IR), a precursor to type 2 diabetes and cardiovascular disease. Vitamin D deficiency is highly prevalent in obese children and may exacerbate IR. The Matsuda index (OGTT-derived, whole-body) and HOMA-IR (fasting-based, primarily hepatic) are commonly used surrogates, yet their comparative performance in vitamin D-deficient prepubertal obese children remains unclear.
Objective To systematically review the comparative performance of the Matsuda index versus HOMA-IR for detecting IR in this specific high-risk population.
Methods A systematic literature search was conducted in PubMed, Embase, and Scopus (January 2015–June 2026) following PRISMA 2020 guidelines. Eligible studies reported both indices in obese children, with preference for vitamin D data or prepubertal stratification. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Due to heterogeneity, a narrative synthesis was performed.
Results Seven published studies (n = 7) met inclusion criteria. No study directly and exclusively compared both indices in strictly prepubertal, vitamin D-deficient obese children. The Matsuda index showed stronger associations with vitamin D status, higher sensitivity for metabolically unhealthy obesity, and more stable performance across pubertal stages compared with HOMA-IR. However, direct head-to-head diagnostic accuracy data (ROC/AUC) in the target population were absent. Overall certainty of evidence was rated Low by GRADE, primarily due to indirectness and heterogeneity.
Conclusions Available evidence suggests potential advantages of the Matsuda index, but robust comparative data specifically in vitamin D-deficient prepubertal obese children are lacking. High-quality primary studies targeting this population are urgently needed to strengthen the evidence base and guide clinical practice.