|Year : 2014 | Volume
| Issue : 2 | Page : 65-68
Association of acanthosis nigricans with anthropometric and biochemical parameters in young Indian males
Pankaj Jorwal1, Prakash Keshwani2, Rohit Verma3
1 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
3 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||16-Mar-2015|
Department of Psychiatry, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Acanthosis nigricans (AN) is a skin condition associated with insulin resistance, and highly correlated with hyperinsulinemia, type 2 diabetes, and obesity; with scarcity of information regarding its status in young adult subjects.
Aim: To determine the association between the presence of AN with biochemical parameters and anthropometric variables.
Subjects and Methods: This analytical cross-sectional study included young male subjects from outpatient department of Medicine of a tertiary care center in North India. They were divided into three group of 40 subjects each. Group I consisted of subjects having AN, Group II consisted of obese/overweight subjects without AN, and Group III consisted of control subjects without AN or obesity. Covariates included family history of diabetes.
Results: There was a significant positive association (P < 0.001) between AN and high body mass index (BMI), fasting glucose, waist-hip ratio (WHR), and systolic blood pressure (BP) even when controlled for obesity. For lipoproteins, insulin, and diastolic BP, the association even though significant, was inconsistent when obesity was taken into consideration.
Conclusion: Individuals with AN have lower high-density lipoproteins, and higher BMI, fasting blood glucose (FBG), serum insulin, total cholesterol, triglycerides, low-density lipoproteins, and systolic as well as diastolic pressure. Irrespective of being obese, AN is associated with a high BMI, WHR, FBG and systolic BP in young adults.
Keywords: Acanthosis nigricans, anthropometry, biochemical parameters, insulin, obesity
|How to cite this article:|
Jorwal P, Keshwani P, Verma R. Association of acanthosis nigricans with anthropometric and biochemical parameters in young Indian males. Ann Nigerian Med 2014;8:65-8
|How to cite this URL:|
Jorwal P, Keshwani P, Verma R. Association of acanthosis nigricans with anthropometric and biochemical parameters in young Indian males. Ann Nigerian Med [serial online] 2014 [cited 2021 May 6];8:65-8. Available from: https://www.anmjournal.com/text.asp?2014/8/2/65/153354
| Introduction|| |
Acanthosis nigricans (AN) is a skin condition characterized by dark, coarse, velvety to grey, thickened skin folds; commonly found at the back of the neck, axilla, elbows, groin, under the breasts, and at the belt line around the umbilicus. In severe cases, acrochordon may also develop on the discolorations.  AN is associated with insulin resistance and is highly correlated with hyperinsulinemia, type 2 diabetes and obesity.  Western literature report a high rates of association between AN and type 2 diabetes in nonwhite as well as in other ethnic groups.  The prevalence of AN in the literature varies from 7% in an unselected population to 74% in obese persons; whereas little information is available on its prevalence in young adult subjects. , To the best of our knowledge there are very few studies showing the prevalence of AN in relation to various anthropometric measurements in Indians. As adolescent obesity rates increase, the appearance of AN earlier in life has also increased. There are currently only a couple of studies in young Indians regarding this association. The purpose of this investigation was to determine the association between AN and multiple health parameters in young males.
| Subjects and Methods|| |
An analytical cross-sectional design was utilized to assess the relationship between the presence of AN and the dependent variables of body mass index (BMI), fasting blood glucose (FBG), serum insulin, lipoproteins, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and systolic and diastolic blood pressure (BP). All consenting consecutive young Indian male patients, between the ages of 18 and 25 years, presenting to out-patient Department of Medicine at a tertiary care center were included. All the study participants belonged to a younger age group as the study was intended to look at the preventive and potentially reversible aspect of this noncommunicable condition. Subjects with a history of intake of drugs including nicotinic acid, oral contraceptives, and application of topical fusidic acid, which can cause AN were excluded from the study. In total there were 120 participants, distributed in three groups of 40 participants each. All subjects having AN (specifically at the back of the neck) were included in Group I. All other subjects without AN were included into other two groups, obese/overweight subjects in Group II and nonobese subjects in Group III as controls. Standardized procedures were used to obtain BP, weight, height, BMI, FBG, total cholesterol, triglycerides, HDL and LDL levels, systolic and diastolic BP, waist-hip ratio (WHR); and to identify AN the subjects. Data collected was analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA), and was used to carryout descriptive statistics and z-tests on each of the variables.
| Results|| |
The mean age (in years) of subjects in each of the three groups (Group I: 21.40 ± 2.64; Group II: 22.15 ± 2.49; Group III: 22.38 ± 2.56) was comparable (P = 0.23). Majority of the subjects in all groups were employed and from urban areas. Our results indicated that consumption of alcohol and nicotine, as well as having a family history of diabetes was not significantly associated with having AN [Table 1].
|Table 1: Intergroup comparison of sociodemographic and clinical parameters|
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Subjects in Group I had significantly lower HDL levels and higher values of BMI, WHR, FBG, serum insulin, insulin-glucose ratio (IGR), total cholesterol, triglycerides, LDL, systolic and diastolic BP when compared to the control groups [Table 2]. When compared to Group II, Group I subjects had significantly higher BMI, WHR, systolic BP and FBG, but were comparable on other parameters. Group II subjects had significantly higher values of BMI, LDL, FBG, serum insulin, and IGR when compared to control group. Thyroid stimulating hormone levels were within normal limits in all three groups and were comparable.
| Discussion|| |
The study was conducted among Indians, a race well known to have higher rates of type 2 diabetes mellitus and obesity. Only male subjects was assessed in this research to look for the association of AN with other parameters, as previous research data in other ethnic groups have found AN to be equally distributed between both sexes. 
Globally, the studies looking at AN and it's association with chronic metabolic conditions in young males are few. Clinically apparent AN has been reported in about 40% of Native American teenagers, and in 13% of African American, 6% of Hispanic, and <1% of white non-Hispanic children aged 10-19 years.  Surveys have demonstrated low prevalence of obesity and AN in young children; which increases with advancing age and reaching almost 50% among those in their 40s.  Among children and adults alike, there is a direct relationship between type 2 diabetes risk factors, and a prevalence ratio for type 2 diabetes in patients with AN of 1.97, after controlling for age, BMI, and the number of type 2 diabetes risk factors. 
Previous studies have also reported a high prevalence of hyperkeratosis and papillomatosis in subjects with AN, which is similar to findings in this study. Another Indian study reported presence of obesity-induced AN or pseudo-AN in 70%, syndromic AN in 23.4%, and malignant AN in 6.6% of patients; with hyperkeratosis in 100% and papillomatosis in 90% of patients. 
The current study found AN to be associated with high FBG and BMI values, that is, hyperglycemia and undesirable weight gain, both of which are rapidly evolving world health issues requiring immediate attention. Previous studies also report of higher serum insulin levels in those with AN as compared to nonacanthotic cohort.  A directly propotional relationship between serum insulin levels and AN severity has been documented.  Native Americans are reported to have higher BMI and fasting insulin levels, and lower HDL-cholesterol in cases with severe AN; than those with less severe AN.  This strong association between the presence of AN and BMI was also found within other major ethnic groups. Hirschler et al. studied 1250 young Hispanic subjects in Argentina, and found a positive correlation between AN with BMI.  AN has been found more often among overweight or obese individuals in ethnic groups that typically experience a higher incidence of type 2 diabetes, including African Americans, Hispanics, American and Canadian Indians, Japanese, Pacific Islanders, Asian and Middle Eastern populations.  Data is also suggestive of significant univariate association between AN and BMI. 
Studies have shown that about 7% of young American males have impaired glucose tolerance (IGT), with higher prevalence of impaired fasting glucose (IFG) in overweight adolescents (17.8%).  Insulin resistance was detected in 81.2% and IGT in 13.5% of obese children and adolescents in a study in Israel.  Indian data estimates the prevalence of IFG to be 8.7%, IGT to be around 8.1%, and and that of newly detected diabetes to be 13.9%. 
A study conducted in young males in Mexico city reported high systolic BP in 8.4%, and systolic values in the prehypertension range in 6% of subjects.  In the current study, this association was accentuated to a much higher degree with all the subjects in Group I being in systolic prehypertensive range; but when controlled for obesity, the association was not significant.
Similar to current findings, significant association between AN and high serum cholesterol has been reported, but this association is not significant when controlled for obesity. 
Our results indicated that consumption of alcohol and nicotine, as well as having a family history of diabetes was not significantly associated with having AN. Previous studies have reported greatly varied prevalence of AN in different ethnic groups, with black people being more commonly affected when compared to white people. Stuart et al. reported the prevalence of AN in an unselected population to vary from 7% to 30-40% in adolescents and adults respectively. 
It was also noticed that, similar to a previous study,  a significant association exist between AN and other anthropometric measurements like weight and WHR. WHR indicates abdominal adiposity and excess visceral adipose tissue, and is suggested to be the one of the best anthropometric predictor for obesity-related health risks; and its use is usually recommended together with BMI when assessing risk factors. 
| Conclusion|| |
Individuals with AN were taller, heavier, and had higher BMI, FBG, serum insulin levels, total cholesterol, triglycerides, LDL, and systolic as well as diastolic BP; with lower HDL. The association between presence of AN with a high BMI, WHR, FBG and systolic BP remained significant even when controlled for obesity. The association between AN and lipoproteins (cholesterol, LDL, HDL and triglycerides), serum insulin, IGR and diastolic BP was not significant when obesity was taken into account.
Health practitioners, school staff, nurses and the general public should be educated on the benefits of these simple, inexpensive, noninvasive, and practical tools for the identification of those who could potentially be in need of additional health assessment for metabolic abnormalities that are associated with insulin resistance. Further research should investigate the exact prevalence of AN, and the relationship between the subject's surroundings and diet with diabetes and AN rates. Recommendations include increased use of BMI and general physical examination by health care practitioners to monitor, educate, treat and prevent obesity and associated diseases in certain ethnic groups which have documented higher rates of type 2 diabetes, such as Asians.  Practitioners must use accurate and consistent calculations of BMI and FBG levels for early detection and prevention of diabetes. For many reasons, the Indian race is at the epicentre of a non-communicable diseases epidemic, specifically obesity and diabetes, which can be prevented/reverted through education, awareness and lifestyle modification.
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[Table 1], [Table 2]