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Peer-reviewedCC BY 4.0PeerJ

Body mass index–stratified inflammatory predictors of insulin resistance in non-obese adults: a retrospective study

  • Aycan Acet1
  • Turkan Pasali Kilit1
  • Sertas Erarslan1
  • Cumali Yalçın2
  • Can Özlü2
  • Çağla Özdemir3
  1. 1Faculty of Medicine, Departmant of Internal Medicine, Kütahya Health Sciences University, Kütahya, Turkey
  2. 2Faculty of Medicine, Departmant of Internal Medicine, Division of Hematology, Kütahya Health Sciences University, Kütahya, Turkey
  3. 3Faculty of Medicine, Departmant of Family Medicine, Kütahya Health Sciences University, Kütahya, Turkey
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Abstract

Background: Insulin resistance (IR) is a key mechanism underlying type 2 diabetes mellitus and cardiometabolic disease. Although obesity-related inflammation is a major contributor to IR, increasing evidence indicates that IR may also develop in non-obese individuals. However, readily available inflammatory markers applicable to this population remain limited. We evaluated the association between inflammatory markers and insulin resistance in non-obese adults and assessed their predictive performance across body mass index (BMI) strata.

Methods: This retrospective cross-sectional study included 149 non-obese adults (BMI < 30 kg/m ² ) evaluated in an internal medicine outpatient clinic between January and December 2025. Insulin resistance was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) ≥ 2.5. Inflammatory markers and composite indices, including the C-reactive protein to high-density lipoprotein cholesterol (CRP/HDL) ratio, were calculated. Multivariable logistic regression, BMI-stratified analyses, and receiver operating characteristic (ROC) curve analyses were performed.

Results: Insulin resistance was identified in 54 participants (36.2%). Individuals with IR had higher white blood cell (WBC) counts, CRP levels, and CRP/HDL ratios (all p < 0.05). In multivariable analysis, WBC count was independently associated with IR (OR = 1.407, 95% CI [1.090–1.815]; p = 0.009). BMI-stratified analyses showed that WBC count independently predicted IR in normal-weight individuals (OR = 1.789, 95% CI [1.218–2.627]; p = 0.003), whereas in overweight participants (BMI 25–30 kg/m ² ), the CRP/HDL ratio was independently associated with IR (OR = 7.793, 95% CI [1.056–57.499]; p = 0.044). ROC analyses demonstrated higher discriminative performance of WBC count in normal-weight individuals (AUC = 0.720) and greater predictive ability of the CRP/HDL ratio in overweight individuals (AUC = 0.695).

Conclusions: Low-grade systemic inflammation is independently associated with insulin resistance in non-obese adults, with distinct inflammatory predictors across BMI categories. WBC count may reflect early immune activation in normal-weight individuals, whereas the CRP/HDL ratio appears more informative among overweight subjects.

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Cite

BibTeXRIS
BibTeX
@article{acet2026body,
  title = {{Body mass index–stratified inflammatory predictors of insulin resistance in non-obese adults: a retrospective study}},
  author = {Aycan Acet and Turkan Pasali Kilit and Sertas Erarslan and Cumali Yalçın and Can Özlü and Çağla Özdemir},
  journal = {PeerJ},
  year = {2026},
  month = oct,
  doi = {10.7717/peerj.21769},
  url = {https://peerj.com/articles/21769},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Body mass index–stratified inflammatory predictors of insulin resistance in non-obese adults: a retrospective study
AU  - Aycan Acet
AU  - Turkan Pasali Kilit
AU  - Sertas Erarslan
AU  - Cumali Yalçın
AU  - Can Özlü
AU  - Çağla Özdemir
PY  - 2026
DA  - 2026/10/02
JO  - PeerJ
DO  - 10.7717/peerj.21769
UR  - https://peerj.com/articles/21769
AB  - Background: Insulin resistance (IR) is a key mechanism underlying type 2 diabetes mellitus and cardiometabolic disease. Although obesity-related inflammation is a major contributor to IR, increasing evidence indicates that IR may also develop in non-obese individuals. However, readily available inflammatory markers applicable to this population remain limited. We evaluated the association between inflammatory markers and insulin resistance in non-obese adults and assessed their predictive performance across body mass index (BMI) strata.  Methods: This retrospective cross-sectional study included 149 non-obese adults (BMI < 30 kg/m ² ) evaluated in an internal medicine outpatient clinic between January and December 2025. Insulin resistance was defined as a homeostasis model assessment of insulin resistance (HOMA-IR) ≥ 2.5. Inflammatory markers and composite indices, including the C-reactive protein to high-density lipoprotein cholesterol (CRP/HDL) ratio, were calculated. Multivariable logistic regression, BMI-stratified analyses, and receiver operating characteristic (ROC) curve analyses were performed.  Results: Insulin resistance was identified in 54 participants (36.2%). Individuals with IR had higher white blood cell (WBC) counts, CRP levels, and CRP/HDL ratios (all p < 0.05). In multivariable analysis, WBC count was independently associated with IR (OR = 1.407, 95% CI [1.090–1.815]; p = 0.009). BMI-stratified analyses showed that WBC count independently predicted IR in normal-weight individuals (OR = 1.789, 95% CI [1.218–2.627]; p = 0.003), whereas in overweight participants (BMI 25–30 kg/m ² ), the CRP/HDL ratio was independently associated with IR (OR = 7.793, 95% CI [1.056–57.499]; p = 0.044). ROC analyses demonstrated higher discriminative performance of WBC count in normal-weight individuals (AUC = 0.720) and greater predictive ability of the CRP/HDL ratio in overweight individuals (AUC = 0.695).  Conclusions: Low-grade systemic inflammation is independently associated with insulin resistance in non-obese adults, with distinct inflammatory predictors across BMI categories. WBC count may reflect early immune activation in normal-weight individuals, whereas the CRP/HDL ratio appears more informative among overweight subjects.
SN  - 2167-8359
ER  -