Paper
Thursday, 20 July 2006
This presentation is part of : Evidence-Based Nursing and Public Policy: Issues Identified
Evidence Against Mass Screening for Acanthosis Nigricans: Relationships with Insulin Resistance, and Waist Circumference in Mexican American Adolescents
Anne R. Rentfro, MSN, RN, Nursing, The University of Texas at Brownsville and Texas Southmost College, Brownsville, TX, USA, Wendy Innis-Whitehouse, PhD, Chemistry, The University of Texas Pan American, Edinberg, TX, USA, Rosa Maria Pones, MPH, RN, Nursing, Brownsville Independent School District - Porter High School, Brownsville, TX, USA, Jeanette Nino, BS, Biology, The University of Texas at Brownsville, Brownsville, TX, USA, Cristina Barroso, DrPH, Public Health, The University of Texas Houston School of Public Health - Brownsville Regional Campus, Brownsville, TX, USA, and Susan Fisher-Hoch, MD, MSc, School of Public Health, UT School of Public Health, Brownsville Campus, Brownsville, TX, USA.
Learning Objective #1: Recognize the importance of using evidence based practice to plan quality school based screening programs.
Learning Objective #2: Analyze the relationships among acanthosis nigricans, insulin resistance and central obesity in Mexican American adolescents.
Background/Purpose: Acanthosis Nigricans (AN) is characterized by increased pigmentation, principally on the posterior neck. School nurses use mass screening for AN as a marker for diseases associated with insulin resistance (IR).  AN is common in Mexican Americans (MAs), possibly due to their genetic makeup.  With the ambiguous relationships among AN, IR, and type 2 diabetes we sought to clarify associations in a high risk adolescent population.
Methods:  AN, IR, body mass index, waist circumference were determined for 320 MA high school students.  A validated survey tool was used to collect demographic characteristics, physical activity and nutritional habits.  Fasting laboratory values were obtained for blood glucose and insulin.
Results:   Participants were 35.6% (114/320) male, 64.4% (206/320) female with a mean age of 16 (range: 14-9). Over 50% of the sample was overweight or at risk for overweight; 36.5% (114/312) had central obesity (CO); 31% (96/308) had AN detected; and 28% (83/297) had insulin resistance (IR). Of the participants with AN, 50% (47/94) were overweight and 28% (21/76) were insulin resistant.
Of the overweight students, 92% (76/83) had CO. IR was not significantly associated with AN (Odds Ratio [OR] 0.9, 95% confidence interval [CI] 0.5-1.6) nor CO (OR 1.4, 95% CI 0.8-2.4).  AN, however, was significantly associated with CO (OR 3.96, 95% CI 2.4-6.7).
Conclusion: No significant association was found between AN and IR, supporting the Centers for Disease Control and Prevention recommendation to eliminate mass screening for AN.  Central obesity was associated with AN, but not with IR. We found central obesity to be a less controversial measure with minimal racial connotations and a more easily standardized tool than AN. These findings support an evidence based approach for the use of waist circumference measurement rather than AN for screening in schools.

See more of Evidence-Based Nursing and Public Policy: Issues Identified
See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)