Biomarkers · Glycemic & Metabolic

Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 11% higher risk of death. We found the same pattern in NHANES

HOMA-IR and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.11×95% CI 1.08–1.15 · 23,276 adults, 3,429 deaths

Published risk of death1.34×highest vs lowest category of HOMA-IR (95% CI 1.11–1.62) · Meta-analysis of 7 prospective observational studies of non-diabetic adults (n=26,976)

Value of the measurement+0.014gain in concordance within age bands; rank 26 of 56 · all tests

HOMA-IR by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (index), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	0.70	1.30	2.16	3.97	8.93	699	NHANES 2017-2018
All	40-59	0.72	1.49	2.42	4.19	10.8	758	NHANES 2017-2018
All	60+	0.96	1.75	2.75	4.85	11.0	909	NHANES 2017-2018
All	all	0.76	1.49	2.44	4.26	10.5	2,366	NHANES 2017-2018
Men	20-39	0.69	1.17	2.06	3.65	8.79	327	NHANES 2017-2018
Men	40-59	0.85	1.55	2.50	4.28	13.5	361	NHANES 2017-2018
Men	60+	1.18	1.98	3.06	6.17	11.7	459	NHANES 2017-2018
Men	all	0.80	1.53	2.48	4.45	11.1	1,147	NHANES 2017-2018
Women	20-39	0.70	1.37	2.26	4.13	9.30	372	NHANES 2017-2018
Women	40-59	0.60	1.45	2.28	4.18	9.53	397	NHANES 2017-2018
Women	60+	0.89	1.61	2.52	4.18	8.65	450	NHANES 2017-2018
Women	all	0.75	1.48	2.39	4.18	9.04	1,219	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in HOMA-IR, study by study

6 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
diet	Increase daily dietary fibre by ~15 g or to 35 g/day in adults with prediabetes or diabetes	HOMA-IR reduced by 1.24 (95% CI -1.72 to -0.76) vs lower-fibre diets	meta-analysis	Reynolds AN, Akerman AP, Mann J. PLoS Med. 2020.
diet	Intermittent fasting / time-restricted eating compared with continuous caloric restriction in obese adults	HOMA-IR -0.14 (p = 0.02) with fasting-based strategies vs continuous caloric restriction	meta-analysis	Siles-Guerrero V, Romero-Marquez JM, Garcia-Perez RN, et al. Nutrients. 2024.
exercise	Resistance training combined with aerobic exercise	Combined aerobic plus resistance training improved HOMA-IR vs control (Hedges' g = -0.59; 21 RCTs, adults aged ≥45)	meta-analysis	Wang T, et al. Effects of combined training on glycemic control and lipid…
exercise	High-intensity interval training (HIIT) or combined aerobic-resistance training	HIIT reduced HOMA-IR (MD = -0.67) and fasting insulin (MD = -2.24 μU/mL) vs usual care; combined training also significant	meta-analysis	Jiao B, et al. Exercise and Insulin-Resistance Biomarkers in Adults With…
exercise	Structured exercise (~900-1200 MET-min/week; HIIT plus resistance training most effective) in youth with overweight/obesity	HOMA-IR reduced by 0.87 (95% CI -1.20 to -0.53) vs control	meta-analysis	Garcia-Hermoso A, Lopez-Gil JF, Izquierdo M, et al. JAMA Pediatr. 2023.
exercise	High-intensity interval training 3 sessions/week for 12 weeks in obese boys aged 10-13	HOMA-IR fell 27.3% after 12 weeks of HIIT	RCT	Meng C, Yucheng T, Shu L, et al. BMC Pediatr. 2022.
lifestyle	Weight loss through lifestyle modification	Each 1 kg sustained lifestyle-induced weight loss associated with HOMA-IR -2.71% and insulin -2.46% (pooled 3 RCTs, n = 761)	meta-analysis	Yaskolka Meir A, et al. Individual response to lifestyle interventions: a…
pharmacologic	Tirzepatide 5-15 mg or semaglutide 1 mg once weekly in type 2 diabetes	HOMA2-IR reduced 15.5%-24.0% with tirzepatide 5-15 mg vs 5.1% with semaglutide 1 mg at 40 weeks	RCT	Frias JP, et al. Tirzepatide Improved Markers of Islet Cell Function and…

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
lifestyle	Severe visceral adiposity	Each SD increase in VAT associated with OR 3.5 (95% CI 3.1-3.9) for insulin resistance (HOMA-IR ≥75th percentile); 2.2 after BMI adjustment	cross-sectional	Preis SR, et al. Abdominal subcutaneous and visceral adipose tissue and insulin…
pharmacologic	Atypical antipsychotics (Olanzapine)	4 weeks of olanzapine significantly increased fasting insulin and HOMA-IR in 74 antipsychotic-naive patients (effect size not reported)	prospective cohort	Li S, et al. Olanzapine-Induced Weight Gain and Glycolipid Metabolism…

Sources

Risk curve: Zhang 2017 (PMID 28811358): all-cause RR 1.34 (1.11-1.62) highest vs lowest category of HOMA-IR. Scaled to US values (NHANES).
Zhang et al. Fasting insulin, insulin resistance, and risk of cardiovascular or all-cause mortality in non-diabetic adults: a meta-analysis. Bioscience reports. 2017;37.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) against another biomarker.

Map HOMA-IR against another marker