Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia

Bridges, Kristie Grove; Jarrett, Traci; Thorpe, Anthony; Baus, Adam; Cochran, Jill

doi:10.1515/jpem-2015-0158

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…A strong correlation between the TG/ HDL-C and HOMA-IR was confirmed in a cross -sectional study of the Korean population (Kang et al, 2012;Park et al, 2016) and in indigenous Argentinean children (Hirschler et al, 2013). Similar results were obtained in groups of overweight and obese children (Bridges et al, 2016;Iwani et al, 2017), in which the relationship between the TG/HDL-C ratio and the hiperinsulinemic -euglicemic clamp (Giannini et al, 2011), and other indirect measurements of insulin resistance, such as QUICKI (Olson et al, 2012) and WBISI (whole body insulin sensitivity index) (Giannini et al, 2011), were documented. Moreover, Giannini and co-workers (Giannini et al, 2011) found that this association is significant only in obese Caucasian children, but not in Hispanic or African American children, so the TG/ HDL-C ratio may be ethnically dependent.…”

Section: Discussionsupporting

confidence: 78%

“…Due to the fact that measurements of TG and HDL-C concentrations are routine and cost-effective outpatient tests, they would greatly facilitate the assessment of reduced insulin sensitivity. Some studies, however, suggest that the relationships described above do not apply to all children and all ethnic groups (Giannini et al, 2011;Sumner et al, 2005;Bridges et al, 2016). There is a need for well-planned studies to confirm the usefulness of the TG/HDL-C ratio in identification of children with a high risk of development of insulin resistance and other obesity-related cardiometabolic disturbances.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents

et al. 2018

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The triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) is a useful surrogate marker of insulin resistance and cardiovascular risk factors. We aimed to assess the relationship between the TG/HDL-C ratio and insulin resistance (IR) and its usefulness in prediction of the metabolic syndrome (MS). This retrospective study involved 122 obese children with the mean age of 11.6±3 years and their 58 healthy lean peers. Anthropometric measurements, blood pressure, the plasma lipid profile and oral glucose tolerance test (OGTT) were analyzed. Based on the obtained results, the TG/HDL-C ratio and surrogate insulin resistance indices (HOMA-IR, FGIR, QUICKI, OGIS, Matsuda index) were calculated. The TG/HDL-C ratio positively correlated with weight, waist circumference, waist to hip ratio (WHR), lipid profile, HOMA-IR, fasting insulin and insulin measurements during OGTT, and negatively correlated with FGIR, QUICKI, OGIS, and the Matsuda index. Obese children with the TG/HDL-C ratio≥3 (47.5%) had higher values of WHR and HOMA-IR, and lower ones of FGIR, QUICKI, OGIS, and the Matsuda index when compared to their obese peers with the TG/HDL-C<3. The area under the curve (AUC) calculated for each insulin resistance index in prediction of the metabolic syndrome was the largest for the TG/HDL-C ratio (0.8936, 95% Cl:0.809–0.977, p=0.000). For 1 unit increase in the TG/HDL-C ratio, the odds for having MS increased by 2.09 times. The TG/HDL-C ratio is a good surrogate marker of insulin resistance in obese children. When comparing the usefulness of some IR markers in prediction of the metabolic syndrome, the TG/HDL-C ratio seems to be the best one and should be used in clinical practice to identify children at risk of metabolic syndrome development.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Usefulness of the Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents

et al. 2018

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“…This score is modified version proposed by Viitasalo et al ( 16 ). Specifically, we used HOMA-IR in lieu of fasting glucose and insulin, as this index has been shown to be a better assessment of glycemic homeostasis in children than glucose or insulin alone ( 17 – 19 ); included HDL and triglycerides individually rather than as a ratio given evidence of limited utility of this ratio in children ( 20 ); and used SBP instead of the average of SBP and DBP since SBP is more reliably measured in children and is a stronger predictor of future health ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

Branched Chain Amino Acids, Androgen Hormones, and Metabolic Risk Across Early Adolescence: A Prospective Study in Project Viva

Perng

Rifas‐Shiman

Hivert

et al. 2018

Obesity

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Objective To examine associations of two obesity-related metabolite patterns with changes in metabolic biomarkers during early adolescence. Methods Using multivariable linear regression, we examined associations of a branched chain amino acid (BCAA) and androgen hormone patterns with changes in glycemia (fasting glucose, insulin, HOMA-IR), adipokines (leptin, adiponectin), inflammation (C-reactive protein, interleukin-6), lipid profile, and blood pressure during ~5 years follow-up among 213 children aged 6–10 years at baseline. We adjusted for baseline age, pubertal status, biomarker level, and BMI percentile; and age at follow-up. We also tested for interactions with sex and baseline BMI percentile. Results Median age at baseline was 7.7 years; 48.8% were boys. In adjusted models, each 1 unit of the BCAA pattern corresponded with a 4.82 (95% CI: 0.92, 8.71) mg/dL decrease in fasting glucose in boys. In girls, the BCAA pattern was associated with an increase in triglycerides (4.17 [0.03, 8.32] mg/dL). The androgen pattern was associated with decreased leptin (−2.35 [−4.34, −0.35] ng/dL) and increased CRP (0.28 [0.03, 0.54] mg/dL) in girls. These relationships did not differ by baseline BMI percentile. Conclusions The BCAA and androgen hormone metabolite patterns are related to changes in metabolic parameters in a sex-specific manner during early adolescence.

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“…Although the difference between 2.5 and 3.16 may not seem significant, the choice of a cutoff value can have a large impact when determining the prevalence of insulin resistance in a population or identifying factors that contribute to its development. For example, in our previous study 34 of overweight and obese Appalachian children, 82% of the patients would have been classified as insulin resistant using 2.5 as a cutoff value, whereas the use of 3.16 would have resulted in a prevalence of 69%. These differences greatly complicate comparisons between studies and impede the development of practice guidelines.…”

Section: Discussionmentioning

confidence: 95%

Inappropriate Use of Homeostasis Model Assessment Cutoff Values for Diagnosing Insulin Resistance in Pediatric Studies

Fox¹,

Bernardino²,

Cochran³

et al. 2017

Journal of Osteopathic Medicine

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Background Assessing pediatric patients for insulin resistance is one way to identify those who are at a high risk of developing type 2 diabetes mellitus. The homoeostasis model assessment (HOMA) is a measure of insulin resistance based on fasting blood glucose and insulin levels. Although this measure is widely used in research, cutoff values for pediatric populations have not been established. Objective To assess the validity of HOMA cutoff values used in pediatric studies published in peer-reviewed journals. Methods Studies published from January 2010 to December 2015 were identified through MEDLINE. Initial screening of abstracts was done to select studies that were conducted in pediatric populations and used HOMA to assess insulin resistance. Subsequent full-text review narrowed the list to only those studies that used a specific HOMA score to diagnose insulin resistance. Each study was classified as using a predetermined fixed HOMA cutoff value or a cutoff that was a percentile specific to that population. For studies that used a predetermined cutoff value, the references cited to provide evidence in support of that cutoff were evaluated. Results In the 298 articles analyzed, 51 different HOMA cutoff values were used to classify patients as having insulin resistance. Two hundred fifty-five studies (85.6%) used a predetermined fixed cutoff value, but only 72 (28.2%) of those studies provided a reference that supported its use. One hundred ten studies (43%) that used a fixed cutoff either cited a study that did not mention HOMA or provided no reference at all. Tracing of citation history indicated that the most commonly used cutoff values were ultimately based on studies that did not validate their use for defining insulin resistance. Conclusion Little evidence exists to support HOMA cutoff values commonly used to define insulin resistance in pediatric studies. These findings highlight the importance of validating study design elements when training medical students and novice investigators. Using available data to generate population ranges for HOMA would improve its clinical utility.

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Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia

Cited by 8 publications

References 25 publications

Usefulness of the Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents

Usefulness of the Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents

Branched Chain Amino Acids, Androgen Hormones, and Metabolic Risk Across Early Adolescence: A Prospective Study in Project Viva

Inappropriate Use of Homeostasis Model Assessment Cutoff Values for Diagnosing Insulin Resistance in Pediatric Studies

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