Abstract
Background: Studies have suggested that triglyceride to HDL-cholesterol ratio (TRG/HDL) is a surrogate marker of insulin resistance (IR), but information regarding its use in pediatric patients is limited. This study investigated the ability of TRG/HDL ratio to assess IR in obese and overweight children.
Methods: The sample consisted of de-identified electronic medical records of patients aged 10–17 years (n=223). Logistic regression was performed using TRG/HDL ratio as a predictor of hyperinsulinemia or IR defined using homeostasis model assessment score.
Results: TRG/HDL ratio had limited ability to predict hyperinsulinemia (AUROC 0.71) or IR (AUROC 0.72). Although females had higher insulin levels, male patients were significantly more likely to have hypertriglyceridemia and impaired fasting glucose.
Conclusions: TRG/HDL ratio was not adequate for predicting IR in this population. Gender differences in the development of obesity-related metabolic abnormalities may impact the choice of screening studies in pediatric patients.
Acknowledgments
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under award number U54GM104942. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All authors have read the journal’s policy on disclosure of potential conflicts of interest and have no conflicts to disclose.
References
1. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab 2010;95:5189–98.10.1210/jc.2010-1047Search in Google Scholar PubMed PubMed Central
2. Otten J, Ahrén B, Olsson T. Surrogate measures of insulin sensitivity vs the hyperinsulinaemic-euglycaemic clamp: a meta-analysis. Diabetologia 2014;57:1781–8.10.1007/s00125-014-3285-xSearch in Google Scholar PubMed
3. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, et al. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010;2:100–6.10.4274/jcrpe.v2i3.100Search in Google Scholar PubMed PubMed Central
4. Yin J, Li M, Xu L, Wang Y, Cheng H, et al. Insulin resistance determined by Homeostasis Model Assessment (HOMA) and associations with metabolic syndrome among Chinese children and teenagers. Diabetol Metab Syndr 2013;5:71.10.1186/1758-5996-5-71Search in Google Scholar PubMed PubMed Central
5. Deskins S, Harris C V, Bradlyn AS, Cottrell L, Coffman JW, et al. Preventive care in Appalachia: use of the theory of planned behavior to identify barriers to participation in cholesterol screenings among West Virginians. J Rural Health 2006;22:367–74.10.1111/j.1748-0361.2006.00060.xSearch in Google Scholar PubMed
6. Franssen R, Monajemi H, Stroes ES, Kastelein JJ. Obesity and dyslipidemia. Med Clin North Am 2011;95:893–902.10.1016/j.mcna.2011.06.003Search in Google Scholar PubMed
7. Kim-Dorner S-J, Deuster PA, Zeno SA, Remaley AT, Poth M. Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance? Metabolism 2010;59:299–304.10.1016/j.metabol.2009.07.027Search in Google Scholar PubMed
8. Salazar MR, Carbajal HA, Espeche WG, Leiva Sisnieguez CE, March CE, et al. Comparison of the abilities of the plasma triglyceride/high-density lipoprotein cholesterol ratio and the metabolic syndrome to identify insulin resistance. Diab Vasc Dis Res 2013;10:346–52.10.1177/1479164113479809Search in Google Scholar PubMed PubMed Central
9. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003;139:802–9.10.7326/0003-4819-139-10-200311180-00007Search in Google Scholar PubMed
10. Olson K, Hendricks B, Murdock DK. The triglyceride to HDL ratio and its relationship to insulin resistance in pre- and postpubertal hildren: observation from the Wausau School Project. Cholesterol 2012;2012:794252.10.1155/2012/794252Search in Google Scholar PubMed PubMed Central
11. Urbina EM, Khoury PR, McCoy CE, Dolan LM, Daniels SR, et al. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics 2013;131:e1082–90.10.1542/peds.2012-1726Search in Google Scholar PubMed PubMed Central
12. Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, et al. The triglyceride-to-HDL cholesterol ratio: association with insulin resistance in obese youths of different ethnic backgrounds. Diabetes Care 2011; 34:1869–74.10.2337/dc10-2234Search in Google Scholar PubMed PubMed Central
13. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555–76.10.1542/peds.114.2.S2.555Search in Google Scholar
14. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164–92.10.1542/peds.2007-2329CSearch in Google Scholar PubMed
15. Schwartz B, Jacobs DR, Moran A, Steinberger J, Hong C-P, et al. Measurement of insulin sensitivity in children: comparison between the euglycemic-hyperinsulinemic clamp and surrogate measures. Diabetes Care 2008;31:783–8.10.2337/dc07-1376Search in Google Scholar PubMed
16. Executive summary: standards of medical care in diabetes–2014. Diabetes Care 2014;37(Suppl 1):S5–13.10.2337/dc14-S005Search in Google Scholar PubMed
17. Murguía-Romero M, Jiménez-Flores JR, Sigrist-Flores SC, Espinoza-Camacho MA, Jiménez-Morales M, et al. Plasma triglyceride/HDL-cholesterol ratio, insulin resistance, and cardiometabolic risk in young adults. J Lipid Res 2013;54:2795–9.10.1194/jlr.M040584Search in Google Scholar PubMed PubMed Central
18. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128 Suppl(December):S213–56.10.1542/peds.2009-2107CSearch in Google Scholar PubMed PubMed Central
19. Tester J, Sharma S, Jasik CB, Mietus-Snyder M, Tinajero-Deck L. Gender differences in prediabetes and insulin resistance among 1356 obese children in Northern California. Diabetes Metab Syndr 2014;7:161–5.10.1016/j.dsx.2013.06.002Search in Google Scholar PubMed
20. Pilia S, Casini MR, Foschini ML, Minerba L, Musiu MC, et al. The effect of puberty on insulin resistance in obese children. J Endocrinol Invest 2009;32:401–5.10.1007/BF03346475Search in Google Scholar PubMed
21. Lee PA. Normal ages of pubertal events among American males and females. J Adolesc Health Care 1980;1:26–9.10.1016/S0197-0070(80)80005-2Search in Google Scholar
22. Goran M, Gower B. Longitudinal study on pubertal insulin resistance. Diabetes. Diabetes 2001;50:2444–50.10.2337/diabetes.50.11.2444Search in Google Scholar PubMed
23. Ball GD, Huang TT, Gower BA, Cruz ML, Shaibi GQ, et al. Longitudinal changes in insulin sensitivity, insulin secretion, and beta-cell function during puberty. J Pediatr 2006;148: 16–22.10.1016/j.jpeds.2005.08.059Search in Google Scholar PubMed
24. August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008;93:4576–99.10.1210/jc.2007-2458Search in Google Scholar PubMed PubMed Central
25. Williams CL, Hayman LL, Daniels SR, Robinson TN, Steinberger J, et al. Cardiovascular health in childhood: A statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002;106:143–60.10.1161/01.CIR.0000019555.61092.9ESearch in Google Scholar PubMed
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