Zerrin GAMSIZKAN, Attila ÖNMEZ, İbrahim Ethem ŞAHİN, Gökhan ERDEMİR, Safa ÜNAL

Can We Use the Triglyceride/HDL Ratio to Determine Insulin Resistance in Obesity Screening and Follow-Up in Primary Care?

Objectives: Obese patients are followed up with periodic laboratory tests. Insulin resistance is also a parameter used in these tests. There is a need for parameters that can determine insulin resistance more easily and practically. The aim of our study is to investigate the discriminative power of triglyceride (Tg) and triglyceride/high-density lipoprotein cholesterol ratio (Tg/HDL) for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in our patient population by examining the laboratory findings. Materials and Methods: In this retrospective study, the laboratory data of patients who applied to the Family Medicine Obesity Polyclinic of Düzce University Hospital between April 2018 and April 2019 with the desire to lose weight and/or have healthy lifestyle suggestions were examined. Results: Of the 512 patients included in our study, 66.40% (n=340) were female and 33.59% (n=172) were male. In the examination performed on patients grouped according to their Body Mass Index (BMI), Total cholesterol, HDL, Low-density lipoprotein (LDL), Tg, HOMA-IR, Insulin and Tg/HDL ratios were significantly different between the groups. The cut-off value in the ROC analysis of the Tg/HDL parameter between patients with and without insulin resistance was found to be 2.29 with 66% sensitivity and 55% specificity (AUC: 0.634, p

PDF

___

1. Albuquerque D, Nóbrega C, Manco L, et al. The contribution of genetics and environment to obesity. Br Med Bull. 2017;123(1):159-73.
2. Blundell JE, Dulloo AG, Salvador J, et al. EASO SAB Working Group on BMI. Beyond BMI--phenotyping the obesities. Obes Facts. 2014;7(5):322-8.
3. Shashaj B, Luciano R, Contoli B, et al. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians. Acta Diabetol. 2016;53(2):251-60.
4. Tang Q, Li X, Song P, et al. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future. Drug Discov Ther. 2015;9(6):380-5.
5. He J, He S, Liu K, et al. The TG/HDL-C Ratio Might Be a Surrogate for Insulin Resistance in Chinese Nonobese Women. Int J Endocrinol. 2014;105168.
6. Behiry EG, El Nady NM, AbdEl Haie OM, et al. Evaluation of TG-HDL Ratio Instead of HOMA Ratio as Insulin Resistance Marker in Overweight and Children with Obesity. Endocr Metab Immune Disord Drug Targets. 2019;19(5):676-82.
7. Ren X, Chen ZA, Zheng S, et al. Association between Triglyceride to HDL-C Ratio (TG/HDL-C) and Insulin Resistance in Chinese Patients with Newly Diagnosed Type 2 Diabetes Mellitus. PLoS One. 2016;11(4):e0154345.
8. Sumner AE, Finley KB, Genovese DJ, et al. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med. 2005;165(12):1395-400.
9. Borrayo G, Basurto L, González-Escudero E, et al. Tg/Hdl-C Ratio As Cardio-Metabolic Biomarker Even In Normal Weight Women. Acta Endocrinol (Buchar). 2018;14(2):261-7.
10. Qian Y, Lin Y, Zhang T, et al. The characteristics of impaired fasting glucose associated with obesity and dyslipidaemia in a Chinese population. BMC Public Health. 2010;10:139.
11. Berings M, Wehlou C, Verrijken A, et al. Glucose intolerance and the amount of visceral adipose tissue contribute to an increase in circulating triglyceride concentrations in Caucasian obese females. PLoS One. 2012;7(9):e45145.
12. M Blüher. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Pract Res Clin Endocrinol Metab. 2013;27(2):163-77
13. Dimitriadis G, Mitrou P, Lambadiari V, et al. Insulin effects in muscle and adipose tissue. Diabetes Res Clin Pract. 2011;93 Suppl 1:S52-9.
14. Çağlar Şimşek CE, Çelik N, Aygüneş U, et al. Obez Çocuk ve Adolesanlarda Hematolojik Parametreler ve Demir Düzeyinin Değerlendirilmesi. Ankara Med J. 2019; 19(3): 479-87.
15. Doğan Ş, Sönmez CI, Başer DA. Evaluation of Anthropometric and Biochemical Properties of Patients who Applied to Obesity Policlinics. Ankara Med J. 2020;20(2):407-15.
16. Moriyama K. Associations Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Metabolic Syndrome, Insulin Resistance, and Lifestyle Habits in Healthy Japanese. Metab Syndr Relat Disord. 2020;18(5):260-6.
17. Gong R, Liu Y, Luo G, et al. Associations of TG/HDL Ratio with the Risk of Prediabetes and Diabetes in Chinese Adults: A Chinese Population Cohort Study Based on Open Data. Int J Endocrinol. 2021;9949579.
18. Nur Zati Iwani AK, Jalaludin MY, Wan Mohd Zin RM, et al. TG : HDL-C Ratio Is a Good Marker to Identify Children Affected by Obesity with Increased Cardiometabolic Risk and Insulin Resistance. Int J Endocrinol. 2019;8586167.
19. Kheirollahi A, Teimouri M, Karimi M, et al. Evaluation of lipid ratios and triglyceride-glucose index as risk markers of insulin resistance in Iranian polycystic ovary syndrome women. Lipids Health Dis. 2020;19(1):235.
20. Krawczyk M, Rumińska M, Witkowska-Sędek E, et al. Usefulness of the Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C) in prediction of metabolic syndrome in Polish obese children and adolescents. Acta Biochim Pol. 2018;65(4):605-11.
21. Pantoja-Torres B, Toro-Huamanchumo CJ, Urrunaga-Pastor D, et al. Insulin Resistance and Metabolic Syndrome Research Group. High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults. Diabetes Metab Syndr. 2019;13(1):382-8.
22. Lemieux I, Després JP. Metabolic Syndrome: Past, Present and Future. Nutrients. 2020;12(11):3501.
23. Gluvic Z, Zaric B, Resanovic I, et al. Link between Metabolic Syndrome and Insulin Resistance. Curr Vasc Pharmacol. 2017;15(1):30-9.
24. Ardıç C, Şahin A, Yazan Arslan A, et al. Changes in Early Childhood Obesity from 2016 to 2019 and Effective Factors. Konuralp Medical Journal. 2020;12(3):435-42.