A novel diagnostic tool in determining insulin resistance in obese children: Triglyceride / HDL ratio



TG / HDL ratio, Insulin resistance, Obese children


Background/Aim: It is known that the frequency of obesity and insulin resistance is increased in children. Diagnostic laboratory criteria of insulin resistance are unclear in children despite the widespread use of the Homeostasis model assessment for insulin resistance (HOMA-IR). Serum triglyceride (TG)/high-density lipoprotein (HDL) ratio is reported to reflect insulin resistance in recent studies. We aimed to investigate the usefulness of the TG/HDL ratio in determining insulin resistance and its correlation with the HOMA-IR index in overweight/obese children. Methods: Patients who presented to the Pediatric Endocrinology outpatient clinic with excessive weight were examined in this retrospective cohort study. The patients were divided into subgroups according to BMI, sex, pubertal stage, and presence of hepatosteatosis, and the HOMA-IR index and TG/HDL ratios were compared. Results: One hundred and fifty-nine patients aged 5-18 years, with a mean age of 11.4 (3.13) years, were included in the study. Of the patients, 93 (58%) were girls, 99 (62%) were pubertal, and 141 (88.6%) were obese. Seventy-nine (49.6%) patients had insulin resistance. The mean HOMA-IR and TG/HDL were 3.89 (2.29) and 2.71 (1.86), respectively. A positive correlation was found between HOMA-IR value and TG / HDL ratio (r= 0.283, P<0.001). TG/HDL ratio was significantly higher in patients who had insulin resistance and hepatosteatosis than those who did not (P=0.008, P=0.032 respectively). There was no significant difference regarding TG/HDL ratio between female-male, prepubertal-pubertal, overweight/obese patients. There was no correlation between age, body mass index standard deviation score (SDS), and TG/HDL ratio. Conclusion: TG/HDL ratio is an easy to use, non-invasive, and useful marker of insulin resistance in overweight/obese children regardless of age, gender, pubertal condition, and body mass index standard deviation score.


Download data is not yet available.


Yoo DY, Kang YS, Kwon EB, Yoo EG. The triglyceride-to-high density lipoprotein cholesterol ratio in overweight Korean children and adolescents. Ann Pediatr Endocrinol Metab. 2017;22(3):158-63.

Elmaoğulları S, Tepe D, Uçaktürk SA, Karaca Kara F, Demirel F. Prevalence of Dyslipidemia and Associated Factors in Obese Children and Adolescents. J Clin Res Pediatr Endocrinol. 2015;7(3):228-34.

Zhou M, Zhu L, Cui X, Feng L, Zhao X, He S, et al. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance but not of β cell function in a Chinese population with different glucose tolerance status. Lipids Health Dis. 2016;15:104.

Lim TK, Lee HS, Lee YJ. Triglyceride to HDL-cholesterol ratio and the incidence risk of type 2 diabetes in community dwelling adults: A longitudinal 12-year analysis of the Korean Genome and Epidemiology Study. Diabetes Res Clin Pract. 2020;163:108150.

Liang J, Fu J, Jiang Y, Dong G, Wang X, Wu W. TriGlycerides and high-density lipoprotein cholesterol ratio compared with homeostasis model assessment insulin resistance indexes in screening for metabolic syndrome in the chinese obese children: a cross section study. BMC Pediatr. 2015;15:138.

Nur Zati Iwani AK, Jalaludin MY, Wan Mohd Zin RM, Fuziah MZ, Hong JYH, Abqariyah Y, 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;2019:8586167.

Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. 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(3):100-6.

McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003 Nov 18;139(10):802-9. doi: 10.7326/0003-4819-139-10-200311180-00007. PMID: 14623617.

Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, et al. The triglyceride-to-HDL cholesterol ratio: association with insulin resistance in obese youths of different ethnic backgrounds. Diabetes Care. 2011;34(8):1869-74.

Sumner AE, Finley KB, Genovese DJ, Criqui MH, Boston RC. 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.

Iwani NA, Jalaludin MY, Zin RM, Fuziah MZ, Hong JY, Abqariyah Y, et al. Triglyceride to HDL-C Ratio is Associated with Insulin Resistance in Overweight and Obese Children. Sci Rep. 2017;7:40055.

Behiry EG, El Nady NM, AbdEl Haie OM, Mattar MK, Magdy A. 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.

Pacifico L, Bonci E, Andreoli G, Romaggioli S, Di Miscio R, Lombardo CV, et al. Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents. Nutr Metab Cardiovasc Dis. 2014;24(7):737-43.

Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, et al. Cardiometabolic risk factors in overweight and obese children in ITALY (CARITALY) Study Group. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study. Nutr Metab Cardiovasc Dis. 2015;25(5):489-94.

Moran A, Jacobs DR, Steinberger J, Hong CP, PrineasR, Luepker R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 1999;48:2039-44.

Tümer L, Kasapkara ÇS. Çocuklarda Hiperlipidemi Taraması. Turkiye Klinikleri J Pediatr. 2013;22(4):171-7.

Aslan Çin NN, Yardımcı H, Koç N, Uçaktürk SA, Akçil Ok M. Triglycerides/high-density lipoprotein cholesterol is a predictor similar to the triglyceride-glucose index for the diagnosis of metabolic syndrome using International Diabetes Federation criteria of insulin resistance in obese adolescents: a cross-sectional study. J Pediatr Endocrinol Metab. 2020 24;33(6):777-84.

Krawczyk M, Rumińska M, Witkowska-Sędek E, Majcher A, Pyrżak B. 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.

Manco M, Grugni G, Di Pietro M, Balsamo A, Di Candia S, Morino GS, et al. Triglycerides-to-HDL cholesterol ratio as screening tool for impaired glucose tolerance in obese children and adolescents. Acta Diabetol. 2016;53(3):493-8.






Research Article

How to Cite

Demiral M. A novel diagnostic tool in determining insulin resistance in obese children: Triglyceride / HDL ratio. J Surg Med [Internet]. 2021 Nov. 1 [cited 2024 Jul. 15];5(11):1144-7. Available from: https://jsurgmed.com/article/view/863978