Insulin resistance (IR) is a risk factor for ischemic heart disease and diabetes and raises the triglyceride/high-density lipoprotein (TG/HDL) ratio in adults, but is not well defined in children. Purpose. To investigate the TG/HDL ratios in children as an IR marker. Methods. Wausau SCHOOL Project assessed 99 prepubertal and 118 postpubertal children. The TG/HDL ratio was correlated with numerous risk factors. Results. TG/HDL ratio was significantly correlated with QUICKI, HOMA-IR, zBMI, waist-to hip ratio, systolic and diastolic BP, LDL size and LDL number. A group of 32 IR children (HOMA-IR > 1 SD from the mean, i.e., >2.45) had significantly higher TG/HDL (3.11 ± 1.77) compared to non-IR children (1.86 ± 0.75). A TG/HDL ratio of ≥2.0 identified 32 of the 40 children deemed IR by HOMA-IR (>2.45) with a sensitivity of 0.80 and a specificity of 0.66. Children with TG/HDL ratio ≥3 were heavier and had higher BP, glucose, HOMA-IR, LDL number, and lower HDL level, QUICKI, and LDL size, regardless of pubertal status. Conclusion. The TG/HDL ratio is strongly associated with IR in children, and with higher BMI, waist hip ratio, BP, and more athrogenic lipid profile. 1. Introduction Insulin resistance (IR) is a major risk factor for ischemic heart disease and diabetes [1–4]. IR significantly impacts lipoprotein metabolism and is associated with an increase in triglyceride (TG) levels, depressed high-density lipoprotein (HDL) levels, and an increase in the number of small dense LDL particles [4, 5]. The effect of IR on TG and HDL has made the TG/HDL ratio a useful marker of insulin resistance in adults [6, 7]. IR is increasingly identified in children [8]. Much less information is available regarding the impact of IR on lipid metabolism in children. The usefulness of the TG/HDL ratio in children as a marker of IR has not been adequately explored. The Wausau SCHOOL Project is the result of a community-based effort to investigate the prevalence and magnitude of cardiovascular risk factors in school age children in the Wausau School District [9, 10]. The Wausau SCHOOL Project database includes anthropometric measurements, fasting lipid profiles, and insulin and glucose levels from pre-and postpubertal children. The purpose of this investigation was to use this database to assess the impact of IR on lipid metabolism and determine the correlation of the TG/HDL ratio to IR and other markers of IR. 2. Methods Details of the data collection for the Wausau SCHOOL Project have been described previously [9, 10]. Briefly, the investigation was reviewed and approved by the
References
[1]
S. H. Golden, A. R. Folsom, J. Coresh, A. R. Sharrett, M. Szklo, and F. Brancati, “Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the atherosclerosis risk in communities study,” Diabetes, vol. 51, no. 10, pp. 3069–3076, 2002.
[2]
R. C. Bonadonna, L. Groop, N. Kraemer, E. Ferrannini, S. del Prato, and R. A. DeFronzo, “Obesity and insulin resistance in humans: a dose-response study,” Metabolism, vol. 39, no. 5, pp. 452–459, 1990.
[3]
K. M. Rexrode, J. E. Manson, and C. H. Hennekens, “Obesity and cardiovascular disease,” Current Opinion in Cardiology, vol. 11, no. 5, pp. 490–495, 1996.
[4]
M. Laakso and E. Barrett-Connor, “Asymptomatic hyerglycemia is associated with lipid and lipoprotein changes favoring atherosclerosis,” Arteriosclerosis, vol. 9, no. 5, pp. 665–672, 1989.
[5]
B. V. Howard, “Insulin resistance and lipid metabolism,” American Journal of Cardiology, vol. 84, pp. 28J–32J, 1999.
[6]
T. Marotta, F. Barbara, B. F. Russo, and L. A. Ferrara, “Triglyceride-to-HDL-cholesterol ratio and metabolic syndrome as contributors to cardiovascular risk in overweight patients,” Obesity, vol. 18, no. 8, pp. 1608–1613, 2010.
[7]
J.-K. Chiang, N.-S. Lai, J.-K. Chang, and M. Koo, “Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in Taiwanese adults,” Cardiovascular Diabetology, vol. 10, article 93, 2011.
[8]
J. Steinberger and S. R. Daniels, “Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American heart association scientific statement from the atherosclerosis, hypertension, and obesity in the young committee (council on cardiovascular disease in the young) and the diabetes committee (council on nutrition, physical activity, and metabolism),” Circulation, vol. 107, no. 10, pp. 1448–1453, 2003.
[9]
P. Hughes, D. K. Murdock, K. Olson et al., “School children have leading risk factors for cardiovascular disease and diabetes: the Wausau SCHOOL project,” Wisconsin Medical Journal, vol. 105, no. 5, pp. 32–39, 2006.
[10]
D. K. Murdock, K. J. Olson, R. M. Juza, and B. L. Hendricks, “Effect of body mass index on insulin resistance and lipids in prepubertal and postpubertal children: SCHOOL observations,” Journal of the Cardiometabolic Syndrome, vol. 1, no. 4, pp. 242–247, 2006.
[11]
D. R. Matthews, J. P. Hosker, A. S. Rudenski, et al., “Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man,” Diabetologia, vol. 28, no. 7, pp. 412–419, 1985.
[12]
A. Katz, S. S. Nambi, K. Mather et al., “Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans,” Journal of Clinical Endocrinology and Metabolism, vol. 85, no. 7, pp. 2402–2410, 2000.
[13]
N. Gungor, R. Saad, J. Janosky, and S. Arslanian, “Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents,” Journal of Pediatrics, vol. 144, no. 1, pp. 47–55, 2004.
[14]
R. J. Kuczmarski, C. L. Ogden, L. M. Grummer-Strawn, et al., “CDC growth charts: United States advance data from vital and health statistics,” Tech. Rep. 314, National Center for Health Statistics, Hyattsville, Md, USA, 2000.
[15]
A. A. Hedley, C. L. Ogden, C. L. Johnson, M. D. Carroll, L. R. Curtin, and K. M. Flegal, “Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002,” Journal of the American Medical Association, vol. 291, no. 23, pp. 2847–2850, 2004.
[16]
C. Giannini, N. Santoro, S. Caprio et al., “The triglyceride-to-HDL cholesterol ratio: association with insulin resistance in obese youths of different ethnic backgrounds,” Diabetes Care, vol. 34, pp. 1869–1874, 2011.
[17]
P. D. Bonito, N. Moio, C. Scilla, et al., “Usefulness of the high triglyceride-to-HDL cholesterol ratio to identify cardiometabolic risk factors and preclinical signs of organ damage in outpatient children,” Diabetes Care, vol. 35, pp. 158–162, 2012.
