Association between the triglyceride to high-density lipoprotein cholesterol ratio and insulin resistance in Korean adolescents: a nationwide population-based study
Abstract
Background:
Studies have suggested the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) as a surrogate marker of insulin resistance. However, few studies have examined the association between TG/HDL-C and insulin resistance in the general adolescent population. This study aimed to examine the association between TG/HDL-C and insulin resistance in a nationally representative sample of Korean adolescents.
Methods:
A total of 2649 participants aged 12–18 years were selected from the 2007 to 2010 Korean National Health and Nutrition Examination Survey (KNHANES). Insulin resistance was defined as the homeostatic model assessment of insulin resistance (HOMA-IR) values greater than the 80th percentile.
Results:
The mean values of most cardiometabolic variables increased proportionally with TG/HDL-C quartiles. Compared to individuals in the lowest TG/HDL-C quartile, the odds ratio for insulin resistance for individuals in the highest quartile was 2.91 in boys and 2.38 in girls after adjusting for confounding variables.
Conclusions:
This study suggests that TG/HDL-C could be a convenient marker for identifying Korean adolescents with insulin resistance.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Lebovitz HE. Insulin resistance: definition and consequences. Exp Clin Endocrinol Diabetes 2001;109(Suppl 2):S135–48.10.1055/s-2001-18576Suche in Google Scholar
2. Tenenbaum A, Adler Y, Boyko V, Tenenbaum H, Fisman EZ, et al. Insulin resistance is associated with increased risk of major cardiovascular events in patients with preexisting coronary artery disease. Am Heart J 2007;153:559–65.10.1016/j.ahj.2007.01.008Suche in Google Scholar
3. Groop LC. Insulin resistance: the fundamental trigger of type 2 diabetes. Diabetes Obes Metab 1999;1(Suppl 1):S1–7.10.1046/j.1463-1326.1999.0010s1001.xSuche in Google Scholar
4. Djiogue S, Nwabo Kamdje AH, Vecchio L, Kipanyula MJ, Farahna M, et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocr Relat Cancer 2013;20:R1-r17.10.1530/ERC-12-0324Suche in Google Scholar
5. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med 2016;374:2430–40.10.1056/NEJMoa1503840Suche in Google Scholar
6. Park MH, Sovio U, Viner RM, Hardy RJ, Kinra S. Overweight in childhood, adolescence and adulthood and cardiovascular risk in later life: pooled analysis of three british birth cohorts. PLoS One 2013;8:e70684.10.1371/journal.pone.0070684Suche in Google Scholar
7. Srinivasan SR, Bao W, Wattigney WA, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism 1996;45:235–40.10.1016/S0026-0495(96)90060-8Suche in Google Scholar
8. Kessaram T, McKenzie J, Girin N, Merilles OE, Jr., Pullar J, et al. Overweight, obesity, physical activity and sugar-sweetened beverage consumption in adolescents of Pacific islands: results from the Global School-Based Student Health Survey and the Youth Risk Behavior Surveillance System. BMC Obes 2015;2:34.10.1186/s40608-015-0062-4Suche in Google Scholar
9. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:766–81.10.1016/S0140-6736(14)60460-8Suche in Google Scholar
10. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–82.10.1016/S0140-6736(02)09678-2Suche in Google Scholar
11. Laws A, Reaven GM. Evidence for an independent relationship between insulin resistance and fasting plasma HDL-cholesterol, triglyceride and insulin concentrations. J Intern Med 1992;231:25–30.10.1111/j.1365-2796.1992.tb00494.xSuche in Google Scholar PubMed
12. Hadaegh F, Khalili D, Ghasemi A, Tohidi M, Sheikholeslami F, et al. Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men. Nutr Metab Cardiovasc Dis 2009;19:401–8.10.1016/j.numecd.2008.09.003Suche in Google Scholar PubMed
13. Kang HT, Yoon JH, Kim JY, Ahn SK, Linton JA, et al. The association between the ratio of triglyceride to HDL-C and insulin resistance according to waist circumference in a rural Korean population. Nutr Metab Cardiovasc Dis 2012;22:1054–60.10.1016/j.numecd.2011.01.013Suche in Google Scholar PubMed
14. Kim JS, Kang HT, Shim JY, Lee HR. The association between the triglyceride to high-density lipoprotein cholesterol ratio with insulin resistance (HOMA-IR) in the general Korean population: based on the National Health and Nutrition Examination Survey in 2007–2009. Diabetes Res Clin Pract 2012;97:132–8.10.1016/j.diabres.2012.04.022Suche in Google Scholar PubMed
15. He J, He S, Liu K, Wang Y, Shi D, et al. The TG/HDL-C ratio might be a surrogate for insulin resistance in chinese nonobese women. Int J Endocrinol 2014;2014:105168.10.1155/2014/105168Suche in Google Scholar PubMed PubMed Central
16. Quijada Z, Paoli M, Zerpa Y, Camacho N, Cichetti R, et al. The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors. Pediatr Diabetes 2008;9:464–71.10.1111/j.1399-5448.2008.00406.xSuche in Google Scholar PubMed
17. Di Bonito P, Moio N, Scilla C, Cavuto L, Sibilio G, 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 2012;35:158–62.10.2337/dc11-1456Suche in Google Scholar PubMed PubMed Central
18. de Giorgis T, Marcovecchio ML, Di Giovanni I, Giannini C, Chiavaroli V, et al. Triglycerides-to-HDL ratio as a new marker of endothelial dysfunction in obese prepubertal children. Eur J Endocrinol 2014;170:173–80.10.1530/EJE-13-0452Suche in Google Scholar PubMed
19. Hirschler V, Maccallini G, Sanchez M, Gonzalez C, Molinari C. Association between triglyceride to HDL-C ratio and insulin resistance in indigenous Argentinean children. Pediatr Diabetes 2015;16:606–12.10.1111/pedi.12228Suche in Google Scholar PubMed
20. Pacifico L, Bonci E, Andreoli G, Romaggioli S, Di Miscio R, 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;24:737–43.10.1016/j.numecd.2014.01.010Suche in Google Scholar PubMed
21. Bridges KG, Jarrett T, Thorpe A, Baus A, Cochran J. Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia. J Pediatr Endocrinol Metab 2016;29:153–6.10.1515/jpem-2015-0158Suche in Google Scholar PubMed PubMed Central
22. Korea Centers for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey. Available at: http://knhanes.cdc.go.kr/knhanes.Suche in Google Scholar
23. Korea Centers for Disease Control and Prevention and Korean Pediatrics Society. 2007 Korean Children and Adolescents Growth Standard. Available at: http://www.cdc.go.kr/CDC.Suche in Google Scholar
24. Moon JS, Lee SY, Nam CM, Choi J-M, Choe B-K, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1–25.10.3345/kjp.2008.51.1.1Suche in Google Scholar
25. Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, et al. Corrigendum to “Comparison of non-HDL-cholesterol versus triglycerides-to-HDLcholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: the CARITALY study” [Nutr Metab Cardiovasc Dis 25 (2015) 489–494]. Nutr Metab Cardiovasc Dis 2016;26:551.10.1016/j.numecd.2016.02.002Suche in Google Scholar PubMed
26. Soutelo J, Graffigna M, Honfi M, Migliano M, Aranguren M, et al. [Triglycerides/HDL-cholesterol ratio: in adolescents without cardiovascular risk factors]. Arch Latinoam Nutr 2012;62:167–71.Suche in Google Scholar
27. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991;14:173–94.10.2337/diacare.14.3.173Suche in Google Scholar PubMed
28. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000;106:453–8.10.1172/JCI10762Suche in Google Scholar PubMed PubMed Central
29. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006;116:1793–801.10.1172/JCI29069Suche in Google Scholar PubMed PubMed Central
30. Dandona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 2004;25:4–7.10.1016/j.it.2003.10.013Suche in Google Scholar PubMed
31. Warnberg J, Marcos A. Low-grade inflammation and the metabolic syndrome in children and adolescents. Curr Opin Lipidol 2008;19:11–5.10.1097/MOL.0b013e3282f4096bSuche in Google Scholar PubMed
32. Festa A, D’Agostino R, Jr., Howard G, Mykkanen L, Tracy RP, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42–7.10.1161/01.CIR.102.1.42Suche in Google Scholar PubMed
33. Nagasawa N, Tamakoshi K, Yatsuya H, Hori Y, Ishikawa M, et al. Association of white blood cell count and clustered components of metabolic syndrome in Japanese men. Circ J 2004;68:892–7.10.1253/circj.68.892Suche in Google Scholar PubMed
34. Lee YJ, Shin YH, Kim JK, Shim JY, Kang DR, et al. Metabolic syndrome and its association with white blood cell count in children and adolescents in Korea: the 2005 Korean National Health and Nutrition Examination Survey. Nutr Metab Cardiovasc Dis 2010;20:165–72.10.1016/j.numecd.2009.03.017Suche in Google Scholar PubMed
35. Lee CD, Folsom AR, Nieto FJ, Chambless LE, Shahar E, et al. White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and White men and women: atherosclerosis risk in communities study. Am J Epidemiol 2001;154:758–64.10.1093/aje/154.8.758Suche in Google Scholar PubMed
36. Tabata S, Yoshimitsu S, Hamachi T, Abe H, Ohnaka K, et al. Waist circumference and insulin resistance: a cross-sectional study of Japanese men. BMC Endocr Disord 2009;9:1.10.1186/1472-6823-9-1Suche in Google Scholar PubMed PubMed Central
37. Olza J, Aguilera CM, Gil-Campos M, Leis R, Bueno G, et al. Waist-to-height ratio, inflammation and CVD risk in obese children. Public Health Nutr 2014;17:2378–85.10.1017/S1368980013003285Suche in Google Scholar PubMed
38. Caminiti C, Armeno M, Mazza CS. Waist-to-height ratio as a marker of low-grade inflammation in obese children and adolescents. J Pediatr Endocrinol Metab 2016;29:543–51.10.1515/jpem-2014-0526Suche in Google Scholar PubMed
39. Moran A, Jacobs DR, Jr., Steinberger J, Hong CP, Prineas R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 1999;48:2039–44.10.2337/diabetes.48.10.2039Suche in Google Scholar PubMed
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Puberty – genes, environment and clinical issues
- Puberty
- Increased levels of bisphenol A (BPA) in Thai girls with precocious puberty
- Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty
- Monitoring treatment of central precocious puberty using basal luteinizing hormone levels and practical considerations for dosing with a 3-month leuprolide acetate formulation
- Original Articles
- Association between the triglyceride to high-density lipoprotein cholesterol ratio and insulin resistance in Korean adolescents: a nationwide population-based study
- Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3–6-year cohort study in southern Thailand
- Investigation of the inflammatory biomarkers of metabolic syndrome in adolescents
- A 10-year experience using combined lipid-lowering pharmacotherapy in children and adolescents
- Prevalence of medically treated children with ADHD and type 1 diabetes in Germany – Analysis of two representative databases
- Association of short stature with life satisfaction and self-rated health in children and adolescents: the CASPIAN-IV study
- Case Reports
- Central precocious puberty in a boy with 22q13 deletion syndrome and NOTCH-1 gene duplication
- Non-androgen secreting adrenocortical carcinoma in preadolescence: a case report and literature review
- Efficacy of growth hormone therapy in Kearns-Sayre syndrome: the KIGS experience
- A unique case of Shwachman-Diamond syndrome presenting with congenital hypopituitarism
Artikel in diesem Heft
- Frontmatter
- Editorial
- Puberty – genes, environment and clinical issues
- Puberty
- Increased levels of bisphenol A (BPA) in Thai girls with precocious puberty
- Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty
- Monitoring treatment of central precocious puberty using basal luteinizing hormone levels and practical considerations for dosing with a 3-month leuprolide acetate formulation
- Original Articles
- Association between the triglyceride to high-density lipoprotein cholesterol ratio and insulin resistance in Korean adolescents: a nationwide population-based study
- Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3–6-year cohort study in southern Thailand
- Investigation of the inflammatory biomarkers of metabolic syndrome in adolescents
- A 10-year experience using combined lipid-lowering pharmacotherapy in children and adolescents
- Prevalence of medically treated children with ADHD and type 1 diabetes in Germany – Analysis of two representative databases
- Association of short stature with life satisfaction and self-rated health in children and adolescents: the CASPIAN-IV study
- Case Reports
- Central precocious puberty in a boy with 22q13 deletion syndrome and NOTCH-1 gene duplication
- Non-androgen secreting adrenocortical carcinoma in preadolescence: a case report and literature review
- Efficacy of growth hormone therapy in Kearns-Sayre syndrome: the KIGS experience
- A unique case of Shwachman-Diamond syndrome presenting with congenital hypopituitarism