Ann Pediatr Endocrinol Metab.  2019 Mar;24(1):41-48. 10.6065/apem.2019.24.1.41.

Risk assessment of metabolic syndrome in adolescents using the triglyceride/high-density lipoprotein cholesterol ratio and the total cholesterol/high-density lipoprotein cholesterol ratio

• Chu SY
• Jung JH
• Park MJ
• Kim SH

• KMID: 2447375
• DOI: http://doi.org/10.6065/apem.2019.24.1.41

Abstract

PURPOSE
This study was conducted to investigate the distributions of the triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C) ratio and total cholesterol (TC) to HDL-C ratio, and to explore their usefulness as markers of metabolic syndrome (MetS) in Korean adolescents.
METHODS
We obtained data for 2,721 adolescents (1,436 boys and 1,285 girls) aged 10-18 years who participated in the Korean National Health and Nutrition Examination Surveys from 2008 to 2010. International Diabetes Federation criteria were used to define MetS.
RESULTS
There were no significant gender-related differences in TG/HDL-C or TC/HDL-C ratios. These lipid ratios showed significant associations with homeostatic model assessment for insulin resistance (HOMA-IR) and waist circumference. Areas under the receiver operating characteristic curve to identify MetS were 0.947 for TG/HDL-C and 0.924 for TC/HDL-C, which were higher than that of HOMA-IR (0.822). Optimal cutoff values (sensitivity, specificity) of TG/HDL-C and TC/HDL-C ratios for MetS prediction were 3.3 (85.7%, 89.9%), and 3.8 (92.9%, 82.8%), respectively. Odds ratio (OR; 95% confidence intervals [CIs]) for MetS in adolescents with TC/HDL-C ratio above the cutoff value was 14.8 (2.8-77.4), while that for TG/HDL-C ratio about the cutoff value was 30.6 (6.0-157.6). In adolescents who had both lipid ratios above the cutoff values, the OR (95% CI) for MetS was 36.2 (7.2-186.2).
CONCLUSION
TG/HDL-C and TC/HDL-C ratios are useful markers of metabolic syndrome with high predictive value in Korean adolescents.

Keyword

Adolescents; Dyslipidemia; Metabolic syndrome; Obesity; Triglycerides; Cholesterol; High-density lipoprotein; Lipids

MeSH Terms

Adolescent*
Cholesterol*
Dyslipidemias
Humans
Insulin Resistance
Lipoproteins*
Obesity
Odds Ratio
Risk Assessment*
ROC Curve
Triglycerides
Waist Circumference
Cholesterol
Lipoproteins
Triglycerides

Figure

• 

  Fig. 1. Receive-operating characteristic (ROC) curves of lipid parameters and homeostatic model assessment for insulin resistance (HOMA-IR) for metabolic syndrome. The area under the curve (AUC) values of the TG/HDL-C ratio and TC/HDL-C ratio were higher than those of the other lipid profiles. The AUC value of the TG/HDL-C ratio was higher than that of the TC/HDL-C ratio in boys. In contrast, the AUC value of the TC/HDL-C ratio was higher than that of the TG/HDL-C ratio in girls. TC/HDL-C, total cholesterol to high density lipoprotein cholesterol; TG/HDL-C, triglyceride to high density lipoprotein cholesterol.

• 

  Fig. 2. Prevalence of metabolic syndrome in Korean adolescents with central obesity (n=234; 113 boys,121 girls) in accordance with TG/HDL-C ratio and TC/HDL-C ratio was as follows: 4.4% in those with both lipid ratios below the cutoffs, 30.7% in those with one of the lipid ratios above the respective cutoff, 52.4% for those with both lipid ratios above the cutoffs. Cutoffs of TG/HDL-C and TC/HDL-C were 3.3 and 3.8, respectively. TC/HDL-C, total cholesterol to high density lipoprotein cholesterol; TG/HDL-C, triglyceride to high density lipoprotein cholesterol.

• 

  Fig. 3. Adjusted odds ratios for metabolic syndrome (MetS) in adolescents whose lipid ratio values were above the cutoffs (TC/HDL-C ratio≥3.8, TG/HDL-C ratio≥3.3) relative to the adolescents whose lipid ratios were within normal ranges (adjusted for sex, age, and body mass index). The odds ratio (95% confidence interval) for MetS in adolescents with a high TC/HDL-C ratio, high TG/HDL-C ratio, and high TG/HDL-C & TC/HDL-C ratios were 14.8 (2.8–77.4), 30.6 (6.0–157.6), and 36.2 (7.2–186.2), respectively. TC/HDL-C, total cholesterol to high density lipoprotein cholesterol; TG/HDL-C, triglyceride to high density lipoprotein cholesterol.

Reference

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