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Pediatrics

Triglycerides/glucose index is a useful surrogate marker of insulin resistance among adolescents

Abstract

Objectives:

Our aim was to investigate the association between the triglycerides/glucose index (TyG index) and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) in the prediction of insulin resistance (IR) among adolescents.

Methods:

We conducted a cross-sectional study among 221 Korean adolescents (168 males and 53 females aged 9–13 years) from May to June 2014 in Chung-ju city. The TyG index was calculated as ln [triglycerides (mg dl−1) × fasting glucose (mg dl−1)/2]. IR was defined using HOMA-IR >95th percentile for age and sex.

Results:

In the IR group, weight, body mass index (BMI), waist circumference, body fat, fasting insulin, fasting plasma glucose, triglyceride levels and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) were significantly higher than that in the non-IR group. The TG index was significantly different between the IR group (n=22) and non-IR group (n=199), at 8.43±0.45 and 8.05±0.41, respectively (P<0.001). The TyG index was well correlated with HOMA-IR (r=0.41; P<0.001) and showed a strong positive association with TG/HDL-C (r=0.84; P<0.001). The cut-off of the TyG index for diagnosis of insulin resistance was 8.18.

Conclusions:

The TyG index is a simple, cost-effective surrogate marker of insulin resistance among adolescents compared with HOMA-IR.

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References

  1. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA et al. Child and adolescent obesity: part of a bigger picture. Lancet 2015; 385: 2510–2520.

    Article  Google Scholar 

  2. Wang Y, Lobstein T . Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006; 1: 11–25.

    Article  Google Scholar 

  3. Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L et al. Health consequences of obesity. Arch Dis Child 2003; 88: 748–752.

    Article  CAS  Google Scholar 

  4. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of childhood and adult obesity in the united states, 2011-2012. JAMA 2014; 311: 806–814.

    Article  CAS  Google Scholar 

  5. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362–2374.

    Article  CAS  Google Scholar 

  6. Caprio S . Insulin resistance in childhood obesity. J Pediatr Endocrinol Metab 2002; 15: 487–492.

    CAS  PubMed  Google Scholar 

  7. Must A, Strauss RS . Risks and consequences of childhood and adolescent obesity. Int J Obes Rel Metab Disord 1999; 23: S2–11.

    Article  Google Scholar 

  8. Romualdo MC, Nobrega FJ, Escrivao MA . Insulin resistance in obese children and adolescents. J Pediatr 2014; 90: 600–607.

    Article  Google Scholar 

  9. Dietz WH . Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998; 101: 518–525.

    CAS  Google Scholar 

  10. Wallace TM, Levy JC, Matthews DR . Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487–1495.

    Article  Google Scholar 

  11. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL . Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr 2014; 61: 533–540.

    Article  Google Scholar 

  12. Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011; 93: e98–e100.

    Article  CAS  Google Scholar 

  13. Simental-Mendia LE, Rodriguez-Moran M, Guerrero-Romero F . The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 2008; 6: 299–304.

    Article  CAS  Google Scholar 

  14. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X . Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 2014; 13: 146.

    Article  Google Scholar 

  15. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010; 95: 3347–3351.

    Article  CAS  Google Scholar 

  16. Lee SH, Yang HK, Ha HS, Lee JH, Kwon HS, Park YM et al. Changes in metabolic health status over time and risk of developing type 2 diabetes: a Prospective Cohort Study. Medicine (Baltimore) 2015; 94: e1705.

    Article  CAS  Google Scholar 

  17. Lee SH, Han K, Yang HK, Kim HS, Cho JH, Kwon HS et al. A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose. Nutr Diabetes 2015; 5: e149.

    Article  CAS  Google Scholar 

  18. Lee SH, Kwon HS, Park YM, Ha HS, Jeong SH, Yang HK et al. Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS One 2014; 9: e90430.

    Article  Google Scholar 

  19. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.

    Article  CAS  Google Scholar 

  20. Yi KH, Hwang JS, Kim EY, Lee SH, Kim DH, Lim JS . Prevalence of insulin resistance and cardiometabolic risk in Korean children and adolescents: a population-based study. Diabetes Res Clin Pract 2014; 103: 106–113.

    Article  CAS  Google Scholar 

  21. Robbins DC, Andersen L, Bowsher R, Chance R, Dinesen B, Frank B et al. Report of the American Diabetes Association's Task Force on standardization of the insulin assay. Diabetes 1996; 45: 242–256.

    Article  CAS  Google Scholar 

  22. 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: 1869–1874.

    Article  Google Scholar 

  23. He S, Wang S, Chen X, Jiang L, Peng Y, Li L et al. Higher ratio of triglyceride to high-density lipoprotein cholesterol may predispose to diabetes mellitus: 15-year prospective study in a general population. Metabolism 2012; 61: 30–36.

    Article  CAS  Google Scholar 

  24. Kimm H, Lee SW, Lee HS, Shim KW, Cho CY, Yun JE et al. Associations between lipid measures and metabolic syndrome, insulin resistance and adiponectin. Usefulness of lipid ratios in Korean men and women. Circ J 2010; 74: 931–937.

    Article  CAS  Google Scholar 

  25. Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS . Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med 2010; 164: 124–128.

    Article  Google Scholar 

  26. O'Malley G, Santoro N, Northrup V, D'Adamo E, Shaw M, Eldrich S et al. High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation. Diabetologia 2010; 53: 1199–1209.

    Article  CAS  Google Scholar 

  27. Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C et al. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index. Int J Clin Pract 2013; 67: 665–672.

    Article  CAS  Google Scholar 

  28. Shimodaira M, Niwa T, Nakajima K, Kobayashi M, Hanyu N, Nakayama T . Impact of serum triglyceride and high density lipoprotein cholesterol levels on early-phase insulin secretion in normoglycemic and prediabetic subjects. Diabetes Metab J 2014; 38: 294–301.

    Article  Google Scholar 

  29. Shimodaira M, Niwa T, Nakajima K, Kobayashi M, Hanyu N, Nakayama T . Serum triglyceride levels correlated with the rate of change in insulin secretion over two years in prediabetic subjects. Ann Nutr Metab 2014; 64: 38–43.

    Article  CAS  Google Scholar 

  30. Freedman DS, Srinivasan SR, Harsha DW, Webber LS, Berenson GS . Relation of body fat patterning to lipid and lipoprotein concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1989; 50: 930–939.

    Article  CAS  Google Scholar 

  31. Abate N . Insulin resistance and obesity. The role of fat distribution pattern. Diabetes Care 1996; 19: 292–294.

    Article  CAS  Google Scholar 

  32. Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Kotani K, Tokunaga K . Pathophysiology and pathogenesis of visceral fat obesity. Obes Res 1995; 3: 187s–194s.

    Article  Google Scholar 

  33. Bickerton AS, Roberts R, Fielding BA, Hodson L, Blaak EE, Wagenmakers AJ et al. Preferential uptake of dietary Fatty acids in adipose tissue and muscle in the postprandial period. Diabetes 2007; 56: 168–176.

    Article  CAS  Google Scholar 

  34. Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S . Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987; 36: 54–59.

    Article  CAS  Google Scholar 

  35. Shimabukuro M, Zhou YT, Levi M, Unger RH . Fatty acid-induced beta cell apoptosis: a link between obesity and diabetes. Proc Natl Acad Sci USA 1998; 95: 2498–2502.

    Article  CAS  Google Scholar 

  36. Jiang X, Srinivasan SR, Webber LS, Wattigney WA, Berenson GS . Association of fasting insulin level with serum lipid and lipoprotein levels in children, adolescents, and young adults: the Bogalusa Heart Study. Arch Intern Med 1995; 155: 190–196.

    Article  CAS  Google Scholar 

  37. Navarro-Gonzalez D, Sanchez-Inigo L, Pastrana-Delgado J, Fernandez-Montero A, Martinez JA . Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: the Vascular-Metabolic CUN cohort. Prev Med 2016; 86: 99–105.

    Article  Google Scholar 

  38. Sanchez-Inigo L, Navarro-Gonzalez D, Fernandez-Montero A, Pastrana-Delgado J, Martinez JA . The TyG index may predict the development of cardiovascular events. Eur J Clin Invest 2016; 46: 189–197.

    Article  CAS  Google Scholar 

  39. Mohd Nor NS, Lee S, Bacha F, Tfayli H, Arslanian S . Triglyceride glucose index as a surrogate measure of insulin sensitivity in obese adolescents with normoglycemia, prediabetes, and type 2 diabetes mellitus: comparison with the hyperinsulinemic-euglycemic clamp. Pediatr Diabetes 2015; 17: 458–465.

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by the Social Problem Solving Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science, Information Communication Technology (ICT) and Future Planning (2013M3C8A2A02078508).

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Correspondence to J-H Lee or K-H Yoon.

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Kang, B., Yang, Y., Lee, E. et al. Triglycerides/glucose index is a useful surrogate marker of insulin resistance among adolescents. Int J Obes 41, 789–792 (2017). https://doi.org/10.1038/ijo.2017.14

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