Evaluation of the relationship between HOMA-IR, triglyceride-glucose index, and triglyceride/HDL-cholesterol ratio with the presence and severity of hepatic steatosis in children with obesity

OBJECTIVES: Hepatic steatosis (HS) represents one of the most frequent metabolic complications of pediatric obesity and is closely linked with insulin resistance (IR). Although the homeostatic model assessment for insulin resistance (HOMA-IR) is widely used, lipid-derived indices such as the triglyceride-glucose (TyG) index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio have recently emerged as simple IR surrogates. Data comparing these indices with HS severity in children remain limited. METHODS: This single-center retrospective study included 462 children aged 6-18 years with overweight or obesity who were evaluated between October 2023 and December 2024. Anthropometry, biochemical data, and ultrasonographic HS grading were obtained from medical records. HOMA-IR, TyG, and TG/HDL-C indices were calculated, and their associations with HS presence and severity were analyzed using correlation and multivariable regression models. RESULTS: HS was identified in 53.5 % of participants (grade 1: 29.9 %, grade 2: 16.6 %, grade 3: 6.0 %). Children with HS demonstrated significantly higher HOMA-IR, TyG index, and TG/HDL-C ratio compared with those without HS (all p<0.001). HOMA-IR increased progressively with HS grade (p<0.05), whereas TyG and TG/HDL-C did not display a significant gradient. Logistic regression confirmed that HOMA-IR was independently associated with HS severity (β=0.261; 95 % CI: 0.030-0.078; p<0.001), while TyG and TG/HDL-C were not. ALT levels rose significantly with HS grade, whereas AST showed no severity-related pattern. CONCLUSIONS: HOMA-IR remains the strongest metabolic predictor of hepatic steatosis severity in pediatric obesity. Although TyG and TG/HDL-C reliably differentiate HS presence, they do not independently estimate HS progression. Lipid-derived markers may support non-insulin-based screening; however, HOMA-IR should be prioritized when stratifying steatosis risk.