Association of Serum Triglyceride-to-High-density Lipoprotein Cholesterol Ratio with Insulin Resistance and Non-alcoholic Fatty Liver Disease in Children and Adolescents

Aim: Insulin resistance (IR) is considered the main contributor to non-alcoholic fatty liver disease (NAFLD). Triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been recommended as a surrogate index of IR. However, the association between TG/HDL-C and NAFLD is as yet unclear. The aim of this study was to investigate the association of TG/HDL-C ratio with IR and NAFLD. Methods: The study population included 228 obese children and adolescents (59% girls, mean age: 12.52±2.94 years) and 46 lean subjects (57% girls, mean age: 12.53±3.30 years). The obese group was further stratified on the basis of NAFLD. Results: The TG/HDL-C ratio was higher in obese subjects compared with controls. The NAFLD group also had a significantly higher TG/HDL-C ratio (3.20±1.9 vs. 2.35±1.09) than the non-NAFLD group. The TG/HDL ratio was correlated with alanine aminotransferase, cholesterol, glucose-to-insulin ratio (FIGR), homeostasis model assessment of IR (HOMA-IR), quantitative insulin-sensitivity check index, and insulin. A cut-off value of 2.27 was used to define a high TG/HDL-C ratio. At multivariate logistic regression analysis, FIGR [odds ratio (OR)=4.20], HOMA-IR (OR=4.15), TG/HDL-C ratio (OR=2.8), HDL-C (OR=2.12), and ALT (OR=6.37) were associated with NAFLD. Conclusion: TG/HDL-C ratio is associated with various well-defined risk factors for NAFLD, and a value of >2.27 may be useful in identifying children at high risk for the condition.