Ratio That Reveals Risk: Defining TG:HDL-C Ratio Cutoff for Insulin Resistance in Adolescents with Obesity

Q: What are the key findings of this study?

A TG:HDL-C ratio cutoff of 0.89 identified insulin resistance with an AUC of 0.73 (62% sensitivity, 75% specificity) and was associated with significantly higher odds of abdominal obesity (AOR 3.6).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obesity (n=215). Intervention: Elevated TG:HDL-C ratio (≥0.89) vs. Adequate TG:HDL-C ratio (<0.89). Primary outcome: Insulin resistance defined by HOMA-IR ≥ 4.0 (AUC 0.73, 95% CI 0.67-0.82).

Q: What does this research mean for the field?

A TG:HDL-C ratio cutoff of 0.89 identifies insulin resistance with moderate accuracy in adolescents with obesity and is associated with increased odds of abdominal obesity. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmad Kamil Nur Zati Iwani; Muhammad Yazid Jalaludin; Abqariyah Yahya; Shazana Rifham Abdullah; Liyana Ahmad Zamri; Fazliana Mansor; Janet Yeow Hua Hong; Abdul Halim Mokhtar

doi:10.3390/children13081098

August 18, 2026ChildrenOpen Access

Ratio That Reveals Risk: Defining TG:HDL-C Ratio Cutoff for Insulin Resistance in Adolescents with Obesity

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Key result

Elevated TG:HDL-C ratio identifies insulin resistance with moderate accuracy and ~3.6-fold higher abdominal obesity odds.

AUC 0.73
95% CI 0.67-0.82
n=215

Why the study?

Does an elevated TG:HDL-C ratio accurately identify insulin resistance in adolescents with obesity?

Key Points

To establish the optimal triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C) ratio cutoff for detecting insulin resistance and assess its associations with cardiometabolic risk factors in adolescents with obesity.
Analyzed fasting blood glucose, lipids, insulin, leptin, and adiponectin in 215 pubertal adolescents aged 13–16 years with obesity.
Identified insulin resistance using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR ≥ 4.0) and evaluated diagnostic thresholds using receiver operating characteristic (ROC) curves.
The TG:HDL-C ratio demonstrated an area under the ROC curve of 0.73 (95% CI: 0.67–0.82), comparable to the leptin-to-adiponectin ratio at 0.68 (p = 0.3).
The optimal TG:HDL-C cutoff identified by the maximum Youden index was 0.89, yielding 62% sensitivity and 75% specificity.
A TG:HDL-C ratio ≥ 0.89 was significantly associated with elevated fasting insulin (AOR 1.1, 95% CI 1.0–1.13), elevated HbA1c (AOR 2.7, 95% CI 1.1–6.6), abdominal obesity (AOR 3.6, 95% CI 1.9–6.7), and raised leptin-to-adiponectin ratio (AOR 1.2, 95% CI 1.0–1.5).

Study Design

Type

Cross-Sectional (n=215)

Multicenter

Yes

Structured PICO

Does an elevated TG:HDL-C ratio accurately identify insulin resistance in adolescents with obesity?

P

Population

215 pubertal adolescents aged 13 to 16 years with obesity in Malaysia evaluated cross-sectionally to determine a TG:HDL-C ratio cutoff for insulin resistance.

E

Exposure

Elevated triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C) ratio (cutoff ≥ 0.89)

C

Comparator

Adequate TG:HDL-C ratio (< 0.89)

O

Outcome

Diagnostic performance (AUC) for detecting insulin resistance (HOMA-IR ≥ 4.0)surrogate

Main Result

Effect estimate: AUC 0.73 (95% CI 0.67-0.82)

Limitations

Predominantly Malay cohort limits generalizability across diverse ethnic groups
Cross-sectional design cannot establish causal or temporal relationships
Secondary analysis including only complete data may introduce selection bias
Modest sensitivity
Predominantly Malay cohort limits ethnic generalizability
Cross-sectional design limits causal inference
Secondary analysis may introduce selection bias

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Answers are grounded in this paper and cite their sources.

Implication

A TG:HDL-C ratio of ≥0.89 is an accessible marker for identifying insulin resistance and elevated cardiometabolic risk in adolescents with obesity.

Abstract

Background/Objectives: Insulin resistance (IR) plays a central role in metabolic dysfunction and elevates the risk of chronic diseases such as type 2 diabetes mellitus in later life. Early identification of IR in adolescents is therefore important. This study aimed to determine the triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C) ratio cutoff for IR and assess its association with IR predictors among adolescents with obesity. Methods: A total of 215 blood samples from adolescents aged 13–16 years with obesity were analyzed for fasting blood glucose, lipids, insulin, leptin, and adiponectin. Obesity was defined using BMI z-scores, while IR was classified using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR ≥ 4.0). Receiver operating characteristic (ROC) analysis was performed to compare the discriminatory performance between the TG:HDL-C ratio and Leptin:Adiponectin ratio (LAR). Multiple logistic regression was performed to assess associations between the TG:HDL-C ratio and IR-related markers. Results: The area under the ROC curve for the TG:HDL-C ratio was comparable to LAR (0.73 vs. 0.68, p = 0.3). The optimal TG:HDL-C ratio cutoff identified using the maximum Youden index was 0.89, with 62% sensitivity and 75% specificity. A TG:HDL-C ratio ≥ 0.89 was associated with higher odds of elevated insulin (AOR 1.1, 95% CI 1.0–1.13), elevated HbA1c (AOR 2.7, 95% CI 1.1–6.6), abdominal obesity (AOR 3.6, 95% CI 1.9–6.7), and raised LAR (AOR 1.2, 95% CI 1.0–1.5). Conclusions: These findings suggest that a TG:HDL-C ratio cutoff of 0.89 may be a useful marker for identifying IR in adolescents with obesity.

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Cite This Study

Iwani et al. (2026) conducted a cross-sectional in Obesity (n=215). Elevated TG:HDL-C ratio (≥0.89) vs. Adequate TG:HDL-C ratio (<0.89) was evaluated on Insulin resistance defined by HOMA-IR ≥ 4.0 (AUC 0.73, 95% CI 0.67-0.82). A TG:HDL-C ratio cutoff of 0.89 identified insulin resistance with an AUC of 0.73 (62% sensitivity, 75% specificity) and was associated with significantly higher odds of abdominal obesity (AOR 3.6).

synapsesocial.com/papers/6a86b5c58a91293e6a1cd466 https://doi.org/10.3390/children13081098

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Ratio That Reveals Risk: Defining TG:HDL-C Ratio Cutoff for Insulin Resistance in Adolescents with Obesity

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Ratio That Reveals Risk: Defining TG:HDL-C Ratio Cutoff for Insulin Resistance in Adolescents with Obesity

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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