Triglyceride-Glucose index as a surrogate marker for insulin resistance in obese adolescents

Hüseyin Taştanoğlu; Nurullah Çelik

doi:10.7197/cmj.1022934

Research Article

Triglyceride-Glucose index as a surrogate marker for insulin resistance in obese adolescents

Year 2021, , 355 - 363, 31.12.2021

Hüseyin Taştanoğlu , Nurullah Çelik

https://doi.org/10.7197/cmj.1022934

Cited By: 2

Abstract

Objective: There is a lot of study in adults investigating the Triglyceride-Glucose (Ty-G) index. However, a limited study has been searched in the pediatric age group. Moreover, to the best of our knowledge, there is no study on Turkish children. The aim of this study, to investigate the usability of the triglyceride-glucose index as an indicator of insulin resistance in obese adolescents and to calculate the cut-off values.

Method: Six hundred twenty-three pubertal obese adolescents (266 boys, and 357 girls) were retrospectively evaluated. Ty-G index and HOMA-IR levels were calculated. ROC analysis was used for the estimations of the Ty-G index cutoff value.

Results: There was positive correlation between HOMA-IR and Ty-G index in boys (r=0.255, p<0.001), in girls (r=0.402, p<0.001), and all study groups (r=0.323, p<0.001). Ty-G index cutoff value for insülin resistance in pubertal obese adolescents was calculated as 8.42 with 70.1 % sensitivity and 59.3 % specificity for all study groups; 8,38 with 71.1 % sensitivity, and 48.3 % specificity for boys; 8,27 with 80% sensitivity, and 52.9% specificity for girls.

Conclusions: Ty-G index may be a reliable indicator for insülin resistance in pubertal obese adolescents. More attention should be given fort his marker with prospective studies.

Keywords

Insülin resistance, Triglyceride-Glucose Index, HOMA-IR, Obesity, Adolescents

References

References 1. Apperley, L. J., Blackburn, J., Erlandson-Parry, K., Gait, L., Laing, P., & Senniappan, S. (2021). Childhood obesity: A review of current and future management options. Clinical endocrinology, 10.1111/cen.14625.
2. GBD 2015 Obesity Collaborators, Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., Marczak, L., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Salama, J. S., Vos, T., Abate, K. H., Abbafati, C., Ahmed, M. B., Al-Aly, Z., Alkerwi, A., Al-Raddadi, R., Amare, A. T., … Murray, C. (2017). Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The New England journal of medicine, 377(1), 13–27.
3. Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., & Dietz, W. H. (1999). The disease burden associated with overweight and obesity. JAMA, 282(16), 1523–1529.
4. Celik N, Cinaz P. Obezitenin Diğer Komplikasyonları. Turkiye Klinikleri J Pediatr Sci 2015;11(3):69-75
5. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MAG, Hernández- González SO et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metabol 2010;95:3347–51
6. Conwell LS, Trost SG, Brown WJ, Batch JA (2004) Indexes of insulin resistance and secretion in obese children and adolescents: A validation study. Diabetes Care 27:314–319.
7. Simental-Mendía LE, Rodríguez-Morán 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.
8. Wan, K., Zhao, J., Huang, H., Zhang, Q., Chen, X., Zeng, Z., Zhang, L., & Chen, Y. (2015). The association between triglyceride/high-density lipoprotein cholesterol ratio and all-cause mortality in acute coronary syndrome after coronary revascularization. PloS one, 10(4), e0123521
9. Vasques, A. C., Novaes, F. S., de Oliveira, M., Souza, J. R., Yamanaka, A., Pareja, J. C., Tambascia, M. A., Saad, M. J., & Geloneze, B. (2011). Ty-G index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes research and clinical practice, 93(3), e98–e100.
10. Guerrero-Romero, F., Simental-Mendía, L. E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, M. G., Hernández-González, S. O., Jacques-Camarena, O., & Rodríguez-Morán, M. (2010). The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. The Journal of clinical endocrinology and metabolism, 95(7), 3347–3351.
11. Bundak R, Furman A, Gunoz H, et al (2006) Body mass index references for Turkish children. Acta Paediatr 95(2):194-8
12. Kurtoğlu, S, Hatipoğlu, N, Mazıcıoğlu, M, Kendirici, M, Keskin, M, & Kondolot, M. (2010). Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. Journal of clinical research in pediatric endocrinology, 2(3), 100–106
13. Freemark M. Childhood Obesity; in Brook C, Clayton P, Brown R, (eds): Brook's Clinical Pediatric Endocrinology. Wiley-Blackwell, 2009, pp 530-558.
14. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al.Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000 Jul;85(7):2402-10
15. Darendeliler F. Beta Hücreleri İşlevleri ve İnsülin Duyarlılığının değerlendirilmesi: Bazal Ölçümlerin Değerlendirilmesi ve Glukoz Klemp Testi.In: Yordam N, Alikaşifoğlu A, Bideci, editors. Çocuk ve Adolesanda Endokrin Testler. 1st ed. Ankara, Güneş Kitabevi, 2006:69-76
16. Malek, M., Khamseh, M. E., Chehrehgosha, H., Nobarani, S., & Alaei-Shahmiri, F. (2021). Triglyceride glucose-waist to height ratio: a novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus. Endocrine, 74(3), 538–545.
17. Mirr, M., Skrypnik, D., Bogdański, P., & Owecki, M. (2021). Newly proposed insulin resistance indexes called Ty-G-NC and Ty-G-NHtR show efficacy in diagnosing the metabolic syndrome. Journal of endocrinological investigation, 44(12), 2831–2843.
18. Liu, Y., Chi, R., Jiang, Y., Chen, B., Chen, Y., & Chen, Z. (2021). Triglyceride glycemic index as a biomarker for gestational diabetes mellitus: a systemic review and meta-analysis. Endocrine connections, 10(11), 1420–1427.
19. Kim, J., Shin, S. J., & Kang, H. T. (2021). The association between triglyceride-glucose index, cardio-cerebrovascular diseases, and death in Korean adults: A retrospective study based on the NHIS-HEALS cohort. PloS one, 16(11), e0259212.
20. Rodriguez-Moran M, Simental-Mendia LE, Guerrero-Romero F. The triglyceride and glucose index is useful for recognisinG insulin resistance in children. Acta Paediatr. 2017;106:979–83.
21. Moon S, Park JS, Ahn Y. The Cut-off Values of Triglycerides and Glucose Index for Metabolic Syndrome in Americanand Korean Adolescents. J Korean Med Sci. 2017;32:427-33.
22. Kang B, Yang Y, Lee EY, Yang HK, Kim HS, Lim SY, et al. Triglycerides/glucose index is a useful surrogate marker ofinsulin resistance among adolescents. Int J Obes (Lond). 2017;41:789-92.
23. Kim JW, Park SH, Kim Y, Im M, Han HS. The cutoff values of indirect indices for measurinG insulin resistance for metabolic syndrome in Korean children and adolescents. Ann Pediatr Endocrinol Metab. 2016;21:143-8.
24. Cho J, Hong H, Park S, Kim S, Kang H. Insulin Resistance and Its Association with Metabolic Syndrome in Korean Children. Biomed Res Int. 2017;2017:8728017.
25. Simental-Mendía LE, Hernández-Ronquillo G, Gómez-Díaz R, Rodríguez-Morán M, Guerrero-Romero F. The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents. Pediatr Res.2017;82:920-5.
26. Calcaterra, V., Montalbano, C., de Silvestri, A., Pelizzo, G., Regalbuto, C., Paganelli, V., Albertini, R., Cave, F. D., Larizza, D., & Cena, H. (2019). Triglyceride Glucose Index as a Surrogate Measure of Insulin Sensitivity in a Caucasian Pediatric Population. Journal of clinical research in pediatric endocrinology, 10.4274/jcrpe.galenos.2019.2019.0024. Advance online publication.
27. Vieira-Ribeiro, S. A., Fonseca, P., Andreoli, C. S., Ribeiro, A. Q., Hermsdorff, H., Pereira, P. F., Priore, S. E., & Franceschini, S. (2019). The Ty-G index cutoff point and its association with body adiposity and lifestyle in children. Jornal de pediatria, 95(2), 217–223.
28. Navarro-González, D., Sánchez-Íñigo, L., Pastrana-Delgado, J., Fernández-Montero, A., & Martinez, J. A. (2016). Triglyceride-glucose index (Ty-G index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Preventive medicine, 86, 99–105. https://doi.org/10.1016/j.ypmed.2016.01.022
29. Brito, A., Hermsdorff, H., Filgueiras, M. S., Suhett, L. G., Vieira-Ribeiro, S. A., Franceschini, S., & Novaes, J. F. (2021). Predictive capacity of triglyceride-glucose (Ty-G) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review. Critical reviews in food science and nutrition, 61(16), 2783–2792.
30. Kelley, D. E., & Goodpaster, B. H. (2001). Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes care, 24(5), 933–941. https://doi.org/10.2337/diacare.24.5.933
31. Marceau, P., Biron, S., Hould, F. S., Marceau, S., Simard, S., Thung, S. N., & Kral, J. G. (1999). Liver pathology and the metabolic syndrome X in severe obesity. The Journal of clinical endocrinology and metabolism, 84(5), 1513–1517. https://doi.org/10.1210/jcem.84.5.5661

Year 2021, , 355 - 363, 31.12.2021

Hüseyin Taştanoğlu , Nurullah Çelik

https://doi.org/10.7197/cmj.1022934

Cited By: 2

Abstract

Supporting Institution

Retrospektif bir çalışma olup destekleyen bir kurum yok

References

References 1. Apperley, L. J., Blackburn, J., Erlandson-Parry, K., Gait, L., Laing, P., & Senniappan, S. (2021). Childhood obesity: A review of current and future management options. Clinical endocrinology, 10.1111/cen.14625.
2. GBD 2015 Obesity Collaborators, Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., Marczak, L., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Salama, J. S., Vos, T., Abate, K. H., Abbafati, C., Ahmed, M. B., Al-Aly, Z., Alkerwi, A., Al-Raddadi, R., Amare, A. T., … Murray, C. (2017). Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The New England journal of medicine, 377(1), 13–27.
3. Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., & Dietz, W. H. (1999). The disease burden associated with overweight and obesity. JAMA, 282(16), 1523–1529.
4. Celik N, Cinaz P. Obezitenin Diğer Komplikasyonları. Turkiye Klinikleri J Pediatr Sci 2015;11(3):69-75
5. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MAG, Hernández- González SO et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metabol 2010;95:3347–51
6. Conwell LS, Trost SG, Brown WJ, Batch JA (2004) Indexes of insulin resistance and secretion in obese children and adolescents: A validation study. Diabetes Care 27:314–319.
7. Simental-Mendía LE, Rodríguez-Morán 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.
8. Wan, K., Zhao, J., Huang, H., Zhang, Q., Chen, X., Zeng, Z., Zhang, L., & Chen, Y. (2015). The association between triglyceride/high-density lipoprotein cholesterol ratio and all-cause mortality in acute coronary syndrome after coronary revascularization. PloS one, 10(4), e0123521
9. Vasques, A. C., Novaes, F. S., de Oliveira, M., Souza, J. R., Yamanaka, A., Pareja, J. C., Tambascia, M. A., Saad, M. J., & Geloneze, B. (2011). Ty-G index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes research and clinical practice, 93(3), e98–e100.
10. Guerrero-Romero, F., Simental-Mendía, L. E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, M. G., Hernández-González, S. O., Jacques-Camarena, O., & Rodríguez-Morán, M. (2010). The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. The Journal of clinical endocrinology and metabolism, 95(7), 3347–3351.
11. Bundak R, Furman A, Gunoz H, et al (2006) Body mass index references for Turkish children. Acta Paediatr 95(2):194-8
12. Kurtoğlu, S, Hatipoğlu, N, Mazıcıoğlu, M, Kendirici, M, Keskin, M, & Kondolot, M. (2010). Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. Journal of clinical research in pediatric endocrinology, 2(3), 100–106
13. Freemark M. Childhood Obesity; in Brook C, Clayton P, Brown R, (eds): Brook's Clinical Pediatric Endocrinology. Wiley-Blackwell, 2009, pp 530-558.
14. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al.Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000 Jul;85(7):2402-10
15. Darendeliler F. Beta Hücreleri İşlevleri ve İnsülin Duyarlılığının değerlendirilmesi: Bazal Ölçümlerin Değerlendirilmesi ve Glukoz Klemp Testi.In: Yordam N, Alikaşifoğlu A, Bideci, editors. Çocuk ve Adolesanda Endokrin Testler. 1st ed. Ankara, Güneş Kitabevi, 2006:69-76
16. Malek, M., Khamseh, M. E., Chehrehgosha, H., Nobarani, S., & Alaei-Shahmiri, F. (2021). Triglyceride glucose-waist to height ratio: a novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus. Endocrine, 74(3), 538–545.
17. Mirr, M., Skrypnik, D., Bogdański, P., & Owecki, M. (2021). Newly proposed insulin resistance indexes called Ty-G-NC and Ty-G-NHtR show efficacy in diagnosing the metabolic syndrome. Journal of endocrinological investigation, 44(12), 2831–2843.
18. Liu, Y., Chi, R., Jiang, Y., Chen, B., Chen, Y., & Chen, Z. (2021). Triglyceride glycemic index as a biomarker for gestational diabetes mellitus: a systemic review and meta-analysis. Endocrine connections, 10(11), 1420–1427.
19. Kim, J., Shin, S. J., & Kang, H. T. (2021). The association between triglyceride-glucose index, cardio-cerebrovascular diseases, and death in Korean adults: A retrospective study based on the NHIS-HEALS cohort. PloS one, 16(11), e0259212.
20. Rodriguez-Moran M, Simental-Mendia LE, Guerrero-Romero F. The triglyceride and glucose index is useful for recognisinG insulin resistance in children. Acta Paediatr. 2017;106:979–83.
21. Moon S, Park JS, Ahn Y. The Cut-off Values of Triglycerides and Glucose Index for Metabolic Syndrome in Americanand Korean Adolescents. J Korean Med Sci. 2017;32:427-33.
22. Kang B, Yang Y, Lee EY, Yang HK, Kim HS, Lim SY, et al. Triglycerides/glucose index is a useful surrogate marker ofinsulin resistance among adolescents. Int J Obes (Lond). 2017;41:789-92.
23. Kim JW, Park SH, Kim Y, Im M, Han HS. The cutoff values of indirect indices for measurinG insulin resistance for metabolic syndrome in Korean children and adolescents. Ann Pediatr Endocrinol Metab. 2016;21:143-8.
24. Cho J, Hong H, Park S, Kim S, Kang H. Insulin Resistance and Its Association with Metabolic Syndrome in Korean Children. Biomed Res Int. 2017;2017:8728017.
25. Simental-Mendía LE, Hernández-Ronquillo G, Gómez-Díaz R, Rodríguez-Morán M, Guerrero-Romero F. The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents. Pediatr Res.2017;82:920-5.
26. Calcaterra, V., Montalbano, C., de Silvestri, A., Pelizzo, G., Regalbuto, C., Paganelli, V., Albertini, R., Cave, F. D., Larizza, D., & Cena, H. (2019). Triglyceride Glucose Index as a Surrogate Measure of Insulin Sensitivity in a Caucasian Pediatric Population. Journal of clinical research in pediatric endocrinology, 10.4274/jcrpe.galenos.2019.2019.0024. Advance online publication.
27. Vieira-Ribeiro, S. A., Fonseca, P., Andreoli, C. S., Ribeiro, A. Q., Hermsdorff, H., Pereira, P. F., Priore, S. E., & Franceschini, S. (2019). The Ty-G index cutoff point and its association with body adiposity and lifestyle in children. Jornal de pediatria, 95(2), 217–223.
28. Navarro-González, D., Sánchez-Íñigo, L., Pastrana-Delgado, J., Fernández-Montero, A., & Martinez, J. A. (2016). Triglyceride-glucose index (Ty-G index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Preventive medicine, 86, 99–105. https://doi.org/10.1016/j.ypmed.2016.01.022
29. Brito, A., Hermsdorff, H., Filgueiras, M. S., Suhett, L. G., Vieira-Ribeiro, S. A., Franceschini, S., & Novaes, J. F. (2021). Predictive capacity of triglyceride-glucose (Ty-G) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review. Critical reviews in food science and nutrition, 61(16), 2783–2792.
30. Kelley, D. E., & Goodpaster, B. H. (2001). Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes care, 24(5), 933–941. https://doi.org/10.2337/diacare.24.5.933
31. Marceau, P., Biron, S., Hould, F. S., Marceau, S., Simard, S., Thung, S. N., & Kral, J. G. (1999). Liver pathology and the metabolic syndrome X in severe obesity. The Journal of clinical endocrinology and metabolism, 84(5), 1513–1517. https://doi.org/10.1210/jcem.84.5.5661

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Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Medical Science Research Articles
Authors	Hüseyin Taştanoğlu 0000-0002-6034-9998 Nurullah Çelik 0000-0003-1583-6807
Publication Date	December 31, 2021
Acceptance Date	December 9, 2021
Published in Issue	Year 2021

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AMA	Taştanoğlu H, Çelik N. Triglyceride-Glucose index as a surrogate marker for insulin resistance in obese adolescents. CMJ. December 2021;43(4):355-363. doi:10.7197/cmj.1022934

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Triglyceride-Glucose index as a surrogate marker for insulin resistance in obese adolescents

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