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Obesity, Physical Activity, Diet / Diabetes, Cardiovascular Risks, and Lipoproteins / Adipokines, Inflammation, and Metabolic Diseases · Journal article
Children · August 18, 2026
Encouraging direction, but not yet definitive.
This cross-sectional study proposes a TG:HDL-C ratio cutoff of 0.89 for identifying insulin resistance in obese adolescents aged 13–16 years using HOMA-IR ≥ 4.0 as the reference standard. The TG:HDL-C ratio showed moderate discriminatory performance (AUC 0.73) with 62% sensitivity and 75% specificity, and was associated with markers of metabolic dysfunction including elevated HbA1c, abdominal obesity, and increased adipokine ratio.
Cross-sectional diagnostic accuracy study with ROC analysis. Adolescents aged 13–16 years with obesity defined by BMI z-scores. Intervention: TG:HDL-C ratio (triglyceride-to-high-density lipoprotein cholesterol ratio). Compared with: Leptin:Adiponectin ratio (LAR) for discriminatory performance comparison; HOMA-IR ≥ 4.0 as reference standard for insulin resistance. n = 215.
AUC for TG:HDL-C ratio was 0.73, comparable to Leptin:Adiponectin ratio (0.68, p = 0.3) Optimal TG:HDL-C cutoff of 0.89 identified by maximum Youden index with 62% sensitivity and 75% specificity TG:HDL-C ratio ≥ 0.89 associated with 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)
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The proposed TG:HDL-C ratio cutoff of 0.89 offers a simple, potentially accessible screening marker for insulin resistance in obese adolescents, but the moderate discriminatory performance (AUC 0.73) and single-centre origin mean it should not yet guide clinical decision-making without external validation in other cohorts.
A single-centre diagnostic accuracy study in obese adolescents with modest discriminatory performance (AUC 0.73) and moderate sensitivity/specificity, proposing a novel cutoff that requires external validation before clinical implementation.
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The proposed TG:HDL-C ratio cutoff of 0.89 offers a simple, potentially accessible screening marker for insulin resistance in obese adolescents, but the moderate discriminatory performance (AUC 0.73) and single-centre origin mean it should not yet guide clinical decision-making without external validation in other cohorts.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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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