High triglyceride-to-HDL ratio linked to worse cardiometabolic profile in children
MedWire News: Research suggests that a high triglyceride-to-high-density lipoprotein (HDL) cholesterol ratio may be useful for detecting children with a poor cardiometabolic risk (CMR) profile.
In adults, there is growing interest in the triglyceride-to-HDL cholesterol ratio as a surrogate marker for atherogenic lipid abnormalities, insulin resistance, and high cardiovascular risk, say Procolo Di Bonito (Pozzuoli Hospital, Naples, Italy) and colleagues. In childhood, the clinical value of lipid ratios has been investigated to a much lesser extent, they add.
The team therefore recruited 884 children and adolescents with an age range of 6-16 years, to evaluate the relationship between the triglyceride-to-HDL cholesterol ratio and CMR factors in a pediatric population.
In all, 23% of the participants were normal weight, 15% overweight, and 61% obese, as defined by the International Obesity Task Force Criteria.
From the lowest to the highest triglyceride-to-HDL cholesterol ratio tertile, the team observed significant increases in levels of body mass index, waist circumference, homeostasis model assessment of insulin resistance (HOMA-IR), white blood cell (WBC) count, alanine amino transferase, systolic blood pressure, total cholesterol, creatinine, and diastolic blood pressure.
Regression analysis revealed that in nonobese children, a high triglyceride-to-HDL cholesterol ratio (≥2.0) was associated with a 3- to 58-fold increased risk for high waist circumference and the metabolic syndrome (defined using cutoffs derived from the Adult Treatment Panel III definition of the metabolic syndrome), as well as high blood pressure (above the 90th percentile for age, gender, and height), impaired fasting glucose (≥100 mg/dL), high WBC count (≥9.0 x103/L), and insulin resistance (95th percentile of HOMA-IR values) than a lower ratio.
In obese children, a high triglyceride-to-HDL cholesterol ratio was associated with a 1.5- to 10.0-fold higher risk for insulin resistance, high waist circumference, and the metabolic syndrome than a lower ratio.
"These results emphasize the clinical usefulness of the triglyceride-to-HDL cholesterol ratio, which is greater in nonobese than in obese children in whom the excess adiposity may likely mask the role for the single CMR factors," comment Di Bonito et al in the journal Diabetes Care.
"These results… need to be replicated in the general pediatric population, and longitudinal evaluations will clarify whether a high triglyceride-to-HDL cholesterol ratio may be a good predictor of cardiovascular disease in adult life," they conclude.
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By Nikki Withers