TG : HDL-C Ratio Is a Good Marker to Identify Children Affected by Obesity with Increased Cardiometabolic Risk and Insulin Resistance

Serum Triglyceride to High-Density Lipoprotein Ratio as a Marker of Insulin Resistance Among 5-15-Year-Old Sri Lankan Children in an Urban Setting

Objective: Prevalence of insulin resistance (IR) among South Asian populations is relatively high. It increases with the obesity epidemic. Since determining IR is costly, triglyceride to high-density lipoprotein (TG/HDL) ratio has shown to be a good proxy marker for IR in adults. However, it is not yet well established in children. This study aimed to assess TG/HDL ratio as a marker of IR in 5-15-year-old children in Colombo District of Sri Lanka. Methods: A cross-sectional descriptive study was conducted among 309 school children 5-15 years of age, selected using two-stage probability-proportionate-to-size cluster sampling technique. Sociodemographic data, and anthropometric and biochemical parameters were obtained. After a 12-hr overnight fast, blood was taken for biochemical investigations. Results: Three hundred nine children (173 girls) were recruited. Mean age of girls was 9.9 years and boys 10.3 years. Based on body mass index (BMI) z-score, 15.3% were overweight and 6.1% were obese. Metabolic syndrome was present in 2.3% of children and IR based on Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) ≥2.5 in 7.5%. Mean TG/HDL ratio, waist circumference (WC), hip circumference (HC), BMI, waist-to-height-ratio (WHtR), and body fat percentage were significantly higher (P < 0.01) among children with IR compared with non-IR children. TG/HDL ratio significantly correlated with BMI, % fat mass, WC, HC, WHtR, and HOMA-IR. TG/HDL ratio is an independent risk factor in determining IR. The cutoff value of TG/HDL ratio ≥3 had higher specificity (89.8%) but lower sensitivity (47.8%) for detection of IR. TG/HDL ratio >1.5 had a higher sensitivity (82.6%) but lower specificity (47.7%). Conclusions: TG/HDL ratio is a good proxy marker of IR among 5-15-year-old children. A cutoff value of ≥1.5 had satisfactory sensitivity and specificity.

Association of adiposity and fitness with triglyceride-to-high-density lipoprotein cholesterol ratio in youth

Background

The ratio of triglycerides-to-high-density lipoprotein cholesterol (TG/HDL-C) is considered a robust biomarker of metabolic syndrome (MetS) and is associated with several diseases, including type 2 diabetes mellitus (T2DM) and hypertension (HTN). This study examined the independent association of adiposity and fitness with the TG/HDL-C ratio.

Materials and Methods

This is a cross-sectional study comprising 403 (201 girls) Nigerian adolescents aged 11-19 years. Participants were evaluated for body mass index, cardiorespiratory fitness, and TG/HDL-C. Regression models adjusting for age and biological maturity were used to evaluate the association of adiposity and fitness with TG/HDL-C ratio. The TG/HDL-C ratios of 1.0 mmol/L and 1.1 mmol/L were used to stratify female and male participants into low- and high-risk groups, respectively.

Results

Of the 135 high-risk adolescents, 21.1%, 5.5%, 12.7%, 14.9%, and 0.5% were at risk of T2DM, systolic HTN, diastolic HTN, abdominal obesity, and MetS, respectively. The independent variables were significantly associated with TG/HDL-C ratio only in boys but not girls. In boys, high adiposity (β = 0.193; P = 0.025) and low fitness (β = -0.169; P = 0.048) were independently associated with the dependent variable. Unfit boys were 3.9 (95% confidence interval [CI] =1.37-10.94, P = 0.011) times more likely to develop elevated TG/HDL-C ratio than their fit peers. The likelihood of girls at risk of MetS developing a high TG/HDL-C ratio was 13.7 (95% CI = 3.89-48.32, P < 0.001) times compared to their counterparts without MetS.

Conclusions

Adiposity and fitness were independently associated with TG/HDL-C in boys but not in girls. Health promotion intervention focusing on lowering TG/HDL-C ratio among Nigerian adolescents should include an emphasis on healthy diet and endurance activity programs.

Alterations in DNA methylation associate with fatty liver and metabolic abnormalities in a multi-ethnic cohort of pre-teenage children

Non-Alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. Epigenetic alterations, such as through DNA methylation (DNAm), may link adverse childhood exposures and fatty liver and provide non-invasive methods for identifying children at high risk for NAFLD and associated metabolic dysfunction. We investigated the association between differential DNAm and liver fat content (LFC) and liver injury in pre-adolescent children. Leveraging data from the Newborn Epigenetics Study (NEST), we enrolled 90    mother-child dyads and used linear regression to identify CpG sites and differentially methylated regions (DMRs) in peripheral blood associated with LFC and alanine aminotransferase (ALT) levels in 7-12yo children. DNAm was measured using Infinium HumanMethylationEPIC BeadChips (Illumina). LFC and fibrosis were quantified by magnetic resonance imaging proton density fat fraction and elastography. Median LFC was 1.4% (range, 0.3-13.4%) and MRE was 2.5 kPa (range, 1.5-3.6kPa). Three children had LFC ≥ 5%, while six (7.6%) met our definition of NAFLD (LFC ≥ 3.7%). All children with NAFLD were obese and five were Black. LFC was associated with 88 DMRs and 106 CpGs (FDR<5%). The top two CpGs, cg25474373 and cg07264203, mapped to or near RFTN2 and PRICKLE2 genes. These two CpG sites were also significantly associated with a NAFLD diagnosis. As higher LFC associates with an adverse cardiometabolic profile already in childhood, altered DNAm may identify these children early in disease course for targeted intervention. Larger, longitudinal studies are needed to validate these findings and determine mechanistic relevance.

Distinct racial and ethnic metabolic syndrome characteristics: A comparative assessment in low-income children 7-10 years of age

BACKGROUND

Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately.

OBJECTIVES

To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence.

METHODS

The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model.

RESULTS

The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K = 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K ≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p = 0.03) and waist circumference, HDL-C, and FPG risk factors (p < 0.05), while NHB children had higher odds for the FPG risk factor (p ≤ 0.007) and lower odds for the plasma triglycerides risk factor (p = 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p < 0.001 and p < 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p < 0.05).

CONCLUSIONS

MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.

Red Cell Distribution Width-to-High-Density Lipoprotein Cholesterol Ratio (RHR): A Promising Novel Predictor for Preoperative Deep Vein Thrombosis in Geriatric Patients with Hip Fracture

Background

Deep vein thrombosis (DVT) is a devastating complication in geriatric patients before hip fracture surgery, and the predictive value of red cell distribution width (RDW) and high-density lipoprotein cholesterol (HDL-C) for DVTs after hip fracture remains to be established. This study aimed to assess the predictive value of RDW, HDL-C, and RDW-to-HDL-C ratio (RHR) in preoperative DVTs screening.

Methods

We retrospectively analyzed the data of geriatric patients (≥65 years old) admitted for hip fracture surgery between 2015 and 2020. The receiver operating characteristic (ROC) curve and related parameters were used to evaluate the predictive value of the biomarkers. Patients were divided into two groups according to the cutoff value of RHR, and propensity score matching (PSM) and subgroup analyses were performed to assess the true correlations between RHR and DVT.

Results

Among 2566 eligible patients included, we identified RDW with the area under ROC curve (AUC) of 0.532, cut-off value of 15.89, specificity of 88.2%, sensitivity of 18.2%, HDL-C with AUC of 0.574, cut-off value of 1.20, specificity of 55.6%, sensitivity of 59.3%, and RHR with AUC of 0.578, cut-off value of 13.45, specificity of 71.3%, sensitivity of 43.4%. RHR (>13.45) was independently associated with 1.54-fold risk (95% CI: 1.11–2.14, P=0.011) of DVTs among the post-PSM cohort. And compared with the counterparts, the relative risk of RHR associated with DVT was higher in the subgroups of aged 65–79 years (1.61 vs 1.45), non-hypoproteinemia (2.70 vs 1.29), non-diabetic (1.58 vs 1.41), non-hypertension (2.40 vs 1.06), ASA score I-II (2.38 vs 1.04), and femoral neck fracture (1.70 vs 1.50).

Conclusion

RDW, HDL-C and RHR were valuable biomarkers in predicting preoperative DVTs in geriatric patients with hip fracture, and RHR would be more efficient in the subgroups of younger age, better medical condition or femoral neck fracture.

Triglyceride to HDL-C ratio is associated with plasma D-dimer levels in different types of pancreatitis

This study aims to evaluate levels of D-dimer and serum lipid in different types of pancreatitis, and the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24 h of admission. The relevant information on epidemiology and etiology was collected. D-dimer and serum lipid levels in different types of pancreatitis were analyzed. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction. We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p < 0.05), respectively. TG/HDL-C was related to D-dimer in different types of pancreatitis. Logistic regression analysis was conducted in the parameters at admission like alcohol abuse, dyslipidemia and coagulation disturbance in distinguishing AP and RAP groups from the control group, and the parameter like diabetes in RAP and CP groups significantly increased compared with that of the control group. The value of D-dimer level and TG/HDL-C ratio in predicting the severity of AP and RAP was confirmed but there was no significant difference between CP group and the control group. The D-dimer level was related to dyslipidemia and TG/HDL-C ratio.

Nonlinear association between changes in fasting plasma glucose and the incidence of diabetes in a nondiabetic Chinese cohort

BACKGROUND

Limited data show that changes in fasting plasma glucose (FPG changes) are related to the incidence of type 2 diabetes (T2D). We aimed to correlate FPG changes with incident diabetes and evaluate FPG changes as a marker to screen participants at high risk of T2D in China.

METHODS

A total of 116,816 individuals were followed during a median follow-up of 3.10 years by secondary analysis in a nondiabetic Chinese cohort. The turning points were derived from a receiver operating characteristic curve. Hazard ratios (HRs) were evaluated by Cox proportional hazards models.

RESULTS

A total of 2669 cases of T2D were identified (788 women and 1881 men). The age-standardized incidence of diabetes was 12.87 per 1000 person-years (women: 11.04; men: 14.69). A nonlinear relationship between FPG changes and incident diabetes is shown by the fitting curves. The curves were categorized into three stages by two turning points (-0.04 and 1.25 mmol/L) and conformed to the hook-like pattern: an initial decrease (stage-1), then a transient sharp elevation (stage-2), followed by a slow increase (stage-3). HRs per SD of FPG changes on incident diabetes varied with stage: stage-1: 0.16 (0.12, 0.23), stage-2: 0.20 (0.15, 0.28) and stage-3: 0.22 (0.16, 0.31). Compared with stage-1, the HR in stage-3 was significantly higher at 28.05 (23.99, 32.79), while the increase in stage-2 was slight at 2.16 (1.79, 2.61), and the HR in stage-3 rose to 30.09 (25.02, 36.19).

CONCLUSIONS

FPG changes had a strong correlation with the incidence of T2D and was a steady indicator that was used to distinguish the participants at high risk of diabetes.

The Prevalence of Insulin Resistance in Malaysia and Indonesia: An Updated Systematic Review and Meta-Analysis

Background and Objectives: Noncommunicable diseases such as diabetes are strongly associated with the insulin resistance (IR) status of an individual. However, the prevalence of insulin resistance in Southeast Asia is poorly reported. Hence, this study investigated the prevalence of IR in Southeast Asia from the year 2016 to 2021. Materials and Methods: This study was carried out according to PRISMA guidelines. The literature search was conducted utilizing the PubMed and SCOPUS databases from the year 2016 to 2021 using the keywords ‘(insulin AND resistance) OR (insulin AND sensitivity) OR (prevalence OR incidence) AND (Malaysia OR Thailand OR Singapore OR Brunei OR Cambodia OR Indonesia OR Laos OR Myanmar OR Philippines OR Timor leste OR Vietnam)’. Funnel plot and publication bias were assessed using Egger’s tests. Data were expressed as the prevalence rate. Results: A total of 12 studies with 2198 subjects were considered in the meta-analysis. Significant heterogeneity (I2 > 94% and p-value < 0.001) was observed in the meta-analysis. The overall prevalence of IR in Southeast Asia was 44.3%, with Malaysia having the highest prevalence rate at 50.4%, followed by Indonesia at 44.2%. Bias was detected in the meta-analysis. It may be that reports published before the year 2016 met the study selection criteria, but were excluded from the meta-analysis. Conclusions: The results from the meta-analysis indicate that the prevalence of IR in Southeast Asia is very high. This provided insights for healthcare policy makers and public health officials in designing IR screening programs.

In search of measures to improve the detection of increased cardiometabolic risk in children using second-generation antipsychotic medications

PURPOSE

Second-generation antipsychotic medications (SGAs) are widely used in child psychiatry. SGA-induced metabolic disturbances are common in children, but monitoring practices need systematisation. The study's aims were to test an SGA-monitoring protocol, examine the distributions of metabolic measurements compared to reference values in child psychiatry patients, and determine whether using a homeostasis model for the assessment of insulin resistance (HOMA-IR) and triglyceride/high-density lipoprotein (TG/HDL) ratio could improve the detection of increased cardiometabolic risk.

MATERIALS AND METHODS

A systematic monitoring protocol was implemented. Weight and height, blood pressure, fasting glucose, insulin, HDL, and TG were measured at baseline and four times during follow-up. HOMA-IR, TG/HDL ratio and zBMI were calculated. Age-, gender- and BMI-specific percentile curves for HOMA-IR were used to define elevated cardiometabolic risk.

RESULTS

The study patients (n = 55, mean age 9.9 years) were followed for a median of 9 months. A disadvantageous, statistically significant shift, often appearing within the reference range, was seen in zBMI, TG, HDL, glucose, insulin, HOMA-IR, and TG/HDL ratio. The increase in HOMA-IR appeared earlier than individual laboratory values and was more evident than the TG/HDL ratio increase. An HOMA-IR cut point of 1.98 resulted in a sensitivity and specificity of 83%. Compared to a previous study performed in the same location, the monitoring rates of metabolic parameters improved.

CONCLUSION

The monitoring protocol implementation improved the monitoring of metabolic parameters in child psychiatric patients using SGAs. Using HOMA-IR as part of systematic SGA monitoring could help detect metabolic adverse effects.

Triglyceride to high-density lipoprotein cholesterol ratio in adolescence as a predictive marker of metabolic syndrome and obesity in early adulthood in China

OBJECTIVE

To explore serum triglyceride (TG) to high-density cholesterol (HDL-C) ratio as a diagnostic marker of metabolic syndrome (MetS) in adolescents and its efficacy in predicting MetS and obesity in the early adulthood.

METHODS

A stratified cluster random sampling method was used to select a total of 935 subjects from senior and junior high schools in Liaoyang, northeast China. The subjects were physically examined and laboratory evaluation was performed. A follow-up examination was performed after 5 years on some (n = 93) of the subjects who had reached adulthood.

RESULTS

TG/HDL-C had significantly high diagnostic accuracy for MetS than HOMA-IR, TG or HDL-C. Subjects with the highest TG/HDL-C at baseline had higher risk of MetS (odds ratio [OR] = 11.65) and obesity (OR = 4.32) in early adulthood.

CONCLUSION

TG/HDL-C ratio has a strong and independent ability in diagnosing MetS in adolescents and predicting the occurrence of MetS and obesity in their early adulthood.

Sex-specific association of sleep duration with subclinical indicators of metabolic diseases among asymptomatic adults

Background

Accumulating evidence suggests sleep duration may be involved in metabolic regulation. However, studies regarding the association with the early stage of the metabolic disease are limited, and the findings were inconsistent.

Methods

A study among 4922 asymptomatic adults was conducted based on a Chinese national survey in 2009. The early stage of metabolic diseases was evaluated using three proxies: triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), the product of triglyceride and fasting glucose (TyG), and lipid accumulation product (LAP). Multivariable linear and logistic regression models were used to explore the associations of sleep duration with the three indicators.

Results

The linear regression models revealed that, among females, sleep duration <7 h per day, compared with 7-9 h, was associated with an increased value of LAP and TyG by 25.232% (95%CI: 10.738%, 41.623%) and 0.104 (95%CI: 0.024, 0.185), respectively, in the crude model. The effects were attenuated but remained significant for LAP (11.405%; 95%CI: 1.613%, 22.262%). Similarly, the logistic regression models further found that sleep duration <7 h per day could increase the risk of elevated LAP (OR: 1.725, 95CI%:1.042, 2.856) after adjusting for multiple covariates. By contrast, no associations were found among males.

Conclusions

Short sleep duration was associated with subclinical indicators of metabolic diseases, and females were more susceptible to the association.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-022-01626-w.

Association of Dyslipidemia and Respiratory Resistance Assessed by the Forced Oscillation Technique in Asthmatic Children

PURPOSE

This study aimed to evaluate the associations between dyslipidemia and pulmonary function parameters assessed by spirometry and the forced oscillation technique in asthmatic children.

METHODS

Asthmatic children (5-18 years old) had fasting serum lipid profiles including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) concentrations, and C-reactive protein (CRP) measured. Pulmonary function tests were assessed by spirometry and the forced oscillation technique (FOT).

RESULTS

One hundred forty-one asthmatic children were enrolled with a mean (SD) age of 11.82 (3.38) years. Eighty-eight (62.4%) children were boys, 64 (45.4%) had dyslipidemia, and 20 (14.2%) were obese. Among the children with dyslipidemia, a high LDL-C concentration (65.6%) was the most common form of dyslipidemia, followed by high TC (57.8%), high TG (35.9%), and low HDL-C concentrations (15.6%). Multivariable analysis showed significant associations between HDL-C concentrations and respiratory resistance at 5 Hz (R₅) and respiratory resistance at 20 Hz (R₂₀), and TC concentrations were modestly associated with reactance at 5 Hz (X₅), the frequency of resonance (Fres), and the area of reactance (ALX). Asthmatic children who had high LDL-C concentrations had a significantly higher expiratory phase R₅, whole breath R₂₀, and expiratory phase R₂₀ than those in children with normal LDL-C concentrations.

CONCLUSION

This study suggests an association of blood cholesterol, especially HDL-C and LDL-C, and respiratory resistance measured by the FOT, irrespective of the obesity status. An intervention for improving LDL-C and HDL-C concentrations may be beneficial on lung function parameters in asthmatic children.

CLINICAL TRIAL REGISTRATION

TCTR20200305005; date of registration: 03-04-2020 (retrospectively registered).

In-vivo skeletal muscle mitochondrial function in Klinefelter syndrome

Klinefelter syndrome (XXY) occurs in 1 in 600 males, resulting in testosterone deficiency and a high prevalence of insulin resistance. Testosterone deficiency in men is a known cause of insulin resistance, and mitochondrial dysfunction is hypothesized to mediate this relationship. The aim of this cross-sectional study was to evaluate muscle mitochondrial function in XXY compared with male controls. Twenty-seven boys with XXY (age 14.7±1.8 years) were compared with 87 controls (age 16.9±0.9). In-vivo calf muscle mitochondrial function was assessed via phosphorus magnetic resonance spectroscopy (³¹P-MRS) following 90 s of isometric 70% maximal exercise. Multiple linear regression was used to compare ³¹P-MRS outcomes (ADP and phosphocreatine (PCr) time constants, rate of oxidative phosphorylation (Oxphos), and Q_max or the maximal mitochondrial function relative to mitochondrial density) between groups after adjusting for age differences. There were no statistically significant differences in the mitochondrial outcomes of ADP, Oxphos, PCr, and Q_max between the groups. There were also no differences in a sensitivity analysis within the XXY group by testosterone treatment status. In this study, in-vivo postexercise skeletal muscle mitochondrial function does not appear to be impaired in adolescents with XXY compared with controls and is not significantly different by testosterone treatment status in XXY.

TG: HDL-C Ratio as Insulin Resistance Marker for Metabolic Syndrome in Children With Obesity

Insulin resistance (IR) is an important variable in the diagnosis of metabolic syndrome (MetS). Currently, IR is not part of the existing pediatric definition of MetS, instead elevated fasting blood glucose (FBG) is measured as an indicator of hyperglycemia. Arguably, many obese children with severe IR are still able to regulate their FBG well. Hence, this study aimed to assess the utility of triglyceride-to-high-density lipoprotein cholesterol (TG : HDL-C) ratio as an IR marker in the modeling of pediatric MetS among children with obesity using structural equation modeling (SEM). A total of 524 blood samples from children with obesity (age 10-16 years old) were analyzed for FBG, lipids, insulin, leptin, and adiponectin. Both exploratory (EFA) and confirmatory factor analysis (CFA) were used to examine TG : HDL-C ratio as an IR marker in pediatric MetS. EFA shows that TG: HDL-C ratio (standardized factor loading = 0.904) groups together with homeostasis model assessment-estimated insulin resistance (HOMA-IR) (standardized factor loading = 0.664), indicating a strong correlation to the IR factor. Replacing FBG with TG: HDL-C ratio improved the modeling of MetS structure in children with obesity. Our MetS model of TG: HDL-C ratio as IR component shows comparable model fitness indices (goodness of fit, Akaike's information criterion, and Bayesian information criterion) with leptin:adiponectin ratio (platinum standard for adiposity:IR marker) model. The least model fit was seen when using FBG as an IR surrogate. TG : HDL-C ratio performed better as IR surrogate in MetS structures (standardized factor loading = 0.39) compared to FBG (standardized factor loading = 0.27). TG: HDL-C ratio may be considered as an IR component in pediatric MetS.

Increased Cholesteryl Ester Transfer Protein and Lipoprotein-Associated Phospholipase A2 Activities in Children and Adolescents Presenting High Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio

OBJECTIVE

To explore the association between Triglyceride/High-density lipoprotein cholesterol (TG/HDL-C) index and these enzymes and proteins in a pediatric population.

METHODS

Children and adolescents (7-14 y old) were recruited (n = 150) and anthropometric data were registered. Glucose, TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), HDL-C plus cholesteryl ester transfer protein (CETP), lipoprotein-associated phospholipase A₂ (Lp-PLA₂) and paraoxonase 1 (PON1) activities were determined.

RESULTS

Twenty-five individuals presented TG/HDL-C ratio ≥ 3.0. These individuals exhibited higher TG [164 (126-186) vs. 65 (48-72) mg/dL; p < 0.01] CETP [250 (232-263) vs. 223 (193-237)% mL/min; p < 0.01] and Lp-PLA₂ (4.5 ± 1.9 vs. 3.5 ± 1.3; p < 0.05) plus lower HDL-C [41 (37-49) vs. 52 (48-62) mg/dL; p < 0.01] compared to an age-matched group with TG/HDL-C < 3.0. TG/HDL-C ratio was associated to CETP (p < 0.01) and Lp-PLA₂ (p < 0.05). Multiple lineal regression analyses showed TG/HDL-C index as an independent predictor of CETP (r² = 0.29; beta = 0.49; p < 0.01) and Lp-PLA₂ (r² = 0.21; beta = 0.32; p < 0.05) activities.

CONCLUSION

Children and adolescents with TG/HDL-C ≥ 3.0 presented a more atherogenic lipid profile and higher CETP and Lp-PLA₂ activities, which would indicate alterations in lipoprotein metabolism and quality.

HOMA-IR as a risk factor of gestational diabetes mellitus and a novel simple surrogate index in early pregnancy

OBJECTIVE

To assess the association between insulin resistance and gestational diabetes mellitus (GDM) in early pregnancy and find a simple surrogate index of the homeostasis model assessment of insulin resistance (HOMA-IR).

METHODS

A total of 700 pregnant women were included in this prospective, double-center, observational cohort study. The glucose and lipid metabolic characterization was performed at 6-12 weeks of pregnancy. All participants underwent a 75-g oral glucose tolerance test at 24-28 weeks of pregnancy. Linear regression analysis was applied to find a novel surrogate index of HOMA-IR. Binary logistic analysis was applied to estimate possible associations of different indices with GDM and insulin resistance.

RESULTS

GDM was diagnosed in 145 of 700 women with singleton pregnancies (20.7%). HOMA-IR was higher in the GDM group than in the normal glucose tolerance (NGT) group and was an individual risk factor for GDM (adjusted risk ratio RR 1.371, 95% confidence interval [CI] 1.129-1.665, P < 0.001). TyHGB index as the surrogate index of HOMA-IR was represented as TG/HDL-C + 0.7*FBG (mmol/L) +0.1*preBMI (kg/m² )(where TG/HDL-C is triglyceride/high-density lipoprotein cholesterol; FBG is fasting blood glucose, and preBMI is the pre-pregnancy body mass index [calculated as weight in kilograms divided by the square of height in meters]). The cut-off point of the TyHGB index was 6.0 (area under the curve 0.827, 95% CI 0.794-0.861, P < 0.001) for mild insulin resistance.

CONCLUSION

Increased HOMA-IR in early pregnancy was a risk factor of GDM. TyHGB index could be a surrogate index of HOMA-IR and had a predictive value for GDM.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

OBJECTIVES

The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity.

METHODS

A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated.

RESULTS

The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m²) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index.

CONCLUSIONS

LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

Dyslipidemia in childhood and adolescence: from screening to management

PURPOSE OF REVIEW

To summarize types of dyslipidemia frequently encountered during childhood and adolescence, with a focus on screening, diagnosis, and management.

RECENT FINDINGS

It is important that screening for atherosclerotic cardiovascular disease (ASCVD) begin in childhood. Genetic testing allows for increased awareness of dyslipidemia and more targeted intervention. Pharmacologic treatment of pediatric dyslipidemias has a good safety profile and can reduce adult ASCVD risk.

SUMMARY

Much of what is known about pediatric dyslipidemia has been extrapolated from adult data, but recently, there have been increasing investigations within the pediatric population to better guide diagnosis and management of these disorders.

Value of simple clinical parameters to predict insulin resistance among newly diagnosed patients with type 2 diabetes in limited resource settings

Background

Insulin resistance (IR) has been considered as a therapeutic target in the management of type 2 diabetes mellitus (T2DM). Readily available, simple and low cost measures to identify individuals with IR is of utmost importance for clinicians to plan optimal management strategies. Research on the associations between surrogate markers of IR and routine clinical and lipid parameters have not been carried out in Sri Lanka, a developing country with rising burden of T2DM with inadequate resources. Therefore, we aimed to study the utility of readily available clinical parameters such as age, body mass index (BMI), waist circumference (WC) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) in the fasting lipid profile in predicting IR in a cohort of patients with newly diagnosed T2DM in Sri Lanka.

Methods and findings

We conducted a community based cross sectional study involving of 147 patients (age 30–60 years) with newly diagnosed T2DM in a suburban locality in Galle district, Sri Lanka. Data on age, BMI, WC, fasting plasma glucose (FPG) concentration, fasting insulin concentration and serum lipid profile were collected from each subject. The indirect IR indices namely homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI) and McAuley index (MCA) were estimated. Both clinical and biochemical parameters across the lowest and the highest fasting insulin quartiles were compared using independent sample t-test. Linear correlation analysis was performed to assess the correlation between selected clinical parameters and indirect IR indices. The area under the receiver operating characteristic (ROC) curve was obtained to calculate optimal cut-off values for the clinical markers to differentiate IR. BMI (p<0.001) and WC (p = 0.01) were significantly increased whereas age (p = 0.06) was decreased and TG/HDL-C (p = 0.28) was increased across the insulin quartiles. BMI and WC were significantly correlated (p<0.05) with HOMA, QUICKI and MCA. Out of the clinical parameters, age showed a borderline significant correlation with QUICKI and TG/HDL-C showed a significant correlation only with MCA. The area under ROC of BMI was 0.728 (95% CI 0.648–0.809; p<0.001) and for WC, it was 0.646 (95% CI 0.559–0.734; p = 0.003). The optimized cut-off value for BMI and WC were 24.91 kg/m² and 81.5 cm respectively to differentiate the patients with IR or ID. Study limitations include small sample size due to recruitment of patients only from a limited geographical locality of the country and not totally excluding of the possibility of inclusion of some patients with slowly progressive type 1 DM or Latent onset diabetes of adulthood from the study population.

Conclusions

The results revealed that there was a significant positive correlation between BMI, WC and HOMA while a significant negative correlation with QUICKI and MCA among the cohort of patients with newly diagnosed T2DM. The cut-off values of BMI and WC as 24.91 kg/m² and 81.5 cm respectively could be used as simple clinical parameters to identify IR in newly diagnosed patients with T2DM. Our results could be beneficial in rational decision making in the management of newly diagnosed patients with T2DM in limited resource settings.

Lower Baseline Serum Triglyceride Levels Are Associated With Higher Decrease in Body Mass Index After Laparoscopy Sleeve Gastrectomy Among Obese Patients

AIMS

To investigate the predictive value of baseline serum triglyceride (TG) levels for improvements of metabolism after laparoscopic sleeve gastrectomy (LSG).

METHODS

112 obese patients [body mass index (BMI) ≥ 35 kg/m²] underwent LSG and with complete information of anthropometric and metabolic parameters were divided into normal TG group (group A) and high TG group (group B), while group A had TG levels ≤ 1.7 mmol/L, and group B had TG levels > 1.7 mmol/L. The post-operative changes (Δ) in metabolic parameters between the two groups were compared.

RESULTS

In the whole cohort, the metabolic parameters were significantly improved at 6 months after LSG. BMI and waist circumference (WC) decreased significantly in the two groups. The ΔBMI among group A and group B were 11.42±3.23 vs 9.13±2.77 kg/m² (p<0.001), respectively. ΔBMI was positively correlated with ΔWC (r=0.696, p<0.001), Δfasting insulin level (r=0.440, p=0.002), Δfasting serum C peptide level (r=0.453, p=0.002), and Δhomeostasis model assessment insulin resistance index (r=0.418, p=0.004) in group A. Compared with group B, group A had a significantly higher odds ratio (OR) of 2.83 (95% confidence interval [CI]1.25-6.38, p=0.012)and 2.73 (95% CI 1.11-6.72, p=0.029) for ΔBMI and ΔWC after adjustment for age and gender, respectively.

CONCLUSIONS

Obese patients with baseline TG levels under 1.7 mmol/L had greater loss of weight at six months follow-up later LSG. This finding suggests that baseline TG level may have a predictive value for weight loss, at least in the short-term follow-up.

Gut Microbiota of Chinese Obese Children and Adolescents With and Without Insulin Resistance

OBJECTIVE

The intestinal flora of gut microbiota in obese Chinese children and adolescents with and without insulin resistance (IR) was analyzed, as well as associations between the gut microbiota and two serum cytokines related to glucose metabolism, adropin and angiopoietin-like 4 (ANGPTL4).

METHODS

Clinical data, fecal bacterial composition, glucose-related hormones, and serum adipokines (adropin and ANGPTL4) were analyzed in 65 Chinese children with exogenous obesity. The composition of the gut microbiota was determined by 16S rRNA-based metagenomics and IR was calculated using the homeostasis model assessment (HOMA).

RESULTS

The 65 obese subjects were divided into two groups: insulin sensitive (IS) (n=40, 57.5% males) or IR (n=25, 60% males). Principal coordinates analysis revealed that the gut microbiota samples from the IS group clustered together and separated partly from the IR group (p=0.008). By Mann-Whitney U-test, at a phylum level, a reduction of Firmicutes and an increase of Bacteroidetes in the IR subjects was observed. LEfSe analysis revealed that IS subject, when compared to their IR counterparts, harbored members of the order Coriobacteriales, Turicibacterales, Pasteurellales and family Turicibacteraceae, that were significantly more abundant. In contrast, the IR subjects had members of family Peptococcaceae that were significantly more prevalent than the IS subjects (all p<0.05). Spearman's correlation analysis revealed that serum ANGPTL4 was positively associated with genus Bacteroides, Butyricimonas, and Alistipes, and adropin was positively associated with genus Anaerostipes and Alistipes, and negatively associated with genus Blautia (all p<0.05).

CONCLUSION

In obese children, the gut microbiome in IR subjects was significantly discordant from the IS subjects, and the abundance of some metabolism-related bacteria correlated with the serum concentrations of adropin and ANGPTL4. These observations infer that the gut microbiota may be involved in the regulation of glucose metabolism in obesity.

Associations of TG/HDL Ratio with the Risk of Prediabetes and Diabetes in Chinese Adults: A Chinese Population Cohort Study Based on Open Data

BACKGROUND

In the global chronic diseases, type 2 diabetes shows a significant upward trend, and there are more people before prediabetes (impaired glucose tolerance). Many patients with impaired glucose tolerance and undiagnosed diabetes do not know that their glucose metabolism system has been in a state of disorder. Every year, about 5% to 10% of prediabetics develop diabetes. One of the important achieving factors may be the increase in blood lipids. However, it is not clear whether the triglyceride/high-density lipoprotein ratio is associated with impaired glucose tolerance and diabetes in the Chinese population. Therefore, we investigated the relationship between triglyceride/high-density lipoprotein and impaired glucose tolerance and diabetes in the Chinese population.

METHODS

We conducted a retrospective cohort study using data from the health screening program. The study included 116,855 participants from 32 locations in China, all of whom were adults over 20. Participants measured fasting blood glucose levels at each visit and collected information about their diabetes history. Impaired glucose tolerance was diagnosed as fasting blood glucose ≥6.00 mmol and self-reported diabetes mellitus. The patient was measured on the date of diagnosis or on his last visit (whichever comes first).

RESULTS

The results showed that, after adjusting the potential confounding factors, the ratio of TG/HDL was positively correlated with the occurrence of prediabetes and diabetes, and there was a saturation effect. The inflection points were 1.04 and 1.33, respectively. The effect value and 95% confidence interval before and after the inflection point of impaired glucose tolerance patients were 1.57 and (1.42, 1.73) and 1.03 and (1.01, 1.05), respectively. The effect value and 95% confidence interval before and after the inflection point in patients with diabetes were 2.07 and (1.80, 2.39) and 1.08 and (1.04, 1.12).

[Blood lipid metabolic profile of overweight/obese boys aged 9-12 years]

OBJECTIVE

To study the features of blood lipid metabolic profile in overweight/obese boys aged 9-12 years and the possible mechanism of overweight/obesity in children.

METHODS

According to body mass index (BMI), 72 boys, aged 9-12 years, were divided into a control group with 42 boys and an overweight/obesity group with 30 boys. Fasting venous blood samples were collected early in the morning. BMI, waist-hip ratio, body composition, and blood lipids were measured. Ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry technique was used to analyze the serum lipid compounds. A statistical analysis and visualization of the data were performed.

RESULTS

Compared with the control group, the overweight/obesity group had significantly higher waist-hip ratio, body fat percentage, and triglyceride level (P<0.05) and a significantly lower level of high-density lipoprotein cholesterol (P<0.05). The metabolomic analysis identified 150 differentially expressed lipid compounds between the two groups, mainly glycerolipids (40.7%), glycerophospholipids (24.7%), fatty acyls (10.7%), and sphingolipids (7.3%). The levels of most of glycerolipids were significantly upregulated in the overweight/obesity group, while those of most of glycerophospholipids and sphingolipids were downregulated in this group. Key lipids with differential expression were enriched into two KEGG metabolic pathways, i.e., ether lipid metabolism pathway and terpenoid backbone biosynthesis pathway (P<0.05), and might further affected the biosynthesis and metabolism of downstream coenzyme Q and other terpenoids (P=0.06).

CONCLUSIONS

Disordered lipid metabolic profile is observed in overweight/obese boys aged 9-12 years, with increases in most glycerolipids and reductions in glycerophospholipids and sphingolipids. Overweight/obese boys may have disorders in ether lipid metabolism and biosynthesis of terpenoid and even coenzyme Q.

Elevated Serum Level of Cytokeratin 18 M65ED Is an Independent Indicator of Cardiometabolic Disorders

BACKGROUND

Recent studies have suggested that cell death might be involved in the pathophysiology of metabolic disorders. The cytokeratin 18 (CK18) fragment, as a cell death marker, plays an important role in nonalcoholic fatty liver disease (NAFLD). However, only a limited number of studies have found elevated serum levels of CK18 in patients with type 2 diabetes. Moreover, no studies have been conducted yet to investigate the role of CK18 in hypertension or dyslipidemia. In particular, CK18 M65ED is a more sensitive marker of cell death, and its role in cardiometabolic disorders has not been revealed yet.

METHODS

A total of 588 subjects were enrolled from the local communities of Shanghai. Serum CK18 M65ED were determined using the enzyme-linked immunosorbent assay. A cardiometabolic disorder was identified by the presence of at least one of the components including overweight or central obesity, diabetes, dyslipidemia, and hypertension.

RESULTS

Subjects with cardiometabolic disorders exhibited significantly higher serum levels of CK18 M65ED than those without cardiometabolic disorders (197.36 (121.13-354.50) U/L versus 83.85 (52.80-153.75) U/L, respectively, P < 0.001). Increased serum CK18 M65ED quartiles were associated with the increased prevalence of cardiometabolic disorders and its components (P < 0.001 for all components). Multiple stepwise regression analysis also revealed that diastolic blood pressure, glycated hemoglobin A1c, alanine transaminase, and high-density lipoprotein cholesterol were independently correlated with serum CK18 M65ED levels (all P < 0.01). In addition, logistic regression analysis showed that the serum CK18 M65ED levels were positively correlated with cardiometabolic disorders and in an independent manner. Further, CK18 M65ED was revealed to be an indicator of cardiometabolic disorders in a NAFLD-independent manner.

CONCLUSIONS

Elevated levels of CK18 M65ED, a sensitive cell death marker, were independently and positively correlated with cardiometabolic disorders, even after the adjustment for the presence of NAFLD and other cardiovascular risk factors.