Identifying children with insulin resistance (IR) is difficult due to insulin assay reliability/reproducibility. We examined if the triglyceride/high-density lipoprotein ratio (TG/HDL) can identify children with IR and if it is important to use age- & sex-specific cutoffs. In a representative sample of 3,464 US adolescents 12-18 yrs participating in NHANES (2003-2020) , we calculated the fasting TG/HDL ratio & homeostasis model assessment-insulin resistance level (HOMA-IR) . We established age- & sex-specific & universal percentiles (10th, 25th, 50th, 75th, 95th) for TG/HDL ratio based on a subset of normal weight adolescents; IR was defined as having a HOMA-IR >4.39. We created receiver operating characteristic (ROC) curves predicting IR comparing age- & sex-specific, universal TG/HDL ratios, and raw TG/HDL cutpoints. Half were female, 14% were black, 13% were Mexican-American, and 24% had IR. AUC was similar for age-,sex-specific (0.69 (SE 0.01)) , universal (0.69 (SE 0.01)) percentiles and raw TG/HDL ratios (0.69 (SE 0.01)) (p=0.22) . Age and sex cutoffs did not provide further discrimination for identifying adolescents with IR. A universal TG/HDL ratio cutoff of 1.0 conferred a sensitivity of 84% and specificity of 42%. A TG/HDL ratio of 1.0 may be a reasonable test cutoff for identifying adolescents with IR, given that higher detection rates may improve identification of high risk children.


D.Eng: None. B.Gregg: None. K.Singer: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc.


Caswell Diabetes Institute at the University of Michigan

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