Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Significance of Triglyceride-to-High-Density Lipoprotein Cholesterol Ratio in Children with Non-Alcoholic Fatty Liver Disease

  • Hyun Jin Kim (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine)
  • Received : 2023.04.20
  • Accepted : 2023.08.23
  • Published : 2023.11.15
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Abstract

Purpose: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome. This study evaluated the significance of markers such as the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and TG-glucose (TyG) indices in a group of patients with NAFLD. Methods: We retrospectively analyzed the data of patients aged 5-18 years diagnosed with NAFLD between January 2014 and January 2021. Results: Among the 151 patients with NAFLD, 79.5% were found to be obese, and the mean TG/HDL-C ratio (3.78±2.54 vs. 3.13±2.24) and TyG index (4.69±0.28 vs. 4.56±0.30) were slightly higher in patients with obesity compared to those without obesity. Patients with severe hepatic steatosis had a significantly higher mean TG/HDL-C ratio (4.11±2.16 vs. 3.11±2.30, p=0.035) than those with mild to moderate steatosis. Severe hepatic steatosis grade was defined as an area under the receiver operating characteristic curve of the TG/HDL-C ratio of 0.760 (95% confidence interval, 0.544-0.875), with an optimal cutoff value of 3.37. Conclusion: A high TG/HDL-C ratio is associated with severe hepatic steatosis and diabetes mellitus in children with NAFLD. Measurement of this ratio can help clinicians in identifying patients and targeting them for treatment and follow-up.

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References

  1. Godoy-Matos AF, Junior WSS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr 2020;12:60.
  2. Jung UJ, Choi MS. Obesity and its metabolic complications: the role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol Sci 2014;15:6184-223. https://doi.org/10.3390/ijms15046184
  3. Gregory JW. Prevention of obesity and metabolic syndrome in children. Front Endocrinol (Lausanne) 2019;10:669.
  4. Moriyama K. Associations between the triglyceride to high-density lipoprotein cholesterol ratio and metabolic syndrome, insulin resistance, and lifestyle habits in healthy Japanese. Metab Syndr Relat Disord 2020;18:260-6. https://doi.org/10.1089/met.2019.0123
  5. Yang Y, Wang B, Yuan H, Li X. Triglycerides to high-density lipoprotein cholesterol ratio is the best surrogate marker for insulin resistance in nonobese middle-aged and elderly population: a cross-sectional study. Int J Endocrinol 2021;2021:6676569.
  6. Lim J, Kim J, Koo SH, Kwon GC. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007-2010 Korean National Health and Nutrition Examination Survey. PLoS One 2019;14:e0212963.
  7. Lin HY, Zhang XJ, Liu YM, Geng LY, Guan LY, Li XH. Comparison of the triglyceride glucose index and blood leukocyte indices as predictors of metabolic syndrome in healthy Chinese population. Sci Rep 2021;11:10036.
  8. Singh SP, Barik RK. NonInvasive biomarkers in nonalcoholic fatty liver disease: are we there yet? J Clin Exp Hepatol 2020;10:88-98. https://doi.org/10.1016/j.jceh.2019.09.006
  9. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al.; Committee for the development of growth standards for Korean children and adolescentsCommittee for School Health and Public Health Statistics, the Korean Pediatric SocietyDivision of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention. The 2017 Korean national growth charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61:135-49. https://doi.org/10.3345/kjp.2018.61.5.135
  10. Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017;64:319-34. https://doi.org/10.1097/MPG.0000000000001482
  11. Association AD 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020;43(Suppl 1):S14-31. https://doi.org/10.2337/dc20-S002
  12. Lim JS, Kim EY, Kim JH, Yoo JH, Yi KH, Chae HW, et al. 2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents. Ann Pediatr Endocrinol Metab 2020;25:199-207. https://doi.org/10.6065/apem.2040198.099
  13. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab 2010;95:3347-51. https://doi.org/10.1210/jc.2010-0288
  14. Ferraioli G, Monteiro LBS. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol 2019;25:6053-62. https://doi.org/10.3748/wjg.v25.i40.6053
  15. Chen Z, Qin H, Qiu S, Chen G, Chen Y. Correlation of triglyceride to high-density lipoprotein cholesterol ratio with nonalcoholic fatty liver disease among the non-obese Chinese population with normal blood lipid levels: a retrospective cohort research. Lipids Health Dis 2019;18:162.
  16. Zhang S, Du T, Zhang J, Lu H, Lin X, Xie J, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis 2017;16:15.
  17. Guo W, Lu J, Qin P, Li X, Zhu W, Wu J, et al. The triglyceride-glucose index is associated with the severity of hepatic steatosis and the presence of liver fibrosis in non-alcoholic fatty liver disease: a cross-sectional study in Chinese adults. Lipids Health Dis 2020;19:218.
  18. Alcala M, Calderon-Dominguez M, Serra D, Herrero L, Ramos MP, Viana M. Short-term vitamin E treatment impairs reactive oxygen species signaling required for adipose tissue expansion, resulting in fatty liver and insulin resistance in obese mice. PLoS One 2017;12:e0186579.
  19. Mustapic S, Ziga S, Matic V, Bokun T, Radic B, Lucijanic M, et al. Ultrasound grade of liver steatosis is independently associated with the risk of metabolic syndrome. Can J Gastroenterol Hepatol 2018;2018:8490242.
  20. Kang BK, Kim M, Shin SJ, Kim YJ. Correlation of clinical and histopathologic parameters with ultrasonographic grades in pediatric non-alcoholic fatty liver disease. J Korean Med Sci 2019;34:e298.
  21. Chu SY, Jung JH, Park MJ, Kim SH. Risk assessment of metabolic syndrome in adolescents using the triglyceride/high-density lipoprotein cholesterol ratio and the total cholesterol/high-density lipoprotein cholesterol ratio. Ann Pediatr Endocrinol Metab 2019;24:41-8. https://doi.org/10.6065/apem.2019.24.1.41
  22. Iwani NA, Jalaludin MY, Zin RM, Fuziah MZ, Hong JY, Abqariyah Y, et al. Triglyceride to HDL-C ratio is associated with insulin resistance in overweight and obese children. Sci Rep 2017;7:40055.
  23. Ruiz-Jaramillo MDLC, Lopez-Acevedo M. Triglycerides/high-density lipoprotein-cholesterol ratio in children with metabolic syndrome. Child and Adolescent Obesity 2021;4:78-88. https://doi.org/10.1080/2574254X.2021.1903297
  24. Rodriguez-Gutierrez N, Vanoye Tamez M, Vazquez-Garza E, Villarreal-Calderon JR, Castillo EC, Laresgoiti-Servitje E. Association of the triglyceride/high-density lipoprotein cholesterol index with insulin resistance in a pediatric population in Northeast Mexico. Metab Syndr Relat Disord 2020;18:333-40. https://doi.org/10.1089/met.2020.0046