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Triglyceride to HDL ratio may better predict insulin resistance in Chinese adults
In middle-aged and older Chinese adults, the triglyceride to HDL cholesterol ratio may serve as a better marker for evaluating insulin resistance and diabetes compared with other lipid measures, according to findings published in Clinical Nutrition.
“Based on recent lipid management recommendations, LDL cholesterol is the main target in the treatment of diabetic dyslipidemia,” Diaozhu Lin, of the department of endocrinology at Sun Yat-sen Memorial Hospital in Guangzhou, China, and colleagues wrote. “However, it has been shown that serum lipid levels and [the] prevalence of dyslipidemia in patients with diabetes vary greatly depending on region, nationality, economic level and health care level. Other lipid metabolism markers, such as combined lipid ratio, may better reflect the overall interaction between lipid/lipoprotein fractions. For now, at least, it is unclear whether lipoprotein parameters other than LDL [cholesterol] could provide additional clinical information regarding diabetes related insulin resistance, or indicate more appropriate treatment targets for glycemic control.”
In a cross-sectional study, Lin and colleagues analyzed data from 9,764 adults from a community in Guangzhou, China, participating in the REACTION study between June and November 2011 (mean age, 56 years). Participants completed lifestyle and medical history questionnaires and provided fasting blood samples to measure serum insulin, fasting plasma glucose, triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol and creatinine, and completed a 2-hour oral glucose tolerance test. Researchers calculated HbA1c, triglyceride glucose index, estimated glomerular filtration rate, homeostatic model of insulin resistance and non-HDL cholesterol. Researchers used logistic regression analyses to assess the prevalence of insulin resistance and diabetes according to quartiles of lipid parameters, adjusted for age, sex, BMI, smoking and drinking status, physical activity level, systolic blood pressure and presence of diabetes, dyslipidemia or CVD.
Within the cohort, 1,630 (16.7%) were diagnosed with diabetes; 2,442 (25%) were considered insulin resistant.
Researchers found that both prevalent insulin resistance and diabetes were increased with elevated quartiles of triglycerides, non-HDL cholesterol, non-HDL cholesterol to HDL cholesterol ratio and triglyceride to HDL cholesterol ratio, and decreased across elevated quartiles of HDL cholesterol (P for all trends < .001). For prevalent diabetes, researchers did not detect trend differences in participants with elevated quartiles of total cholesterol or LDL cholesterol, they noted.
In logistic regression analysis, researchers found that participants were more likely to have prevalent insulin resistance with elevated quartiles of triglycerides, total cholesterol, LDL cholesterol, non-HDL cholesterol, non-HDL cholesterol to HDL cholesterol ratio and triglyceride to HDL cholesterol ratio; however, there were no observed associations between total cholesterol and LDL cholesterol and diabetes.
“When compared with other lipid parameters, [triglyceride to HDL cholesterol] ratio has shown the strongest correlation with increased odds of both insulin resistance and diabetes across all logistic regression models,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.