Abstract
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.
Highlights
Metabolic syndrome (MetS) is a cluster of risk factors that includes obesity, dyslipidemia, insulin resistance (IR) or impaired glucose tolerance, and elevated blood pressure (BP)
We used structural equation modeling (SEM) to examine the usefulness of to-high-density lipoprotein cholesterol (TG): HDL-C ratio as an IR surrogate in the diagnosis of MetS in children with obesity
We have shown by exploratory factor analysis (EFA) that TG: HDL-C ratio distinctively grouped with homeostasis model assessment-estimated insulin resistance (HOMA-IR), indicating a strong correlation between TG : HDL-C ratio and homeostasis model assessment (HOMA)-IR, representing the IR group
Summary
Metabolic syndrome (MetS) is a cluster of risk factors that includes obesity, dyslipidemia, insulin resistance (IR) or impaired glucose tolerance, and elevated blood pressure (BP). Identification and treatment of obese children and adolescents with multiple metabolic derangements, those at higher risk, may curb the risk of developing cardiometabolic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Identifying those who are affected is rather difficult because clear recommendations about how to diagnose MetS in the young age group are still lacking [1]. One of the limitations is the reliance on elevated fasting blood glucose (FBG) rather than fasting insulin or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) as a measure of impaired glucose regulation whereby many children with severe IR can still regulate their FBG [2]. There is a need to search for a simple, reliable, and applicable surrogate marker to measure IR among children to improve the existing pediatric MetS definition
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