Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness, insulin resistance and nonalcoholic fatty liver disease in children and adolescents

Nutr Metab Cardiovasc Dis. 2014 Jul;24(7):737-43. doi: 10.1016/j.numecd.2014.01.010. Epub 2014 Jan 29.


Background and aims: The triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD).

Methods and results: The study population, including 548 children (aged 6-16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08-3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03-15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30-3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62-4.56); P < 0.01].

Conclusion: TG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.

Keywords: Carotid artery intima-media thickness; Children; Insulin resistance; Nonalcoholic fatty liver disease; Triglyceride-to-HDL cholesterol ratio.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Pressure
  • Body Mass Index
  • C-Reactive Protein / metabolism
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / prevention & control
  • Carotid Arteries / diagnostic imaging
  • Carotid Arteries / physiopathology*
  • Carotid Intima-Media Thickness*
  • Child
  • Cholesterol, HDL / blood*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Insulin Resistance*
  • Liver / diagnostic imaging
  • Liver / physiopathology
  • Logistic Models
  • Male
  • Metabolic Syndrome / blood
  • Multivariate Analysis
  • Non-alcoholic Fatty Liver Disease / blood*
  • Obesity / blood
  • Overweight / blood
  • Risk Factors
  • Triglycerides / blood*
  • Waist Circumference


  • Cholesterol, HDL
  • Triglycerides
  • C-Reactive Protein