Skip to main content

Advertisement

SpringerLink
Log in

Validity of triglyceride–glucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to determine the cut-off values of triglycerides and glucose (TyG) index as one of the indirect indices for metabolic syndrome (MetS) in a pediatric population.

Methods

This national study was conducted in 2015 on 14400 students, aged 7–18 years. They were selected by random cluster sampling from 30 provinces of our country during the fifth survey of a national school-based surveillance program. MetS was defined based on the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. The cut-off values of TyG index for MetS were obtained using the receiver operation characteristic (ROC) curve analysis by gender and age groups.

Results

Totally, 3843 students (52.3% boys) with mean (SD) age of 12.45 (3.04) years were assessed. The area under the ROC curve of TyG index for MetS was 0.83 in total participants. According to the ATP III criteria the cut-off values of the TyG index were 8.33 (8.21–8.45) in total students, 8.47 (8.36–8.58) in boys, and 8.33 (8.18–8.48) in girls. In the 7–12 and 13–18 years’ age groups, these values were 8.47 (8.32–8.63) and 8.34 (8.22–8.45) in total, 8.39 (8.26–8.52) and 8.47 (8.33–8.61) in boys, 8.33 (8.11–8.55) and 8.35 (8.22–8.47) in girls, respectively.

Conclusion

The findings of this study can be clinically helpful for screening MetS in children and adolescents but the effectiveness of these criteria needs to be evaluated by further longitudinal surveys.

Level of evidence

Level V, cross-sectional descriptive study (National surveillance study).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Day C (2007) Metabolic syndrome, or what you will: definitions and epidemiology. Diabetes Vasc Dis Res 4:32–38. https://doi.org/10.3132/dvdr.2007.003

    Article  Google Scholar 

  2. Morrison JA, Friedman LA, Wang P, Glueck CJ (2008) Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr 152:201–206. https://doi.org/10.1016/j.jpeds.2007.09.010

    Article  CAS  Google Scholar 

  3. Ejtahed HS, Qorbani M, Motlagh ME, Angoorani P, Hasani-Ranjbar S, Ziaodini H et al (2017) Association of anthropometric indices with continuous metabolic syndrome in children and adolescents: the CASPIAN-V study. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0455-0 (online)

    Article  PubMed  Google Scholar 

  4. Barbaro G, Piedimonte A, Podagrosi M, Mercurio R, Mosca A, D’Avanzo M et al (2016) Epicardial adipose tissue and signs of metabolic syndrome in children. Eat Weight Disord 21:269–286. https://doi.org/10.1007/s40519-015-0221-0

    Article  PubMed  Google Scholar 

  5. Bergman RN, Phillips LS, Cobelli C (1981) Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Investig 68:1456–1467. https://doi.org/10.1172/JCI110398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kelley DE, Goodpaster BH (2001) Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes Care 24:933–941. https://doi.org/10.2337/diacare.24.5.933

    Article  CAS  PubMed  Google Scholar 

  7. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO et al (2010) The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic–hyperinsulinemic clamp. J Clin Endocrinol Metab 95:3347–3351. https://doi.org/10.1210/jc.2010-0288

    Article  CAS  PubMed  Google Scholar 

  8. Kang B, Yang Y, Lee EY, Yang HK, Kim HS, Lim SY et al (2017) Triglycerides/glucose index is a useful surrogate marker of insulin resistance among adolescents. Int J Obes 41:789–792. https://doi.org/10.1038/ijo.2017.14

    Article  CAS  Google Scholar 

  9. Motlagh ME, Ziaodini H, Qorbani M, Taheri M, Aminaei T, Goodarzi A et al (2017) Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: the CASPIAN-V study. Int J Prev Med 8:4. https://doi.org/10.4103/2008-7802.198915

    Article  PubMed  PubMed Central  Google Scholar 

  10. Organization WH (1995) Physical status: the use of and interpretation of anthropometry, Report of a WHO Expert Committee

  11. Knowles K, Paiva L, Sanchez S, Revilla L, Lopez T, Yasuda M et al (2011) Waist circumference, body mass index, and other measures of adiposity in predicting cardiovascular disease risk factors among Peruvian adults. Int J Hypertens. https://doi.org/10.4061/2011/931402

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aswathappa J, Garg S, Kutty K, Shankar V (2013) Neck circumference as an anthropometric measure of obesity in diabetics. N Am J Med Sci 5:28. https://doi.org/10.4103/1947-2714.106188

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nyland J, Fried A, Maitra R, Johnson DL, Caborn DN (2006) Wrist circumference is related to patellar tendon thickness in healthy men and women. Clin Imaging 30:335–338. https://doi.org/10.1016/j.clinimag.2006.02.004

    Article  PubMed  Google Scholar 

  14. McNamara JR, Schaefer EJ (1987) Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chim Acta 166:1–8. https://doi.org/10.1016/0009-8981(87)90188-4

    Article  CAS  PubMed  Google Scholar 

  15. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S et al (2007) The metabolic syndrome in children and adolescents. Lancet 369(9579):2059–2061. https://doi.org/10.1016/s0140-6736(07)60958-1

    Article  PubMed  Google Scholar 

  16. Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X (2014) Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 13:146. https://doi.org/10.1186/s12933-014-0146-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R (2009) First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East. Diabetes Care 32:1092–1097. https://doi.org/10.2337/dc08-1800

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kelishadi R, Gouya MM, Adeli K, Ardalan G, Gheiratmand R, Majdzadeh R et al (2008) Factors associated with the metabolic syndrome in a national sample of youths: CASPIAN study. Nutr Metab Cardiovasc Dis 18:461–470. https://doi.org/10.1016/j.numecd.2007.02.014

    Article  PubMed  Google Scholar 

  19. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL (2014) Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr 61:533–540. https://doi.org/10.1016/j.endonu.2014.06.009

    Article  PubMed  Google Scholar 

  20. Lee SH, Han K, Yang HK, Kim MK, Yoon KH, Kwon HS et al (2015) Identifying subgroups of obesity using the product of triglycerides and glucose: the Korea National Health and Nutrition Examination Survey, 2008–2010. Clin Endocrinol 82:213–220. https://doi.org/10.1111/cen.12502

    Article  CAS  Google Scholar 

  21. Lee S-H, Kwon H-S, Park Y-M, Ha H-S, Jeong SH, Yang HK et al (2014) Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS One 9:e90430. https://doi.org/10.1371/journal.pone.0090430

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mohd Nor NS, Lee S, Bacha F, Tfayli H, Arslanian S (2016) Triglyceride glucose index as a surrogate measure of insulin sensitivity in obese adolescents with normoglycemia, prediabetes, and type 2 diabetes mellitus: comparison with the hyperinsulinemic–euglycemic clamp. Pediatr Diabetes 17:458–465. https://doi.org/10.1111/pedi.12303

    Article  CAS  PubMed  Google Scholar 

  23. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, De Francisco A et al (2013) Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord 13:47. https://doi.org/10.1186/1472-6823-13-47

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tomé M, Botana M, Cadarso-Suárez C, Rego-Iraeta A, Fernández-Mariño A, Mato J et al (2009) Prevalence of metabolic syndrome in Galicia (NW Spain) on four alternative definitions and association with insulin resistance. J Eendocrinol Investig 32:505. https://doi.org/10.1007/BF03346497

    Article  Google Scholar 

  25. Esteghamati A, Ashraf H, Esteghamati A-R, Meysamie A, Khalilzadeh O, Nakhjavani M et al (2009) Optimal threshold of homeostasis model assessment for insulin resistance in an Iranian population: the implication of metabolic syndrome to detect insulin resistance. Diabetes Res Clin Pract 84:279–287. https://doi.org/10.1016/j.diabres.2009.03.005

    Article  CAS  PubMed  Google Scholar 

  26. Lee S, Choi S, Kim HJ, Chung Y-S, Lee KW, Lee HC et al (2006) Cutoff values of surrogate measures of insulin resistance for metabolic syndrome in Korean non-diabetic adults. J Korean Med Sci 21:695–700. https://doi.org/10.3346/jkms.2006.21.4.695

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kwon HC, Woo SI, Kim YK, Ahn SM, Song KE, Jung SH et al (2005) Cutoff values of surrogate measures of insulin resistance for metabolic syndrome in Korean non-diabetic adults. Korean J Obes 14:69–75. https://doi.org/10.3346/jkms.2006.21.4.695

    Article  Google Scholar 

  28. Grzybowski M, Younger JG (1997) Statistical methodology: III. Receiver operating characteristic (ROC) curves. Acad Emerg Med 4:818–826

    Article  CAS  PubMed  Google Scholar 

  29. Faraggi D, Reiser B (2002) Estimation of the area under the ROC curve. Stat Med 21:3093–3106. https://doi.org/10.1002/sim.1228

    Article  PubMed  Google Scholar 

  30. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F (2008) The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 6:299–304. https://doi.org/10.1089/met.2008.0034

    Article  CAS  PubMed  Google Scholar 

  31. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO et al (2010) The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic–hyperinsulinemic clamp. J Clin Endocrinol Metab 95:3347–3351. https://doi.org/10.1210/jc.2010-0288

    Article  CAS  PubMed  Google Scholar 

  32. Moon S, Park J-S, Ahn Y (2017) The cut-off values of triglycerides and glucose index for metabolic syndrome in American and Korean adolescents. J Korean Med Sci 32:427–433. https://doi.org/10.3346/jkms.2017.32.3.427

    Article  PubMed  Google Scholar 

  33. Kim JW, Park SH, Kim Y, Im M, Han H-S (2016) The cutoff values of indirect indices for measuring insulin resistance for metabolic syndrome in Korean children and adolescents. Ann Pediatr Endocrinol Metab 21:143–148. https://doi.org/10.6065/apem.2016.21.3.143

    Article  PubMed  PubMed Central  Google Scholar 

  34. Vasques ACJ, Novaes FS, de Oliveira MdS, Souza JRM, Yamanaka A, Pareja JC et al (2011) TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 93:e98–e100. https://doi.org/10.1016/j.diabres.2011.05.030

    Article  CAS  Google Scholar 

  35. Mohd Nor NS, Lee S, Arslanian SA (2015) Triglyceride Glucose (TyG) Index As a surrogate measure of insulin sensitivity in obese adolescents. Nucl Pept Regul Glucose Metab Endocr Soc. https://doi.org/10.1111/pedi.12303

    Article  Google Scholar 

  36. Rodríguez-Morán M, Simental-Mendía L, Guerrero-Romero F (2017) The triglyceride and glucose index is useful for recognising insulin resistance in children. Acta Paediatr 106:979–983. https://doi.org/10.1111/apa.13789

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Ministry of Health and Medical education, Ministry of Education and Training, Isfahan University of Medical Sciences, and Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences. We are indebted to the participating schools, families and students in the study for their cooperation.

Funding

This study was funded by the Ministry of Health and Medical education, Ministry of Education and Training, Isfahan University of Medical Sciences, and Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences (Grant no. 194049).

Author information

Author notes

  1. Mostafa Qorbani and Roya Kelishadi have equally contributed.

Authors and Affiliations

  1. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Pooneh Angoorani & Ramin Heshmat

  2. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hanieh-Sadat Ejtahed

  3. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Mohammad Esmaeil Motlagh

  4. Health Psychology Research Center, Education Ministry, Tehran, Iran

    Hasan Ziaodini

  5. Office of Adolescents and School Health, Ministry of Health and Medical Education, Tehran, Iran

    Majzoubeh Taheri & Tahereh Aminaee

  6. Medical Faculty, Tarbiat Modarres University, Tehran, Iran

    Azam Goodarzi

  7. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mostafa Qorbani

  8. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mostafa Qorbani

  9. Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

    Roya Kelishadi

Authors
  1. Pooneh Angoorani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramin Heshmat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanieh-Sadat Ejtahed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Esmaeil Motlagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hasan Ziaodini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Majzoubeh Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tahereh Aminaee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Azam Goodarzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mostafa Qorbani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roya Kelishadi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Mostafa Qorbani or Roya Kelishadi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angoorani, P., Heshmat, R., Ejtahed, HS. et al. Validity of triglyceride–glucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study. Eat Weight Disord 23, 877–883 (2018). https://doi.org/10.1007/s40519-018-0488-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-018-0488-z

Keywords

Search

Navigation