title: The association of the triglyceride-to-HDL cholesterol ratio with insulin resistance in White European and South Asian men and women.
abstract: BACKGROUND
  There is recent interest surrounding the use of the triglyceride-to-HDL cholesterol ratio as a surrogate marker of insulin resistance in clinical practice, as it may identify people at high risk of developing diabetes or its complications. However, it has been suggested using this lipid ratio may not be appropriate for measuring insulin resistance in African-Americans, particularly women. We investigated if this inconsistency extended to South Asian women in a UK multi-ethnic cohort of White Europeans and South Asians.
  
  
  METHODS
  Cross-sectional analysis was done of 729 participants from the ADDITION-Leicester study from 2005 to 2009. The association between tertiles of triglyceride-to-HDL cholesterol ratio to fasting insulin, homeostatic model of assessment for insulin resistance (HOMA1-IR), quantitative insulin sensitivity check index (QUICKI) and glucose: insulin ratio was examined with adjustment for confounding variables.
  
  
  RESULTS
  Incremental tertiles of the triglyceride-to-HDL cholesterol ratio demonstrated a significant positive association with levels of fasting insulin, HOMA1-IR, glucose: insulin ratio and a negative association with QUICKI in White European men (n = 255) and women (n = 250) and South Asian men (n = 124) (all p<0.05), but not South Asian women (n = 100). A significant interaction was demonstrated between sex and triglyceride-to-HDL cholesterol ratio tertiles in South Asians only (p<0.05). The area under the receiver operating characteristic curve for triglyceride-to-HDL cholesterol ratio to detect insulin resistance, defined as the cohort HOMA1-IR ≥ 75(th) percentile (3.08), was 0.74 (0.67 to 0.81), 0.72 (0.65 to 0.79), 0.75 (0.66 to 0.85) and 0.67 (0.56 to 0.78) in White European men and women, South Asian men and women respectively. The optimal cut-points for detecting insulin resistance were 0.9-1.7 in mmol/l (2.0-3.8 in mg/dl) for the triglyceride-to-HDL ratio.
  
  
  CONCLUSIONS
  In South Asian women the triglyceride-to-HDL cholesterol ratio was not associated with insulin resistance; therefore there may be limitations in its use as a surrogate marker in this group.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Samiul A
authors.initials: SA
authors.lastname: Mostafa
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Morris
authors.forename: Tom
authors.initials: T
authors.lastname: Yates
authors.forename: Balasubramanian Thiagarajan
authors.initials: BT
authors.lastname: Srinivasan
authors.forename: David
authors.initials: D
authors.lastname: Webb
authors.forename: Emer
authors.initials: E
authors.lastname: Brady
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005215:Fasting; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood*; D044465:White People
chemical_list: D008076:Cholesterol, HDL; D014280:Triglycerides