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. 2022 Dec 16:13:1071350.
doi: 10.3389/fendo.2022.1071350. eCollection 2022.

Triglyceride to high-density lipoprotein cholesterol ratio is an independent predictor of liver fibrosis among pediatrics non-alcoholic fatty liver disease

Yi-Wen Ting  1 , Muhammad Yazid Jalaludin  2 , Azriyanti Anuar Zaini  2 , Rosmawati Mohamed  3
Affiliations

Triglyceride to high-density lipoprotein cholesterol ratio is an independent predictor of liver fibrosis among pediatrics non-alcoholic fatty liver disease

Yi-Wen Ting et al. Front Endocrinol (Lausanne). .

Abstract

Background: Insulin resistance (IR), one of the key components of the metabolic syndrome, is recognized as the pathophysiological hallmark of non-alcoholic fatty liver disease (NAFLD). This study aims to investigate the relationship between surrogate markers of IR and the severity of NAFLD among overweight or obese children.

Methodology: A total of 56 consecutive children aged 6 to 18 years old were recruited from the pediatric obesity and type 2 diabetes mellitus (T2DM) clinic in University Malaya Medical Centre (UMMC) from 2016 to 2019. Data on anthropometric measurements, clinical components of metabolic syndrome and fasting serum insulin were collected. Triglyceride to high-density lipoprotein cholesterol ratio (TG: HDL-C), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Single Point Insulin Sensitivity Estimator (SPISE) were calculated. Transient elastography was performed with hepatic steatosis and liver fibrosis assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.

Results: A total of 44 children (78.6%) had liver steatosis and 35.7% had presence of significant liver fibrosis (stage F≥2). Majority (89.3%) are obese and 24 children (42.9%) were diagnosed with metabolic syndrome. Higher number of children with T2DM and significant liver fibrosis were associated with higher tertiles of TG: HDL-C ratio (p<0.05). Top tertile of TG: HDL-C ratio was an independent predictor of liver fibrosis (OR=8.14, 95%CI: 1.24-53.36, p=0.029). ROC analysis showed that the area under the curve (AUC) of HOMA-IR (0.77) and TG: HDL-C ratio (0.71) were greater than that of metabolic syndrome (0.70), T2DM (0.62) and SPISE (0.22). The optimal cut-off values of HOMA-IR and TG: HDL-C ratio for detecting liver fibrosis among children with NAFLD are 5.20 and 1.58, respectively.

Conclusion: Children with NAFLD and higher TG: HDL-C ratio are more likely to have liver fibrosis. TG: HDL-C ratio is a promising tool to risk stratify those with NAFLD who are at risk of developing advanced liver disease.

Keywords: TG: HDL-C ratio; body mass index; hepatic fibrosis; insulin resistance; overweight and obese children; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Relationship between TG: HDL-C ratio, liver steatosis and fibrosis. Mann-Whitney U tests were performed and results showed that patients with liver fibrosis have higher TG: HDL-C ratio (p = 0.013) whereas no difference was found among patients with liver steatosis. Significance was assumed when p <0.05.
Figure 2
Figure 2
Receiver operating characteristic (ROC) describing the predictive value of insulin resistance parameters, metabolic syndrome and T2DM for the presence of liver fibrosis. The area under the ROC curve (AUC) of TG: HDL-C ratio is 0.71 (95% CI: 0.54-0.88, p = 0.022), SPISE is 0.22 (95% CI: 0.06-0.37, p = 0.002), HOMA-IR is 0.77 (95% CI: 0.63-0.91, p = 0.003), metabolic syndrome is 0.704 (95% CI: 0.54-0.87, p = 0.026) and T2DM is 0.62 (95% CI: 0.44-0.80, p = 0.197).
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