Triglyceride to High Density Lipoprotein Cholesterol Ratio and its Association with Body Composition, Anthropometric, and Dietary Factors in a Sample of Lebanese Adolescents

Abstract

The rising prevalence of pediatric and adolescent obesity in the Middle East and North Africa (MENA) region has led to an increase in metabolic abnormalities, with insulin resistance (IR) being a key precursor to long-term health complications. While early IR detection is crucial, conventional diagnostic methods are often invasive and costly. The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio has emerged as a simple and accessible alternative biomarker for IR, yet its clinical significance amongst adolescents in the MENA region remains unexplored.

This cross-sectional study aimed at assessing the TG/HDL-C ratio in Lebanese adolescents (n=114; 15–18 years old), and examining its associations with anthropometric parameters, body composition, and dietary factors while proposing a TG/HDL-C cut-off value for predicting the metabolic syndrome (MetS). Anthropometric and body composition characteristics were measured at the department of Nutrition and Food Sciences (AUB), dietary intakes were assessed using the 24-hour recall approach, and fasting blood samples were obtained and analyzed for lipid profiles and glucose levels. The TG/HDL-C ratio was calculated, and MetS was diagnosed using the harmonized IDF definition. Elevated TG/HDL-C ratio was defined using two approaches, as follows: 1) TG/HDL-C ratio above the median; and 2) TG/HDL-C ratio above a previously published cut-off of 2.2. Regression analyses were conducted to examine the association of elevated TG/HDL-C with anthropometric, metabolic, and dietary factors.

Mean TG/HDL-C ratio was 1.61 ± 1.004, with a median of 1.324 (interquartile range: 1.07), and a range of 0.42 to 6.17 mg/dl. Results showed that an elevated TG/HDL-C ratio, a marker of IR, was significantly associated with BMI, body composition (FM, FMI, and %BF), WC, WHtR, and MUAC, but not with CC or dietary intakes. Obese participants had 4-5 times higher odds of having an elevated TG/HDL-C ratio based on both approach 1 and 2, respectively, after adjusting for potential confounders (OR= 4.001; 95%CI: 1.340-11.943 and OR= 5.575; 95% CI: 1.668-18.628, respectively). Similarly, central adiposity, as assessed by WC, was associated with approximately five times higher odds of having an elevated TG/HDL-C ratio based on approach 1, and after adjusting for confounders (OR= 5.145; 95%CI: 1.664-15.908). In addition, using both approaches 1 and 2, higher FM (OR = 1.063; 95% CI: 1.016-1.112 and OR = 1.049; 95% CI: 1.006-1.095, respectively), FMI (OR = 1.189; 95% CI: 1.044-1.354 and OR = 1.178; 95% CI:1.037-1.377, respectively), and %BF (OR = 1.050; 95% CI: 1.003-1.101 and OR = 1.072; 95% CI: 1.011-1.136, respectively) were all associated with higher odds of having an elevated TG/HDL ratio. Receiver operating characteristic (ROC) curve analysis identified a TG/HDL-C cut-off of 1.75 for predicting MetS, with 71.4% sensitivity, 71.67% specificity, and an AUC of 0.77 (95% CI: 0.48–0.96; p = 0.06). Adolescents exceeding this threshold had a 6.3-fold higher risk of MetS.

These findings highlight the TG/HDL-C ratio as a cost-effective and reliable marker for metabolic risk assessment, with potential applications in routine screening. Several anthropometric indicators were found to be significantly associated with an elevated TG/HDL ratio, highlighting the importance of such measurements in both clinical and public health practice. Future large-scale studies are needed to validate these results and refine screening strategies.