A high triglyceride/ high-density lipoprotein ratio is associated with an increased risk of insulin resistance in the US population: a cross-sectional study from the US National Health and Nutrition Examination Survey, 2017–2018

Abstract Background Some previous studies have reported that the ratio of triglycerides to high-density lipoprotein may indicate insulin resistance, but the results suggest that there are differences between different ethnic groups. In this study, the NHANES 2017-2018 database was used to explore the relationship between TG/HDL-C and IR in the American population. Methods This trial comes from a cross-sectional study of NHANES ( http://www.cdc.gov/nchs/nhanes/ ) conducted by the National Center for Health Statistics (NCHS) of the US Centers for Diseases and Control and Prevention. IR uses the homeostatic model assessment (HOMA) formula as an indicator: [fasting insulin (μU/mL)×fasting blood glucose (mmol/L)]/22.5, with ≥75th percentile of HOMA-IR as an indicator. Use logistic regression to explore the relationship between TG/HDL ratio and IR occurrence. Results In this study, a total of 450 participants (40%,450/1902) developed insulin resistance. Using logistic regression model of the association between TG/HDL-C and insulin resistance risk, after adjusting for potential confounding factors, as the TG/HDL ratio increases, the probability of insulin resistance increases significantly (OR: 1.91, 95% CI: 1.59-2.30, P<0.0001). At the same time, we performed a smooth curve fitting and found a non-linear relationship between TG/HDL and IR. Even if the adjusted covariate is deleted from the model, the association remains unchanged. The smooth curve of TG/HDL-C The inflexion point is 0.95. When TG/HDL-C<0.95, the effect value is very significant (OR: 27.34, 95%CI, 10.61-70.47, P<0.0001), when TG/HDL-C≥0.95, the effect value is relatively reduced (OR: 1.29, 95% CI, 1.03-1.61, P<0.0001). We grouped them by inflexion points. Multiple regression equations showed that after adjustment, the group's risk of insulin resistance greater than 0.95 increased by two times compared with the group less than 0.95. Conclusions In this study, we found that the increase of TG/HDL-C ratio in the American population was significantly related to IR. It is clinically acceptable and can save some extra costs for patients. However, in different situations, combining the TG/HDL-C ratio with other risk factors to predict whether IR will occur is worthwhile for the next step.