DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184902

Association of triglycerides/high density lipoprotein cholesterol ratio with insulin resistance in polycystic ovary syndrome

Sreenivasulu Karli, Kiranmayi V. S., Rajendra Prasad Namburi, Aparna Rajeshwar Rao Bitla, Alok Sachan

Abstract


Background: Insulin resistance (IR) is frequently observed in women with polycystic ovary syndrome (PCOS). Recent studies advocated that triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) can be used as a simple clinical indicator of IR. Hence, the present study was performed to investigate the use of TG/HDL-C and its association with IR in PCOS.

Methods: Forty-one patients with PCOS and 40 healthy age matched women were randomly enrolled. Demographic and clinical characteristics were obtained. Insulin resistance was defined by the homeostasis model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI).

Results: In PCOS group, the insulin, HOMA-IR and TG/HDL-C ratio were significantly higher (p=0.001) than controls while, QUICKI was lower (p=0.001). Insulin, HOMA-IR were positively correlated with TG/HDL-C (ρ=0.303, p=0.006 and ρ=0.312, p=0.005 respectively) while, QUICKI was negatively correlated (ρ=-0.698, p=0.001). In receiver operating characteristic (ROC) analysis, area under the curve (AUC) for model based on QUICKI levels was better 0.898 (95% CI: 0.811-0.955, p=0.001) than HOMA-IR 0.636 (95% CI: 0.522-0.740, p=0.03). A cut-off value 3.23 for TG/HDL-C is proposed from the model based on QUICKI with best combination of sensitivity 83.3% and specificity 86.7%.

Conclusions: Results of present study support that TG/HDL-C ratio may be a simple indicator of IR in PCOS patients which helps clinicians to identify IR in small centers, where the assays for insulin measurement are not available.


Keywords


HOMA-IR; insulin resistance, QUICKI, PCOS, TG/HDL-C ratio

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References


Ilhan T, Berrin C, Zeynep C, Erdem T. The plasma homocysteine concentrations and relationship with insulin resistance in young women with polycystic ovary syndrome. Turkish J Endocrinol Meta. 2005;1:23-8.

Mather KJ, Kwan F, Corenblum B. Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity. Fertil Steril. 2000;73:150-6.

Morales AJ, Laughlin GA, Butzow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Meta. 1996;81:2854-64.

Nestler JE. Obesity, insulin, sex steroids and ovulation. Int J Obes Relat Metab Dis. 2000;24(Suppl)2:S71-3.

Levy-Marchal C, Arslanian S, Cutfield W, Sianko S, Druet C, Marcovecchio ML, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Meta. 2010;95:5189-98.

Pisprasert V, Ingram KH, Lopez-Davila MF, Munoz AJ, Garvey WT. Limitations in the use of indices using glucose and insulin levels to predict insulin sensitivity: impact of race and gender and superiority of the indices derived from oral glucose tolerance test in African Americans. Diabetes Care. 2013;36:845-53.

Anderwald C, Anderwald-Stadler M, promintzer M, Prager G, Mandl M, Nowotny P, et al. The clamp like index: a noval and highly sensitive insulin sensitivity index to calculate hyper insulinemic clamp glucose infusion rates from oral glucose tolerance test in non diabetic subjects. Diabetes Care. 2007;30:2374-80.

Lewis GF, Uffelman KD, Szeto LW, Steiner G. Effects of acute hyperinsulinemia on VLDL triglyceride and VLDL apoB production in normal weight and obese individuals. Diabetes. 1993;42:833-42.

Van Linthout S, Spillmann F, Schultheiss HP, Tschope C. High-density lipoprotein at the interface of type 2 diabetes mellitus and cardiovascular disorders. Curr Pharm Des. 2010;16:1504-16.

Li C, Ford ES, Meng YX, Mokdad AH, Reaven GM. Does the association of the triglyceride to high density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovas Diabetol. 2008;28:7:4.

Mc Laughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96:399-404.

Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif, A, Givens, JR, Haseltine, FP, Merriam, GE, editors. Current Issues in Endocrinology and Metabolism: Polycystic ovary syndrome. Boston: Blackwell Scientific Publications;1992:377.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499e502.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-19.

Duncan MH, Singh BM, Wise PH, Carter G, Alaghband-Zadeh J. A simple measure of insulin resistance. Lancet. 1995;346:120-1.

Tarkun I, Arslan BC, Cantürk Z, Türemen E, Sahin T, Duman C. Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J Clin Endocrinol Meta. 2004;89:5592-6.

Mai K, Bobbert T, Reinecke F, Andres J, Maser-Gluth C, Wudy SA, et al. Intravenous lipid and heparin infusion-induced elevation in free fatty acids and triglycerides modifies circulating androgen levels in women: a randomized, controlled trial. J Clin Endocrinol Meta. 2008;93:3900-6.

Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106:473-81.

Mannerås-Holm L, Leonhardt H, Kullberg J, Jennische E, Odén A, Holm G, et al. Adipose tissue has aberrant morphology and function in PCOS: enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance. J Clin Endocrinol Meta. 2011;96:E304-11.

Hong Y, Yang D, Liu W, Zhao X, Chen X, Li L. Dyslipidemia in relation to body mass index and insulin resistance in Chinese women with polycystic ovary syndrome. J Biol Regul Homeost Agents. 2011;25:365-74.

Dunaf A. Insulin Resistance and the Polycystic Ovary Syndrome: Mechanism and Implications for Pathogenesis Endocrine Reviews. 1997;18:774-800.

Shoaib OM, Mustafa SM, Nourein IH. Serum lipid profile of polycystic ovary syndrome in Sudanese women. Inter J Med Sci Pub Heal. 2015;4:1605-10.

Mc Laughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139:802-9.

Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, et al. The triglyceride to HDL cholesterol ratio. Diabetes Care. 2011;34:1869-74.

Kim-Dorner SJ, Deuster PA, Zeno SA, Remaley AT, Poth M. Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance? Metabolism. 2010;59:299-304.

Gasevic D, Frohlich J, Mancini GB, Lear SA. The association between triglyceride to high-density-lipoprotein cholesterol ratio and insulin resistance in a multiethnic primary prevention cohort. Metabolism. 2012;61:583-9.

Sumner AE, Finley KB, Genovese DJ, Criqui MH, Boston RC. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans Arch Intern Med. 2005;165:1395-1400.

Eckel RH, Yost TJ, Jensen D. Alterations in lipoprotein lipase in insulin resistance. Int J Obes. 1995;19(suppl 1):S16-S21.

Sumner AE, Vega GL, Genovese DJ, Finley KB, Bergman RN, Boston RC. Normal triglyceride levels despite insulin resistance in African Americans: role of lipoprotein lipase. Metabolism. 2005;54:902-9.

Anuradha K, Sreekumaran N, Lavanya R. Association of obesity and insulin resistance with Dyslipidemia in Indian women with polycystic ovarian Syndrome. Indian J Med Sci. 2006;60:447-53.