Diabetes, Metabolic Syndrome and Obesity (May 2025)
Association Between Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Insulin Resistance in Mongolian Adults
Abstract
Galsanjigmed Narkhajid,1,* Byambasukh Oyuntugs,1 Altangerel Yagaantsetseg,2 Enkhtuvshin Bolormaa,3 Erdembileg Anuurad,4 Byambaa Enkhmaa,5 Lars Berglund,5 Tumenbayar Bayasgalan2,* 1Department of Endocrinology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, 13270, Mongolia; 2Postgraduate Training Institute, Mongolian National University of Medical Sciences, Ulaanbaatar, 14210, Mongolia; 3Intermed Hospital, Ulaanbaatar, Mongolia; 4Office of Research, School of Medicine, University of California – Davis, Sacramento, CA, 95817, USA; 5Department of Internal Medicine, School of Medicine, University of California – Davis, Davis, CA, USA*These authors contributed equally to this workCorrespondence: Tumenbayar Bayasgalan, Postgraduate Training Institute, Mongolian National University of Medical Sciences, S. Zorig Street, Sukhbaatar District, 1st Khoroo, Ulaanbaatar, 14210, Mongolia, Tel +976 96664800, Email [email protected]: While the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) is widely used to identify insulin resistance, its clinical utility can be cumbersome. An alternative, the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL) ratio, offers simplicity but may exhibit variability across different populations. This study aimed to investigate its association with HOMA-IR adjusting for waist circumference among Mongolian adults.Materials and Methods: This cross-sectional study, conducted at the Mongolian National University of Medical Sciences Hospital, included 365 participants over 35 who participated in health check-up examinations (mean age 46.8 ± 8.8 years, 37.0% male). Waist circumference was categorized into tertiles. Associations between the TG/HDL ratio and HOMA-IR were meticulously assessed within the waist circumference tertiles (0– 33.3%, 33.4– 66.6%, and 66.7– 100%), ensuring a comprehensive understanding of the data.Results: A significant positive correlation (r = 0.391, p = 0.019) was observed between the TG/HDL ratio and HOMA-IR levels in all participants. Analyses by waist circumference tertiles revealed a progressively stronger correlation (ranging from r = 0.241 to 0.469) with increasing waist circumference (p < 0.05). The diagnostic accuracy of the TG/HDL ratio in identifying insulin resistance was assessed using HOMA-IR thresholds of 2.0 and 2.5, yielding AUC values of 0.693 and 0.746, respectively. When considering waist circumference thresholds (> 90 cm for men and > 80 cm for women), TG/HDL ratio thresholds of 1.2 (sensitivity 56%, specificity 90%) in men and 0.69 (sensitivity 46%, specificity 80%) in women were identified.Conclusion: The study indicates that the TG/HDL ratio, adjusted for waist circumference, could be a useful marker for insulin resistance in Mongolian adults, supporting its potential in clinical practice.Keywords: insulin resistance, TG/HDL ratio, HOMA-IR, waist circumstance
