Horm Metab Res 2017; 49(07): 542-549
DOI: 10.1055/s-0043-107782
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Impact of the Triglyceride/High-Density Lipoprotein Cholesterol Ratio and the Hypertriglyceremic-Waist Phenotype to Predict the Metabolic Syndrome and Insulin Resistance

Helene von Bibra
1   Clinic for Endocrinology, Diabetes and Vascular Medicine, Staedt. Klinikum Bogenhausen, Academic Hospital of the TUM, Munich, Germany
Sarama Saha
2   Department of Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Germany
Alexander Hapfelmeier
3   Institute for Statistics and Epidemiology in Medicine of the Technische Universität, Munich, Germany
Gabriele Müller
4   Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, TU Dresden, Germany
Peter E. H. Schwarz
2   Department of Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Germany
5   Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany
6   German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
› Author Affiliations
Further Information

Publication History

received 30 June 2016

accepted 21 March 2017

Publication Date:
08 June 2017 (online)


Insulin resistance is the underlying mechanism for the metabolic syndrome and associated dyslipidaemia that theoretically implies a practical tool for identifying individuals at risk for cardiovascular disease and type-2-diabetes. Another screening tool is the hypertriglyceremic-waist phenotype (HTW). There is important impact of the ethnic background but a lack of studied European populations for the association of the triglyceride/high-density lipoprotein cholesterol (HDL-C) ratio and insulin resistance. This observational, retrospective study evaluated lipid ratios and the HTW for predicting the metabolic syndrome/insulin resistance in 1932 non-diabetic individuals from Germany in the fasting state and during a glucose tolerance test. The relations of triglyceride/HDL-C, total-cholesterol/HDL-C, and low-density lipoprotein cholesterol/HDL-C with 5 surrogate estimates of insulin resistance/sensitivity and metabolic syndrome were analysed by linear regression analysis and receiver operating characteristics (ROC) in participants with normal (n=1 333) or impaired fasting glucose (n=599), also for the impact of gender. Within the lipid ratios, triglyceride/HDL-C had the strongest associations with insulin resistance/sensitivity markers. In the prediction of metabolic syndrome, diagnostic accuracy was good for triglyceride/HDL-C (area under the ROC curve 0.817) with optimal cut-off points (in mg/dl units) of 2.8 for men (80% sensitivity, 71% specificity) and 1.9 for women (80% sensitivity, 75% specificity) and fair for HTW and HOMA-IR (area under the curve 0.773 and 0.761). These data suggest the triglyceride/HDL-C ratio as a physiologically relevant and practical index for predicting the concomitant presence of metabolic syndrome, insulin resistance and dyslipidaemia for therapeutic and preventive care in apparently healthy European populations.