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Vol. 96. Issue 1.
Pages 133-134 (January - February 2020)
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Vol. 96. Issue 1.
Pages 133-134 (January - February 2020)
Letter to the Editor
DOI: 10.1016/j.jped.2019.09.003
Open Access
Answer to the letter “TyG in insulin resistance prediction”
Resposta à carta “TyG na predição da resistência à insulina”
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Sarah A. Vieira-Ribeiroa,
Corresponding author
sarah.vieira@ufv.br

Corresponding author.
, Poliana C.A. Fonsecaa, Cristiana S. Andreolia, Andréia Q. Ribeirob, Helen H.M. Hermsdorffb, Patrícia F. Pereirab, Silvia E. Prioreb, Sylvia C.C. Franceschinib
a Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
b Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
Related content
J Pediatr (Rio J). 2020;96:132-310.1016/j.jped.2019.09.002
Wendell Arthur Lopes, Gustavo Henrique de Oliveira, João Carlos Locateli, Caroline Ferraz Simões
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Dear Editor,

We carefully evaluated with great interest the comments made by the authors of the Letter to the Editor and we appreciate the opportunity to answer them.

To calculate the TyG (triglyceride-glucose índex) in our study1, we used the formula proposed by Simental-Mendía et al.2 in 2008 and Guerrero-Romero et al.3 in 2010, described as follows:Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2].Moreover, the same formula was also used in other studies4–7 that evaluated the TyG index in predicting insulin resistance in children and adolescents, with similar cutoffs to those identified in our study.

As our main objective was to evaluate the factors associated with the TyG index (dependent variable), linear regression analysis was used (the index was included in the analyses as a quantitative variable). Therefore, regardless of the formula used in the calculation of TyG, there is no change in the observed associations.

Additionally, we redid the TyG index calculation using the following formula: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2, which was used by the same authors in another study in 20168. As shown below, the cutoff point identified for the index was lower, as expected. However, the sensitivity and specificity values are similar.

Formula  Cutoff point  Sensitivity (%)  Specificity (%) 
ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]  7.88  80.0  53.2 
ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2  4.29  80.0  53.9 

In response to the email sent by a researcher from our institution inquiring about the correct formula for calculating TyG, Fernando Guerrero-Romero points out that: “Both procedures appropriately identify the presence of insulin resistance; however, using the procedure [ln(glucose × triglycerides/2)] gives higher cutoff values for the TyG.”

We believe in the importance of the standardized formula use for the index calculation;however,to the best of our knowledge, there is no opinion from the authors who validated itregarding which one would be better.

Finally, we would like to highlight the importance of the observations made by the authors of the Letter, as they will greatly contribute to other studies that adopt the TyG index.

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
S.A. Vieira-Ribeiro, P.C. Fonseca, C.S. Andreoli, A.Q. Ribeiro, H.H. Hermsdorff, P.F. Pereira, et al.
The TyG index cutoff point and its association with body adiposity and lifestyle in children.
J Pediatr (Rio J), 95 (2019), pp. 217-223
[2]
L.E. Simental-Mendıa, M. Rodrıguez-Moraan, F. Guerrero-Romero.
The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects.
Metab Syndr Relat Disord, 6 (2008), pp. 299-304
[3]
F. Guerrero-Romero, L.E. Simental-Mendía, M. González-Ortiz, E. Martínez-Abundis, M.G. Ramos-Zavala, S.O. Hernández-González, et al.
The product of triglycerides and glucose, a simple measure of insulin sensitivity.Comparison with the euglycemic-hyperinsulinemic clamp.
J Clin Endocrinol Metab, 95 (2010), pp. 3347-3351
[4]
J.H. Kim, S.H. Park, Y. Kim, M. Im, H.S. Han.
The cutoff values of indirect indices formeasuring insulin resistance for metabolic syndrome in Korean children andadolescents.
Ann Pediatr Endocrinol Metab, 21 (2016), pp. 143-148
[5]
B. Kang, Y. Yang, E.Y. Lee, H.K. Yang, H.S. Kim, S.Y. Lim, et al.
Triglycerides/glucose index is a useful surrogate marker of insulin resistance among adolescents.
Int J Obes (Lond), 41 (2017), pp. 789-792
[6]
S. Moon, J.S. Park, Y. Ahn.
The cut-off values of triglycerides and glucose index for metabolic syndrome in American and Korean adolescents.
J Korean Med Sci, 32 (2017), pp. 427-433
[7]
P. Angoorani, R. Heshmat, H.S. Ejtahed, M.E. Motlagh, H. Ziaodini, M. Taheri, et al.
Validity of triglyceride–glucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study.
Eat Weight Disord, 23 (2018), pp. 877-883
[8]
F. Guerrero-Romero, R. Villalobos-Molina, Jiménez-Flores, L.E. Simental-Mendía, R. Méndez-Cruz, M. Murguía-Romero, et al.
Fasting triglycerides and glucose index as a diagnostic test for insulin resistance in young adults.
Arch Med Res, 47 (2016), pp. 382-387

Please cite this article as: Vieira-Ribeiro SA, Fonseca PC, Andreoli CS, Ribeiro AQ, Hermsdorff HH, Pereira PP, et al. Answer to the Letter “TyG in insulin resistance prediction”. J Pediatr (Rio J). 2020;96:133–4.

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