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    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "TyG in insulin resistance prediction"
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        "autoresLista" => "Wendell Arthur Lopes, Gustavo Henrique de Oliveira, Jo&#227;o Carlos Locateli, Caroline Ferraz Sim&#245;es"
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          2 => array:2 [
            "nombre" => "Jo&#227;o Carlos"
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            "entidad" => "Universidade Estadual de Maring&#225; &#40;UEM&#41;&#44; Centro de Ci&#234;ncias da Sa&#250;de&#44; Departamento de Educa&#231;&#227;o F&#237;sica&#44; Curitiba&#44; PR&#44; Brazil"
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        "titulo" => "TyG na predi&#231;&#227;o da resist&#234;ncia &#224; insulina"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article &#8220;The TyG index cutoff point and its association with body adiposity and lifestyle in children&#8221; by Vieira-Ribeiro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> published in the <span class="elsevierStyleItalic">Jornal de Pediatria&#44;</span> which proposes TyG &#40;triglyceride-glucose &#237;ndex&#41; cutoff points for the prediction of insulin resistance &#40;IR&#41; in school-aged children and preschoolers&#46; The study makes an important contribution to the topic&#44; considering the need to establish cutoff points to use this tool in the Brazilian pediatric population&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From this perspective&#44; we believe it is very important to warn the authors about a probable mistake in the calculation of TyG&#46; Although the calculation error does not impair the predictive capacity of this method&#44; the proposed cutoff points are significantly altered&#46; This method was proposed by Guerrero-Romero in an article published in 2010&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and the calculation is described as follows&#58; &#91;ln&#40;fasting triglycerides&#41; &#40;mg&#47;dL&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>fasting glucose &#40;mg&#47;dL&#41;&#47;2&#93;&#44; and the values found by the authors was 3&#46;7 &#40;values for healthy adults&#41;&#46; However&#44; in another publication by the same authors in 2016&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> we can verify that the indicated calculation is as follows&#58;&#91;ln&#40;fasting triglycerides &#40;mg&#47;dL&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>fasting glucose &#40;mg&#47;dL&#41;&#93;&#47;2&#44; and the values shown by the authors in this article was 4&#46;5 &#40;values for healthy adult men and women&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The chart below shows that&#44; according to the formula used&#44; different TyG values will be obtained&#44; since the first formula divides by 2 before performing the logarithmic operation and the second formula divides by 2 after the logarithmic operation of the serum triglyceride and glucose product&#46;<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; it is likely that the formula used by the authors who proposed the method is the latter of the two&#44; since the values presented in both articles are between 3&#46;7 and 4&#46;5&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This error in the formula presentation led other authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> including Vieira-Ribeiro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> to use the first formula to obtain the TyG&#44; achieving much higher values than those shown by the method&#8217;s proponents&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore&#44; we suggest to the authors Vieira-Ribeiro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that they recalculate the values of TyG based on the second formula&#44; aiming to present more appropriate cutoffs to the original proposal and to allow an appropriate comparison with future studies&#44; which also must adhere to the proper calculation of this index&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lopes WA&#44; Oliveira GH&#44; Locateli JC&#44; Sim&#245;es CF&#46; TyG in insulin resistance prediction&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;132&#8211;3&#46;</p>"
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Journal Information
Vol. 96. Issue 1.
Pages 132-133 (January - February 2020)
Vol. 96. Issue 1.
Pages 132-133 (January - February 2020)
Letter to the Editor
Open Access
TyG in insulin resistance prediction
TyG na predição da resistência à insulina
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Wendell Arthur Lopes
Corresponding author
warthurlopes@gmail.com

Corresponding author.
, Gustavo Henrique de Oliveira, João Carlos Locateli, Caroline Ferraz Simões
Universidade Estadual de Maringá (UEM), Centro de Ciências da Saúde, Departamento de Educação Física, Curitiba, PR, Brazil
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Dear Editor,

We read with interest the article “The TyG index cutoff point and its association with body adiposity and lifestyle in children” by Vieira-Ribeiro et al.,1 published in the Jornal de Pediatria, which proposes TyG (triglyceride-glucose índex) cutoff points for the prediction of insulin resistance (IR) in school-aged children and preschoolers. The study makes an important contribution to the topic, considering the need to establish cutoff points to use this tool in the Brazilian pediatric population.

From this perspective, we believe it is very important to warn the authors about a probable mistake in the calculation of TyG. Although the calculation error does not impair the predictive capacity of this method, the proposed cutoff points are significantly altered. This method was proposed by Guerrero-Romero in an article published in 2010,2 and the calculation is described as follows: [ln(fasting triglycerides) (mg/dL)×fasting glucose (mg/dL)/2], and the values found by the authors was 3.7 (values for healthy adults). However, in another publication by the same authors in 2016,3 we can verify that the indicated calculation is as follows:[ln(fasting triglycerides (mg/dL)×fasting glucose (mg/dL)]/2, and the values shown by the authors in this article was 4.5 (values for healthy adult men and women).

The chart below shows that, according to the formula used, different TyG values will be obtained, since the first formula divides by 2 before performing the logarithmic operation and the second formula divides by 2 after the logarithmic operation of the serum triglyceride and glucose product.

Formula  TG  Glucose  TyG 
1st [ln(fasting triglycerides) (mg/dL)×fasting glucose (mg/dL)/2]  168.3  88.3  8.91 
2nd [ln(fasting triglycerides (mg/dL)×fasting glucose (mg/dL)]/2  168.3  88.3  4.80 

Therefore, it is likely that the formula used by the authors who proposed the method is the latter of the two, since the values presented in both articles are between 3.7 and 4.5.

This error in the formula presentation led other authors,4–6 including Vieira-Ribeiro et al.,1 to use the first formula to obtain the TyG, achieving much higher values than those shown by the method’s proponents.

Therefore, we suggest to the authors Vieira-Ribeiro et al.1 that they recalculate the values of TyG based on the second formula, aiming to present more appropriate cutoffs to the original proposal and to allow an appropriate comparison with future studies, which also must adhere to the proper calculation of this 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]
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
[3]
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
[4]
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, 41 (2017), pp. 789-792
[5]
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
[6]
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

Please cite this article as: Lopes WA, Oliveira GH, Locateli JC, Simões CF. TyG in insulin resistance prediction. J Pediatr (Rio J). 2020;96:132–3.

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