Diagnostic Accuracy of the Triglyceride-Glucose Derived Indices in Detecting Metabolic Syndrome in Pediatric Patients

Background: Given the challenges associated with direct insulin measurements, several surrogate markers combining both anthropometric data and laboratory tests (such as glucose and lipid levels) have been developed. This study aims to assess the diagnostic accuracy of the following indices: triglyceride-glucose (TyG) index, TyG index adjusted for body mass index (TyG-BMI), TyG index adjusted for waist circumference (TyG-WC), and TyG index adjusted for waist-to-height ratio (TyG-WHtR), for detecting metabolic syndrome (MetS) in the pediatric population, in comparison with conventional parameters. Methods: We retrospectively analyzed data from 746 children and adolescents (372 female/374 male) categorized into groups based on BMI z-score. Insulin resistance (IR) surrogates were calculated as: homeostasis model assessment of insulin resistance (HOMA-IR), TyG, TyG-BMI, TyG-WC, and TyG-WHtR. MetS was defined by the presence of at least three of the following components: BMI z-score ≥2 standard deviation and/or WC/height ratio ≥0.5; fasting blood glucose >100 mg/dL and/or pathological HOMA-IR; dyslipidemia; and hypertension. Results: The overall prevalence of MetS was 15.01% (112/746), occurring exclusively in children with obesity or overweight (P=0.004). The third quartile (Q3) was identified as the optimal cut-off point for the TyG indices (TyG, 8.1; TyG-BMI, 231.54; TyG-WC, 734.03; and TyG-WHtR, 4.73). The areas under the receiver operating characteristic curves (AUCs) of TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 0.801 (P<0.001), 0.840 (P<0.001), 0.832 (P<0.001), and 0.816 (P<0.001) respectively, comparable to the AUC of HOMA-IR, which was 0.866 (P<0.001). Conclusion: The TyG, TyG-BMI, TyG-WC, and TyG-WHtR indices demonstrated promising predictive value for MetS in children with overweight or obesity. These markers can effectively identify high-risk individuals and offer a cost-effective alternative to direct assessment of insulin sensitivity.