O0007: Prevalence of Cardiometabolic Risk Clusters Using TG/HDL-C Ratio Among South Bronx Children and Adolescent Population and Evaluation of Predictive Accuracy for Pediatric Metabolic Syndrome

Background: Metabolic syndrome (METs) is a clustering of multiple cardiometabolic risk factors; evaluation is critical among children and adolescents as it can predict cardiovascular disease in adulthood. METs has no consensus definition in pediatrics and putting components together is cumbersome in a fast-paced outpatient setting. Studies (mostly outside the U.S) have examined the clinical utility of lipid ratios as surrogates for METs, and TG/HDL ratio has the best predictive accuracy. To evaluate the prevalence and factors associated with high TG/HDL-C ratio and determine the predictive accuracy in pediatric METs

Methods: This is a cross-sectional study of adolescents aged 9-21 years seen in the outpatient clinic of a community hospital in the South Bronx in 2021. Lipid profile parameters, blood pressure, BMI percentile, and demographic data were extracted from the electronic medical records to determine the prevalence of TG/HDL-C ratio and METs, which was then compared between Bronxcare data 2019 and NHANES (National Health and Nutrition Examination Survey) 2011-2018 data. A previously established cutoff of 2.5 was used to determine a high TG/HDL-C ratio. METs was defined as the presence of 3 or more of the following criteria: BMI>97th percentile, Triglyceride>110mg/dl, HDLC < 40mg/dl, and Blood pressure >90th percentile. Chi-square test and Mann-Whitney U test were used to compare characteristics between groups. Factors associated with elevated TG/HDL-C ratio were evaluated and a discriminatory analysis to evaluate its predictive accuracy for METs was also assessed.

Results: Of the total 604 subjects included in the final analysis, males constituted 51.3%, majority (54.5%) are in the age group (12-16 years), and Hispanics are 46%. 54.5% are obese 18.2% overweight. The prevalence of high TG/HDL-C was 29.8% compared to 24.5% and 27.5% in 2019 and NHANES data respectively Figure 1. Following stratification by age, 31%, 25%, and 29% had high TG/HDL-C ratios in the pre-pubertal, pubertal and post-pubertal subgroups respectively the difference is not statistically significant. The prevalence of METs was 28.2%. Among patients with METs, 64% of patients with obesity had elevated TG/HDL ratio compared to patients without obesity (14%) after stratification by obese status (p < 0.05). Gender, obesity, ethnicity, and METS are significantly associated with a high TG/HDL-C ratio (Table 1). TG/HDL-C has a good discriminatory ability to distinguish patients with METs from those without, Area under the curve (AUC) 0.6528 (p < 0.05).

Conclusion: Our patients have a disproportionately high prevalence of elevated TG/HDL ratio and obesity compared to the national average. The high prevalence of TG/HDL may be partly due to some non-fasting triglyceride results included in our data.  Patients with obesity have higher cardiometabolic risk. Our finding supports previous evidence of a good correlation between TG/HDL and METs. Hence, TG/HDL may be employed for rapid risk assessment.