The Journal of Maternal-Fetal & Neonatal Medicine
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/ijmf20
Triglyceride-to-high density lipoprotein cholesterol ratio and triglyceride-glucose index in the perinatal period of neonates Emel Kabakoğlu Ünsür & Fatma Kutlusoy Güçlü To cite this article: Emel Kabakoğlu Ünsür & Fatma Kutlusoy Güçlü (2020): Triglycerideto-high density lipoprotein cholesterol ratio and triglyceride-glucose index in the perinatal period of neonates, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1826926 To link to this article: https://doi.org/10.1080/14767058.2020.1826926
Published online: 30 Sep 2020.
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THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE https://doi.org/10.1080/14767058.2020.1826926
ORIGINAL ARTICLE
Triglyceride-to-high density lipoprotein cholesterol ratio and triglycerideglucose index in the perinatal period of neonates € u lu Uns €ra and Fatma Kutlusoy Gu €c¸lu €b Emel Kabakog a
Department of Pediatrics, Acıbadem Kayseri Hospital, Acıbadem unıversity, Istanbul, Turkey; bDepartment of Obstetrics and Gynecology, Acıbadem Kayseri Hospital, Istanbul, Turkey ABSTRACT
ARTICLE HISTORY
Background: Environmental factors and growth disturbances, either intra-uterine, or post-natal, can result in permanent changes in tissues and also long-term effects that may present themselves as pathological conditions in adulthood, including increased incidence of insulin resistance, impaired glucose tolerance, and also higher likelihood for diabetes mellitus. The triglyceride to glucose index (TyG) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) have been proposed as reliable and simple alternatives for the evaluation of insulin resistance. To date, there was limited data regarding the TyG index and TG/HDL-c ratio in the perinatal period of neonates. We aimed to investigate the possible relationships between HOMA-IR, TyG index, and TG/HDL-c in the cord blood of neonates. Materials-Methods: One hundred and six pregnant women with singleton gestation who gave birth to full-term, normal-weight Turkish neonates without fetal distress were included in the study. The samples of maternal serum and cord blood in neonates were obtained after delivery. Results: Mean TyG index was 3.71 ± 0.38 and the mean TG/HDL-c ratio was 3.12 ± 3.00 in this group. Correlations were found between maternal age and neonate glucose levels and HOMA-IR (p < .05). HOMA-IR was negatively correlated with triglyceride, TG/HDL-c ratio, TyG index þ TG/ HDL, and positively correlated with HDL and TyG index. Conclusions: Our study indicates that the TyG index and TG/HDL-C may be used as an indicator of insulin sensitivity in the perinatal period of neonates. However, the validity of these results should be tested in other centers with a larger neonate population in order to evaluate whether ethnic and racial diversity influence these relationships.
Received 3 September 2020 Accepted 18 September 2020
Introduction The metabolic disease with the highest global disease burden, diabetes mellitus, is characterized by hyperglycemia due to defects in insulin secretion and/or function. It is a very well-known cause of various short and long-term complications that particularly affect the kidneys, peripheral nerves, blood vessels, the heart, and the eyes [1]. Depending on the type of diabetes mellitus, complications of the disease may be seen in the young adult age group, particularly in those with type 1 diabetes mellitus. However, even in patients with type 2 diabetes mellitus, early diagnosis or determination of individuals prone to develop the disease are crucial to prevent morbidity and positively impact disease course. Therefore, early childhood parameters associated with diabetes development could help in the identification of those at risk. The intrauterine environment and early neonatal life are considered as important determinants of € ur CONTACT EMEL Kabako glu Uns€
[email protected]
ß 2020 Informa UK Limited, trading as Taylor & Francis Group
KEYWORDS
Insulin resistance; TyG index; TG/HDL-c; HOMAIR; neonates
disease and disorder development in adulthood. Changes in the intrauterine and early-postnatal hormonal, metabolic, and nutritional environment can lead to adverse alterations in neuro-endocrine metabolism resulting in increased susceptibility to various diseases throughout life. This phenomenon has been termed as perinatal programming [2]. Studies have revealed that when exposed to high concentrations of insulin with insulin resistance during the perinatal period may epigenetically induce a predisposition for obesity, metabolic syndrome, and diabetes mellitus [3]. Moreover, neonatal hyperinsulinism and also insulin resistance are thought to be related to maternal diabetes, maternal pre-gestational weight/body mass index, cortisol levels, pancreas beta-cell functionality, and birth weight [4,5]. Hyperinsulinemic-euglycemic clamp is considered as the gold standard for insulin resistance evaluation, although it is invasive, impractical, and expensive, and
Seyitgazi mah. Mustafa Kemal pas¸a Bulvarı 1-A, 38030 Melikgazi/Kayseri, Turkey
2
E. K. ÜNSÜR AND F. KUTLUSOY GÜÇLÜ
cannot be used at birth or with cord blood specimens [5,6]. Since plasma insulin level measurements remain expensive, limited, and unreliable which have poor reproducibility and high variability in different laboratories, the homeostasis model assessment of insulin resistance (HOMA-IR) index (using fasting insulin and glucose) is widely used to assess insulin resistance in clinical practice [5]. The triglyceride to glucose index (TyG) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) has been proposed as reliable and simple alternatives to evaluate insulin resistance. To date, there is only one study to examine the TyG index in neonates, while no studies have investigated TG/HDL-c values in neonates [5]. The aims of the study were (i) to investigate relationships between TyG index and HOMA-IR in cord blood samples of neonates, (ii) to determine the ability of the TyG index and TG/HDL-c, and the combination of these two indices to predict insulin resistance in newborns.
Material and methods The study was jointly carried out by the Obstetrics and Gynecology Department and the Neonatal Care Unit of our Hospital, Kayseri, Turkey, from April 2020 to July 2020. A total of 119 Turkish pregnant women with singleton gestation who gave birth full-term (between 37 and 42 weeks), normal-weight (between 2.5 and 4 kg) neonates without fetal distress were included in the study randomly by convenience sampling method. However, 6 pregnant women were excluded from the study after randomization with their requests. Also, seven pregnant women were excluded due to the lack of data about labor and neonates conditions. 106 pregnant women participated in the study. Fetal distress refers to the presence of signs and findings in a pregnant woman during the antepartum or intrapartum period. The signs and findings were abnormal slowing of labor, late decelerations and/or changes in fetal heart rate in the non-stress testing, the presence of meconium (dark green fecal material from the fetus), fetal monitoring with an electronic device that shows a fetal scalp pH of less than 7.0, and a low APGAR score as
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/ijmf20
Triglyceride-to-high density lipoprotein cholesterol ratio and triglyceride-glucose index in the perinatal period of neonates Emel Kabakoğlu Ünsür & Fatma Kutlusoy Güçlü To cite this article: Emel Kabakoğlu Ünsür & Fatma Kutlusoy Güçlü (2020): Triglycerideto-high density lipoprotein cholesterol ratio and triglyceride-glucose index in the perinatal period of neonates, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1826926 To link to this article: https://doi.org/10.1080/14767058.2020.1826926
Published online: 30 Sep 2020.
Submit your article to this journal
Article views: 1
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ijmf20
THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE https://doi.org/10.1080/14767058.2020.1826926
ORIGINAL ARTICLE
Triglyceride-to-high density lipoprotein cholesterol ratio and triglycerideglucose index in the perinatal period of neonates € u lu Uns €ra and Fatma Kutlusoy Gu €c¸lu €b Emel Kabakog a
Department of Pediatrics, Acıbadem Kayseri Hospital, Acıbadem unıversity, Istanbul, Turkey; bDepartment of Obstetrics and Gynecology, Acıbadem Kayseri Hospital, Istanbul, Turkey ABSTRACT
ARTICLE HISTORY
Background: Environmental factors and growth disturbances, either intra-uterine, or post-natal, can result in permanent changes in tissues and also long-term effects that may present themselves as pathological conditions in adulthood, including increased incidence of insulin resistance, impaired glucose tolerance, and also higher likelihood for diabetes mellitus. The triglyceride to glucose index (TyG) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) have been proposed as reliable and simple alternatives for the evaluation of insulin resistance. To date, there was limited data regarding the TyG index and TG/HDL-c ratio in the perinatal period of neonates. We aimed to investigate the possible relationships between HOMA-IR, TyG index, and TG/HDL-c in the cord blood of neonates. Materials-Methods: One hundred and six pregnant women with singleton gestation who gave birth to full-term, normal-weight Turkish neonates without fetal distress were included in the study. The samples of maternal serum and cord blood in neonates were obtained after delivery. Results: Mean TyG index was 3.71 ± 0.38 and the mean TG/HDL-c ratio was 3.12 ± 3.00 in this group. Correlations were found between maternal age and neonate glucose levels and HOMA-IR (p < .05). HOMA-IR was negatively correlated with triglyceride, TG/HDL-c ratio, TyG index þ TG/ HDL, and positively correlated with HDL and TyG index. Conclusions: Our study indicates that the TyG index and TG/HDL-C may be used as an indicator of insulin sensitivity in the perinatal period of neonates. However, the validity of these results should be tested in other centers with a larger neonate population in order to evaluate whether ethnic and racial diversity influence these relationships.
Received 3 September 2020 Accepted 18 September 2020
Introduction The metabolic disease with the highest global disease burden, diabetes mellitus, is characterized by hyperglycemia due to defects in insulin secretion and/or function. It is a very well-known cause of various short and long-term complications that particularly affect the kidneys, peripheral nerves, blood vessels, the heart, and the eyes [1]. Depending on the type of diabetes mellitus, complications of the disease may be seen in the young adult age group, particularly in those with type 1 diabetes mellitus. However, even in patients with type 2 diabetes mellitus, early diagnosis or determination of individuals prone to develop the disease are crucial to prevent morbidity and positively impact disease course. Therefore, early childhood parameters associated with diabetes development could help in the identification of those at risk. The intrauterine environment and early neonatal life are considered as important determinants of € ur CONTACT EMEL Kabako glu Uns€
[email protected]
ß 2020 Informa UK Limited, trading as Taylor & Francis Group
KEYWORDS
Insulin resistance; TyG index; TG/HDL-c; HOMAIR; neonates
disease and disorder development in adulthood. Changes in the intrauterine and early-postnatal hormonal, metabolic, and nutritional environment can lead to adverse alterations in neuro-endocrine metabolism resulting in increased susceptibility to various diseases throughout life. This phenomenon has been termed as perinatal programming [2]. Studies have revealed that when exposed to high concentrations of insulin with insulin resistance during the perinatal period may epigenetically induce a predisposition for obesity, metabolic syndrome, and diabetes mellitus [3]. Moreover, neonatal hyperinsulinism and also insulin resistance are thought to be related to maternal diabetes, maternal pre-gestational weight/body mass index, cortisol levels, pancreas beta-cell functionality, and birth weight [4,5]. Hyperinsulinemic-euglycemic clamp is considered as the gold standard for insulin resistance evaluation, although it is invasive, impractical, and expensive, and
Seyitgazi mah. Mustafa Kemal pas¸a Bulvarı 1-A, 38030 Melikgazi/Kayseri, Turkey
2
E. K. ÜNSÜR AND F. KUTLUSOY GÜÇLÜ
cannot be used at birth or with cord blood specimens [5,6]. Since plasma insulin level measurements remain expensive, limited, and unreliable which have poor reproducibility and high variability in different laboratories, the homeostasis model assessment of insulin resistance (HOMA-IR) index (using fasting insulin and glucose) is widely used to assess insulin resistance in clinical practice [5]. The triglyceride to glucose index (TyG) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) has been proposed as reliable and simple alternatives to evaluate insulin resistance. To date, there is only one study to examine the TyG index in neonates, while no studies have investigated TG/HDL-c values in neonates [5]. The aims of the study were (i) to investigate relationships between TyG index and HOMA-IR in cord blood samples of neonates, (ii) to determine the ability of the TyG index and TG/HDL-c, and the combination of these two indices to predict insulin resistance in newborns.
Material and methods The study was jointly carried out by the Obstetrics and Gynecology Department and the Neonatal Care Unit of our Hospital, Kayseri, Turkey, from April 2020 to July 2020. A total of 119 Turkish pregnant women with singleton gestation who gave birth full-term (between 37 and 42 weeks), normal-weight (between 2.5 and 4 kg) neonates without fetal distress were included in the study randomly by convenience sampling method. However, 6 pregnant women were excluded from the study after randomization with their requests. Also, seven pregnant women were excluded due to the lack of data about labor and neonates conditions. 106 pregnant women participated in the study. Fetal distress refers to the presence of signs and findings in a pregnant woman during the antepartum or intrapartum period. The signs and findings were abnormal slowing of labor, late decelerations and/or changes in fetal heart rate in the non-stress testing, the presence of meconium (dark green fecal material from the fetus), fetal monitoring with an electronic device that shows a fetal scalp pH of less than 7.0, and a low APGAR score as
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