SUN-219 - Association of Triglyceride-Glucose Index with HOMA-IR and Adiposity in Children and Adolescents Evaluated for Overweight/Obesity: A Cross-Sectional Study in Bogotá, Colombia

Background: pediatric insulin resistance (IR) is often estimated using HOMA-IR, which requires fasting insulin. The triglyceride–glucose (TyG) index is derived from routine fasting triglycerides and glucose and may represent an accessible surrogate marker.

Objective: characterize TyG and HOMA-IR distributions; quantify their associations with adiposity; and evaluate the ability of TyG to identify elevated HOMA-IR in children and adolescents with overweight or obesity.

Methods: cross-sectional study of children and adolescents aged 5–17 years with overweight or obesity receiving care at two quaternary-care hospitals in Bogotá, Colombia; TyG = ln(triglycerides [mg/dL] × glucose [mg/dL] / 2) and HOMA-IR = insulin [uIU/mL] × glucose [mg/dL] / 405. Adiposity was assessed using BMI and WHO BMI-for-age z-score (zBMI). Spearman correlations quantified bivariate associations. Multivariable linear regression modeled ln(HOMA-IR) on TyG adjusting for age, sex, and zBMI using robust standard errors. Elevated HOMA-IR was defined a priori as ≥3.2. Discrimination was evaluated with ROC AUC (bootstrap 95% CI) and the Youden-optimal TyG cutoff.

Results: among 52 participants (age 11.2±2.7 years; 63.5% female), BMI was 23.37±4.43 kg/m² and zBMI 1.82±1.15. TyG was 8.68±0.49. Fasting insulin was 16.3 (IQR 10.5–22.0) uIU/mL, triglycerides 145.2 (112.3–177.5) mg/dL, glucose 89.0 (83.8–93.0) mg/dL, and HOMA-IR 3.49 (2.15–4.72). TyG correlated strongly with HOMA-IR (rho=0.721, p< 0.001) and modestly with adiposity (TyG–BMI rho=0.362, p=0.008; TyG–zBMI rho=0.395, p=0.004). HOMA-IR correlated with BMI (rho=0.453, p< 0.001) and zBMI (rho=0.331, p=0.016). In adjusted analyses, each 0.1-unit higher TyG was associated with 7.1% higher HOMA-IR (95% CI 4.5–9.8; p< 0.001). Elevated HOMA-IR prevalence was 55.8% (29/52). TyG showed high discrimination for elevated HOMA-IR (AUC 0.921, 95% CI 0.827–0.986); the optimal cutoff was 8.75 (sensitivity 86.2%, specificity 91.3%).

Conclusion: in children and adolescents with overweight or obesity, TyG is strongly associated with HOMA-IR and modestly associated with adiposity; the association persists after adjustment for age, sex, and zBMI. TyG also demonstrates high accuracy for identifying elevated HOMA-IR, supporting its potential use as an accessible tool to prioritize early IR risk stratification in pediatric clinical settings

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