Background: In West Virginia (WV), 47% of fifth-grade children are either overweight or obese. There is no clear consensus regarding the definition of insulin resistance in children, and directly measuring insulin on the population level is costly. Two proposed measures examined further in this study include triglyceride (TRIG)/high-density lipoprotein cholesterol (HDLC) ratio and TRIG/low-density lipoprotein (LDL-C) ratio. The purpose of this study is to examine the relationship between TRIG/HDL-C ratio, TRIG/LDL-C ratio and insulin resistance in fifth-graders with acanthosis nigricans (AN).

Methods: Between 2007 and 2016, 52,545 fifth-grade students in WV were assessed for AN. Fasting glucose and insulin levels were collected only for a sub-group of students who were AN-positive and was used to determine insulin resistance using the Homeostatic Model for Insulin Resistance (HOMA-IR) equation. Statistical analysis included t tests and logistic regression with receiver operating characteristic curves.

Results: Of the students assessed for AN, 4.5% (n = 2360) tested positive. The prevalence of insulin resistance was 79% (n = 814) among 1030 with AN and complete HOMA-IR. TRIG/HDL-C ratio and TRIG/LDL-C ratio were significantly associated with insulin resistance (TRIG/HDL-C:Est. = 0.36, P < 0.0001, AUC = 0.68; TRIG/LDL-C: Est. = 0.87, P < 0.0001, AUC = 0.69). Multivariate analysis showed that increased body mass index (Est. = 0.05, P < 0.0001), gender (Est. = 0.49, P < 0.0001) and TRIG/HDL-C ratio (Est. = 0.21, P < 0.0001) were significantly associated with insulin resistance.