Association of triglycerides/high density lipoprotein cholesterol ratio with insulin resistance in polycystic ovary syndrome

Background: Insulin resistance (IR) is frequently observed in women with polycystic ovary syndrome (PCOS). Recent studies advocated that triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) can be used as a simple clinical indicator of IR. Hence, the present study was performed to investigate the use of TG/HDL-C and its association with IR in PCOS.Methods: Forty-one patients with PCOS and 40 healthy age matched women were randomly enrolled. Demographic and clinical characteristics were obtained. Insulin resistance was defined by the homeostasis model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI).Results: In PCOS group, the insulin, HOMA-IR and TG/HDL-C ratio were significantly higher (p=0.001) than controls while, QUICKI was lower (p=0.001). Insulin, HOMA-IR were positively correlated with TG/HDL-C (ρ=0.303, p=0.006 and ρ=0.312, p=0.005 respectively) while, QUICKI was negatively correlated (ρ=-0.698, p=0.001). In receiver operating characteristic (ROC) analysis, area under the curve (AUC) for model based on QUICKI levels was better 0.898 (95% CI: 0.811-0.955, p=0.001) than HOMA-IR 0.636 (95% CI: 0.522-0.740, p=0.03). A cut-off value 3.23 for TG/HDL-C is proposed from the model based on QUICKI with best combination of sensitivity 83.3% and specificity 86.7%.Conclusions: Results of present study support that TG/HDL-C ratio may be a simple indicator of IR in PCOS patients which helps clinicians to identify IR in small centers, where the assays for insulin measurement are not available

Branched chain amino acid profile in early chronic kidney disease

The nutritional status in chronic kidney disease (CKD) patients is a predictor of prognosis during the first period of dialysis. Serum albumin is the most commonly used nutritional marker. Another index is plasma amino acid profile. Of these, the plasma levels of branched chain amino acids (BCAA), especially valine and leucine, correlate well with nutritional status. Plasma BCAAs were evaluated along with albumin and C-reactive protein in 15 patients of early stages of CKD and 15 age- and sex-matched healthy controls. A significant decrease in plasma valine, leucine and albumin levels was observed in CKD patients when compared with the controls (P <0.05). No significant difference in C-reactive protein (CRP) levels was observed between the two groups. Malnutrition seen in our CKD patients in the form of hypoalbuminemia and decreased concentrations of BCAA points to the need to evaluate the nutritional status in the early stages itself. Simple measures in the form of amino acid supplementation should be instituted early to decrease the morbidity and mortality before start of dialysis in these patients