# Comparative diagnostic accuracy of the triglyceride/HDL-c ratio and lipid accumulation product index for the early detection of metabolic syndrome among adults with obesity in Indonesia: findings from the 2023 Health Survey

## TL;DR

The study finds that the lipid accumulation product index is better than the triglyceride/HDL-c ratio for detecting metabolic syndrome in obese adults in Indonesia.

## Contribution

The study provides sex-specific cutoff values for two lipid metrics to screen for metabolic syndrome in an Indonesian population.

## Key findings

- The lipid accumulation product index outperformed the triglyceride/HDL-c ratio in predicting metabolic syndrome.
- Sex-specific cutoff values improved the reliability of the lipid accumulation product index for early detection.
- Men showed higher predictive accuracy with the lipid accumulation product index compared to women.

## Abstract

To evaluate the diagnostic performance and determine the optimal cutoff
values of the triglyceride-to-high-density lipoprotein cholesterol ratio and
lipid accumulation product index as predictors of metabolic syndrome among
adults with obesity in Indonesia.

This cross-sectional study analyzed secondary data from the 2023 Indonesia
Health Survey, which included 3,988 samples (2,958 women). Descriptive
statistics were used to characterize the sample. Receiver Operating
Characteristic curve analysis and the Youden index were employed to assess
diagnostic performance and determine the optimal cutoff values of the
triglyceride-to-high-density lipoprotein cholesterol ratio and lipid
accumulation product index. The associations between both predictors and the
presence of metabolic syndrome were examined using multivariable logistic
regression.

The lipid accumulation product index exhibited greater predictive accuracy
than the triglyceride-to-high-density lipoprotein cholesterol ratio,
particularly among men. This result indicated the superior utility of the
lipid accumulation product index as a clinical screening tool for metabolic
syndrome, with area under the curve values of 0.842 (95% CI 0.817-0.866) for
men and 0.737 (95% CI 0.720-0.755) for women, compared to that of the
triglyceride-to-high-density lipoprotein cholesterol ratio, with area under
the curve values of 0.810 (95% CI 0.784–0.837) for men and 0.728 (95% CI
0.710-0.746) for women. The optimal cutoff values of the
triglyceride-to-high-density lipoprotein cholesterol ratio and lipid
accumulation product index were 4.456 (sensitivity 64.8%, specificity 81.4%)
and 45.752 (sensitivity 75.5%, specificity 81.2%) for men and 2.792
(sensitivity 59.2%, specificity 76.8%) and 41.285 (sensitivity 58.6%,
specificity 75.8%) for women, respectively.

The lipid accumulation product index demonstrated superior accuracy in
predicting metabolic syndrome among adults with obesity, particularly among
men. Sex-specific cutoff values enhance its reliability and practicality for
early screening and intervention to prevent metabolic complications.