Triglyceride–glucose index identifies early metabolic stress and β-cell vulnerability in pediatric obesity

Among children and adolescents with obesity, higher triglyceride–glucose index values were associated with a less favorable metabolic profile, lower insulin sensitivity and weaker coupling between insulin secretion and insulin sensitivity, even when participants had comparable severity of obesity. The cross-sectional study indicates that the index may capture metabolic differences not fully reflected by body mass index alone, although the results establish associations rather than a cause-and-effect relationship or a prediction of future disease. Researchers enrolled children and adolescents with obesity who underwent comprehensive metabolic evaluation, including an oral glucose tolerance test.

They divided participants into tertiles according to their triglyceride–glucose, or TyG, index and also assigned them to conventional metabolic classifications. From the oral glucose tolerance test data, the investigators derived measures of insulin sensitivity, insulin secretion and β-cell disposition. Correlation analysis, multivariable regression and unsupervised clustering were then used to examine the relationships among TyG, BMI Z-score and metabolic biomarkers.

Participants in the highest TyG tertile had higher glycemic and hepatic markers and reduced insulin sensitivity than those in the lower tertiles, despite broadly comparable severity of obesity. As TyG increased, the oral glucose tolerance test-derived indices showed lower insulin sensitivity and reduced secretion–sensitivity coupling. The investigators interpreted this pattern as consistent with metabolic stress and potential β-cell vulnerability.

However, the study did not directly demonstrate deterioration in β-cell function over time, and the cross-sectional design cannot establish that elevated TyG caused the observed differences. One β-cell measure, the hybrid disposition index, remained preserved across the three TyG tertiles. That result did not mean that every assessed feature of β-cell function was equivalent.

Instead, the study found a specific pattern: insulin secretion and insulin sensitivity became less closely coupled as TyG rose, while the hybrid disposition index remained stable. The findings therefore point to a dimension of metabolic vulnerability that the preserved composite measure did not fully display. TyG showed broader and more robust associations with metabolic and β-cell-related indices than BMI Z-score, and multivariable models found TyG independently associated with β-cell disposition indices.

Cluster analysis also separated children with similar degrees of obesity into distinct metabolic phenotypes. TyG distinguished profiles characterized by impaired insulin sensitivity and potential β-cell vulnerability, while comparisons across metabolic states indicated that it supplied information not fully captured by conventional categorical definitions of metabolic dysfunction.

Subject of Research: Triglyceride–glucose index associations with metabolic and β-cell measures in pediatric obesity

Article Title: Triglyceride–glucose index identifies early metabolic stress and β-cell vulnerability in pediatric obesity

Article References: Ying, L.-W., Hu, J.-Y., She, J.-X., Feng, B.-Y., Wang, L.-B., Gao, S.-Y., Yang, F., Huang, Y.-G., Zhang, Q.-W., Li, J., Ding, Y., Wang, X.-M., & Chang, G.-Y. (2026). Triglyceride–glucose index identifies early metabolic stress and β-cell vulnerability in pediatric obesity. World Journal of Pediatrics. https://doi.org/10.1007/s12519-026-01105-7

Image Credits: AI Generated

DOI: 10.1007/s12519-026-01105-7

Keywords: pediatric obesity, triglyceride–glucose index, insulin sensitivity, β-cell function, metabolic stress, oral glucose tolerance test, metabolic phenotyping, BMI Z-score, cross-sectional study, Triglyceride, glucose, index