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

OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.