KUMJ | VOL. 24 | NO. 1 | ISSUE 94 | JANUARY - MARCH, 2026

Association of Triglyceride-to-HDL Cholesterol ratio with Body Mass Index in Nepalese Adults with Non-Alcoholic Fatty Liver Disease
Pandey R, Gupta N, Takhache Shrestha J, Pokhrel BR, Yadav RK, Gupta BK

Abstract:
Background The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio is an emerging marker of insulin resistance and metabolic dysfunction, even among nonobese individuals. Evidence from South Asia, particularly Nepal, remains limited. Objective To assess the association between TG/HDL-C ratio and BMI and to evaluate its distribution across BMI categories among adults with Non-Alcoholic Fatty Liver Disease (NAFLD). Method A cross-sectional study was conducted among 400 adults with ultrasonographyconfirmed NAFLD attending a tertiary care hospital in Nepal. Participants were categorized into BMI groups, and fasting lipid profiles were obtained. The TG/ HDL-C ratio was calculated, and values > 2.4 were considered elevated based on previously published evidence demonstrating its association with advanced nonalcoholic fatty liver disease and hepatic fibrosis. Associations were evaluated using correlation analysis, group comparisons across BMI categories, and multivariable linear regression. Result The median BMI and TG/HDL-C ratio of the participants were 30.04 (IQR: 26.06 – 32.84) kg/m² and 3.91 (IQR: 3.12 – 5.26), respectively. The TG/HDL-C ratio showed a weak positive correlation with BMI (ρ = 0.302, p < 0.001) and a very weak negative correlation with age (ρ = -0.142, p = 0.004). Significant differences in TG/HDL-C ratio were observed across BMI categories (p < 0.001), with the highest median values among obese individuals. Elevated TG/HDL-C ratio was present in 84% of participants and remained highly prevalent even among normal-weight individuals (75.8%). BMI remained an independent predictor of TG/HDL-C ratio, where each 5 kg/m2 increase in BMI was associated with a 0.705 unit increase in the ratio (β=0.705; p <0.001) after adjusting for age, sex, and LDL cholesterol. Conclusion TG/HDL-C ratio was significantly associated with BMI and was highly prevalent even among normal-weight individuals with NAFLD. This lipid ratio may serve as a simple and cost-effective marker for identifying metabolic risk in clinical settings.
Keyword : Body mass Index, Dyslipidemia, Metabolic risk, Non-alcoholic fatty liver disease, TG/ HDL-C ratio