|Much retweeting of this letter and a good question asked, is TG/HDL best marker to test hypothesis and how do we validate it as such?|
At present TG/HDL is pragmatic choice, and can be validated against OGTT 2-hour insulin in subgroup.
Causes of hyperinsulinaemia will always be debated but a dietary intervention that resolves essential hypertension will lower TG/HDL and if isocaloric involve CHO restriction.
It’s unlikely the full hypothesis can be tested epidemiologically, but rather by the combination of epidemiology and experiment.
|I checked validity of TG/HDL in this paper (just the first that came to to hand with metsyn clusters). A doubling of the TG/HDL ratio from 2 to 4 correlates well with a doubling of the 2-hour insulin level in non-diabetics.|