Reference vs optimal range
| Typical lab reference range | Vively optimal range | |
|---|---|---|
| Men | Below 3.0 (molar ratio) | Below 2.6 |
| Women | Below 2.2 (molar ratio) | Below 1.7 |
Most labs do not print this ratio, so it is calculated from the client's triglyceride and HDL results; read each component against the range on the report (RCPA). The optimal cut-offs are targets for metabolic work, not diagnostic thresholds.
Why the optimal range sits there
Triglycerides and HDL move in opposite directions as insulin resistance develops. The liver exports more triglyceride-rich VLDL, and HDL is remodelled and cleared faster. Dividing one by the other amplifies that shared signal, which is why the ratio tracks insulin resistance and small, dense LDL more closely than either marker alone (Kosmas and colleagues, Diagnostics, 2023). Our optimal cut-offs of below 2.6 in men and below 1.7 in women sit under the reference cut-offs to flag that drift early. Women's cut-offs are lower because women carry higher HDL at the same level of metabolic risk. Much of the research, including McLaughlin and colleagues (Annals of Internal Medicine, 2003), reports the ratio from mg/dL values, so check units before comparing figures with overseas papers.
Reading the result
Patterns with other markers
| Pattern | What it can point to |
|---|---|
| Ratio above optimal, fasting insulin above 10 mIU/L | Is often seen with insulin resistance; HOMA-IR and waist measurement add weight to the picture. See: Fasting Insulin, HOMA-IR |
| Ratio raised mainly by triglycerides | Can point to alcohol, refined carbohydrate or excess energy intake, or an unfasted sample; confirm the fast first. See: Triglycerides |
| Ratio raised mainly by low HDL | Is often seen with inactivity, smoking and central adiposity. See: HDL Cholesterol |
| Raised ratio, LDL in range, ApoB above range | Can point to more small LDL particles than the LDL cholesterol suggests. See: Apolipoprotein B (ApoB), LDL Cholesterol |
| Raised ratio with raised ALT or GGT | Can point to fatty liver. See: ALT, GGT |
What can skew the result
- A non-fasting sample, which raises triglycerides and the ratio.
- Alcohol in the 24 to 48 hours before collection.
- Hypothyroidism, which can raise triglycerides; check TSH.
- Oral oestrogen and the combined pill, which raise both triglycerides and HDL and blur the ratio.
- Very high HDL from genetics or regular alcohol, which can flatter the ratio.
- Ethnicity: the ratio predicts insulin resistance less well in some populations.
When to refer to the client's GP
- Triglycerides above 5.6 mmol/L, whatever the ratio, given the rising risk of pancreatitis.
- A raised ratio with fasting glucose 6.1 mmol/L or above, or HbA1c 42 mmol/mol or above.
- A raised ratio with high blood pressure or early heart disease in the family, for absolute risk assessment.
- Thirst, frequent urination or unexplained weight loss.
Using it in practice
Triglycerides respond within weeks to less alcohol, fewer refined carbohydrates and added sugars, and more whole foods, so the ratio is a useful early feedback marker. HDL moves more slowly, so expect most early change to come from the triglyceride side.
Frequently asked questions
Can a naturopath, nutritionist or dietitian get this ratio for a client through Vively?
Yes. It is calculated from the triglyceride and HDL results in the Baseline and Full Body Health Check, which you can add to a client's request on the Vively practitioner platform. A Vively doctor reviews and signs the request. Baseline markers can be Medicare-funded when a Vively GP issues the referral after a short telehealth consult with your client.
Why are the cut-offs lower for women?
Women have higher HDL on average at the same level of metabolic risk, so a given ratio means more in a woman. Our reference cut-offs are below 3.0 in men and below 2.2 in women, with optimal below 2.6 and below 1.7. Menopause, pregnancy and oral oestrogen all shift HDL and triglycerides, so read the ratio with the client's hormonal context.
Is the ratio as good as fasting insulin for insulin resistance?
No, it is a weaker proxy. Fasting insulin and HOMA-IR measure the insulin response directly, while the ratio infers it from lipids and is affected by alcohol, oestrogen, ethnicity and genetics. Use the ratio as a screening signal and for trend, and confirm with fasting insulin when it is raised.
References
- McLaughlin T, Abbasi F, Cheal K, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine. 2003.
- Kosmas CE, Rodriguez Polanco S, Bousvarou MD, et al. The triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio as a risk marker for metabolic syndrome and cardiovascular disease. Diagnostics. 2023.
- Royal College of Pathologists of Australasia. RCPA Manual: Lipids.
- Pathology Tests Explained. Triglycerides.