What are triglycerides / HDL Ratio?
Triglycerides are the fat your liver makes from surplus sugar and alcohol and sends into the blood in particles, and HDL is the particle that brings cholesterol back from the vessel wall. With a healthy sugar metabolism triglycerides are low and HDL is high. With belly fat and insulin resistance that tips: the liver makes more triglycerides, those particles swap fat with HDL on the way, and HDL becomes smaller and is broken down faster. Triglycerides go up and HDL goes down, in one movement, and the ratio between the two therefore rises on two sides at once. That makes the ratio a handy summary of the lipid pattern that goes with a deranged sugar metabolism, and that is also the lipid pattern that yields the small, dense LDL particles that lodge most easily in the vessel wall. A high ratio with a normal LDL is therefore a signal LDL alone does not show. The limitation is the same as with every division: the result does not say which of the two moved, and triglycerides move strongly with what you ate and drank in the hours before. Your report does not print the ratio; you calculate it with the calculator on this page, from triglycerides and HDL in mmol/L, and the result has no unit. The best-known cut-off, 2.27, comes from research in obese youths in American units and, converted to Dutch units, is about a 1. Anyone slim, who exercises and eats little sugar usually sits below 1; above 2 the lipid pattern of insulin resistance belongs with it.
Why are triglycerides / HDL Ratio relevant?
The ratio is the value that shows whether your sugar metabolism is already working through into your lipid profile. Insulin resistance begins years before fasting glucose rises, and one of the first places it becomes visible is exactly this pair: triglycerides up, HDL down. Anyone with belly fat, who exercises little or eats a lot of sugar and fast carbohydrates sees the ratio rise while LDL and glucose are still normal. That is an early and cheap signal, from two numbers that sit in every lipid profile. The second reason is that the ratio shows the gain of lifestyle quickly. Triglycerides respond within weeks to less sugar, less alcohol and more exercise, and HDL follows over months; the ratio therefore falls earlier than LDL or HbA1c. Anyone working on their weight and their exercise has in this ratio a number that moves with what they do. The honest limitation is that the ratio appears on no Dutch report, that the Dutch risk estimate does not work with it, and that the only published cut-off comes from research in children in other units. The ratio is a summary and a trend, not a verdict. The direction, high triglycerides with low HDL, is the pattern described in type 2 diabetes, and that pattern counts.
Triglycerides / HDL Ratio decision limits
What counts beside the number:
- Whether you were fasting, because triglycerides move most strongly with that
- The separate values of triglycerides and HDL, because those are on your report and have a band
- Your waist, and glucose, insulin and HbA1c, which show the sugar metabolism behind it
- How much alcohol, sugar, soft drinks and fast carbohydrates you use
- Non-HDL and ApoB, the measures the Dutch risk estimate works on
- In which unit a cut-off you come across elsewhere was calculated, because in mg/dL the number is more than twice as high
This is the only published limit for this ratio, and it is about youths in other units, so do not read it one to one. No Dutch lab prints the ratio and the Dutch risk estimate does not work with it; what that does describe is the pattern itself, high triglycerides with a low HDL, as the lipid pattern in type 2 diabetes. Anyone slim, who exercises and eats little sugar usually sits below 1; above 2 that pattern belongs with it. Measure fasting, and read the ratio as a trend beside the two numbers themselves.
triglycerides / HDL = triglycerides divided by HDL, both in mmol/L
Dividing is dividing: there is no constant to account for. No favourable zone is drawn beside the result, because there is no published limit to base such a zone on: the only one there is was worked out from milligrams per decilitre, which puts it on a different scale from the result below.
÷ =
Triglycerides / HDL Ratio high or low: what it means
A low ratio is favourable: triglycerides are low and HDL is high, the pattern of a healthy sugar metabolism. Drawing blood fasting instead of after a meal lets triglycerides fall and the ratio with them, so compare only measurements under the same conditions. Treating the underlying cause, losing weight, less alcohol, a diabetes coming under control, lets the ratio fall on two sides. A high HDL makes the denominator larger without anything changing about the triglycerides, and then a low ratio can hide triglycerides that are at the high end in themselves. A high ratio means triglycerides are high, HDL low, or both. Having eaten or drunk recently is the most common reason for an unexpectedly high result, because triglycerides rise after a meal and certainly after alcohol; repeat fasting. Belly fat and insulin resistance are the structural reason, and type 2 diabetes the end point of that, in which high triglycerides with a low HDL are the typical lipid pattern. Alcohol lifts triglycerides, even without a meal. Rare is oestrogen therapy, which raises triglycerides. A ratio above 2 with a normal LDL is a reason to look at glucose, insulin and your waist. What you do about it: less sugar, soft drinks, juice and fast carbohydrates, because your liver makes triglycerides from those, and less alcohol; more oily fish, nuts and olive oil; and exercise, because working muscles take triglycerides out of the blood and lift HDL. Losing weight around the waist is the biggest lever: every kilo of belly fat less lets triglycerides fall and HDL rise. Count on weeks for the triglycerides and months for HDL, and measure fasting and under the same conditions. Set the ratio beside the triglycerides and HDL themselves, because those are on your report and have a band, beside glucose, insulin and HbA1c, which show the sugar metabolism behind it, and beside non-HDL and ApoB, which the Dutch risk estimate works on.
What lowers it
Favourable: low triglycerides, a high HDL, or both.
| Cause | How often |
|---|---|
| Drawn fasting rather than non-fastingTriglycerides fall when you draw fasting, and the ratio falls with them; compare only measurements under the same conditions | Often |
| Treating the underlying causeLosing weight, less alcohol, less sugar and a diabetes coming under control let triglycerides fall and HDL rise | Sometimes |
| A high HDLMakes the denominator larger without anything changing about the triglycerides; a low ratio can then hide triglycerides that are at the high end in themselves | Sometimes |
What raises it
High triglycerides, a low HDL, or both, and first the question whether you were fasting.
| Cause | How often |
|---|---|
| Having eaten or drunk recentlyTriglycerides rise after a meal and certainly after alcohol; the most common reason for an unexpectedly high result, and repeating fasting solves it | Often |
| Belly fat and insulin resistanceThe liver makes more triglycerides and HDL becomes smaller and is broken down faster; the ratio rises on two sides at once | Often |
| Type 2 diabetesThe end point of insulin resistance, with high triglycerides and a low HDL as the typical lipid pattern | Often |
| AlcoholThe liver makes triglycerides from alcohol; a few weeks without often already lets the numerator fall | Sometimes |
| Oestrogen therapyOestrogen by mouth raises the production of triglycerides in the liver | Rare |
How does a triglycerides / HDL Ratio blood test work?
- Referral
- Not needed. You can have the lipid profile the ratio follows from measured yourself; you calculate the ratio with the calculator on this page.
- Fasting
- Yes, for this ratio it matters, because the triglycerides in the numerator rise after a meal and after alcohol. Twelve hours without food, no alcohol the evening before, water is fine.
- When
- In the morning fasting, on an ordinary day, not after a party and not during an illness. Three months after a change in weight, diet or exercise to see the effect.
- The draw
- One tube of blood from a vein in your arm. Triglycerides and HDL come from the same tube, and glucose, insulin and non-HDL alongside.
- Repeating
- With a high result fasting, after two to four weeks. Anyone working on weight and exercise measures again after three months, always fasting and under the same conditions.
- Which test
- Triglycerides / HDL Ratio is in the Heart health test (€69) and in .
- Where to draw
- You can draw at 250+ locations near you, no referral needed. See the locations
Frequently asked questions
What is the triglycerides/HDL ratio?
Your triglycerides divided by your HDL cholesterol, both in mmol/L from the same lipid profile. The two move in opposite directions with belly fat and insulin resistance, triglycerides up and HDL down, and the ratio catches those two movements in one number. It is a calculation, not a separate test, and the result has no unit.
Is there a normal value for the triglycerides/HDL ratio?
No lab band, because no Dutch lab prints the ratio. Anyone slim, who exercises and eats little sugar usually sits below 1, and above 2 the lipid pattern of belly fat and insulin resistance belongs with it. The only published cut-off comes from research in youths in American units. More important than a limit is your own trend, measured fasting and under the same conditions.
Where does the cut-off you come across online come from?
From an American study in obese youths of on average thirteen, in which a ratio of 2.27 predicted insulin resistance. That number is calculated from triglycerides and HDL in milligrams per decilitre, and that unit makes the ratio more than twice as large as in the Dutch unit mmol/L. Converted, 2.27 corresponds to about a 1. Anyone who sets the American number beside a Dutch result is comparing two scales.
Can I compare my result with that number?
Only after converting, and even then with a pinch of salt: the study was about obese youths and not about adults in the Netherlands. If you calculate your Dutch ratio in mmol/L, the limit of that study is about a 1. More usable than a limit is the direction: a ratio that rises over the years while your waist grows is the signal, and a ratio that falls as you lose weight and exercise is the gain.
What does a high triglycerides/HDL ratio mean?
That your triglycerides are high, your HDL low, or both. First the question whether you were fasting, because triglycerides rise after a meal and after alcohol. If the ratio stays high fasting, it is usually belly fat and insulin resistance, the lipid pattern that also goes with type 2 diabetes and that yields small, dense LDL particles. That is a reason to look at glucose, insulin, HbA1c and your waist, even if LDL is normal.
What does a low triglycerides/HDL ratio mean?
That your triglycerides are low and your HDL high, the pattern of a healthy sugar metabolism: a slim waist, exercise, little sugar and little alcohol. That is the favourable state. Do check that HDL is not only lifting the denominator while the triglycerides are at the high end in themselves, because then the ratio hides something the separate numbers show.
How do I bring my ratio down?
On two sides. Less sugar, soft drinks, juice and fast carbohydrates, and less alcohol, because your liver makes triglycerides from those; more oily fish, nuts and olive oil. Exercise, because working muscles take triglycerides out of the blood and lift HDL. And losing weight around the waist, the biggest lever. Triglycerides respond within weeks, HDL over months, and the ratio therefore falls earlier than LDL or HbA1c.
Do I need to fast for this test?
Yes, for this ratio you do. The ordinary lipid profile is measured non-fasting, but the triglycerides in the numerator rise after a meal and certainly after alcohol, and then the ratio measures your last meal instead of your metabolism. Twelve hours without food, no alcohol the evening before, water is fine. And compare only measurements under the same conditions.
Which tests include triglycerides / HDL Ratio?
Triglycerides / HDL Ratio is in the Heart health test (€69, also as an add-on for €39), in the Blood sugar & metabolism test (€59, also as an add-on for €15), in the comprehensive test (€229) and in .
Related biomarkers
Read on
Sources
- 1.Giannini C et al., The triglyceride-to-HDL cholesterol ratio: association with insulin resistance in obese youths of different ethnic backgrounds, Diabetes Care. 2011. pmc.ncbi.nlm.nih.gov
- 2.CVRM, Dutch cardiovascular risk management guideline, module on lipid treatment. 2018. richtlijnendatabase.nl
- 3.CVRM, module on fasting versus non-fasting sampling. 2018. richtlijnendatabase.nl
- 4.CVRM, summary of the Dutch cardiovascular risk management guideline. 2024. richtlijnendatabase.nl
- 5.Unilabs, test catalogue (Dutch): the full index. 2026. bepalingenklapper.nl
- 6.Unilabs, test catalogue (Dutch): cholesterol/HDL ratio, the only lipid ratio in that index. 2026. bepalingenklapper.nl
- 7.Star-shl, test catalogue (Dutch): the full index. 2026. star-shl.nl
- 8.Certe, test catalogue (Dutch): cholesterol/HDL ratio, the only lipid ratio in the catalogue. 2026. bepalingenwijzer.certe.nl
- 9.Clinical Diagnostics, lab guide (Dutch): Cholesterol+ratio. 2026. clinicaldiagnostics.nl
Educational information only, not medical advice. Consult a healthcare professional for clinical decisions.
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