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Who would benefit most from postprandial lipid screening?

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journal contribution
posted on 2023-05-01, 19:03 authored by Christina M Sciarrillo, Nicholas A Koemel, Bryant H. Keirns, Nile F. Banks, Emily RogersEmily Rogers, Sara K. Rosenkranz, Stephanie P. Kurti, Nathaniel D.M. Jenkins, Sam R. Emerson

Background & aims: Individuals with fasting triglycerides (TG) <150 mg/dL can experience a deleterious

postprandial TG response  220 mg/dL to a high-fat meal (HFM). The purpose of this study was to

identify individuals based on fasting TG that would benefit most from additional postprandial screening.

Methods: We conducted a secondary analysis of 7 studies from our laboratories featuring 156 diseasefree

participants (64 M, 92 F; age 18e70 years; BMI 18.5e30 kg/m2). Participants observed a 10e12 h

overnight fast, after which they consumed an HFM (10e13 kcal/kg body mass; 61e64% kcal from fat).

Two methods were used to identify lower and upper fasting TG cut points. Method 1 identified the lower

limit as the TG concentration at which  90% of individuals presented peak postprandial TG

(PPTG) <220 mg/dL and the upper limit as the concentration which  90% of individuals presented PPTG

 220 mg/dL. Method 2 utilized receiver operating characteristic (ROC) curves and identified the lower

limit as the fasting TG concentration where sensitivity was z95% and the upper limit as the concentration

at which specificity was z95%.

Results: In Method 1, 90% of individuals with fasting TG >130 mg/dL (>1.50 mmol/L) exhibited PPTG

 220 mg/dL ( 2.50 mmol/L), while 100% of individuals with fasting TG <66 mg/dL (0.75 mmol/L) had

PPTG that did not exceed 220 mg/dL (2.50 mmol/L). In Method 2, when sensitivity was z95%, the

corresponding fasting TG concentration was 70 mg/dL (0.79 mmol/L). When specificity was z95%, the

corresponding fasting TG concentration was 114 mg/dL (1.29 mmol/L). Based on methods 1 and 2, there

was a moderate positive association (r ¼ 0.37, p < 0.004) between fasting and PPTG for individuals with

fasting TG between 70 and 130 mg/dL (0.79e1.50 mmol/L), in which 24% exhibited PPTG  220 mg/dL

( 2.50 mmol/L) while 76% did not.

Conclusions: Postprandial TG testing is likely most useful for individuals with fasting TG concentrations

between 70 and 130 mg/dL (0.79e1.50 mmol/L). Outside of this range, postprandial TG responses are

largely predictable. Establishing a specific patient group for which postprandial TG testing is most useful

may lead to earlier risk detection in these individuals.

History

Grant ID

18AIREA33960528