Fasting, non-fasting and postprandial triglycerides for screening cardiometabolic risk

 

High fasting triglycerides have been

 associated with cardiovascular disease (CVD) 

since the 1950s,

 and nearly one-third of Americans display

 elevated triglycerides (>1⋅70 mmol/l or 150 mg/dl)(1,2).

 Triglycerides >1⋅70 mmol/l (150 mg/dl)

 are also one criterion for diagnosis of the metabolic syndrome and are frequently observed in those with type 2 diabetes(3–6)

Fasting triacylglycerols have long been associated with cardiovascular disease (CVD) and other cardiometabolic conditions. 

Evidence suggests that non-fasting triglycerides 

(i.e. measured within 8 h of eating) better predict CVD than fasting triglycerides, 

which has led several organisations to recommend non-fasting lipid panels as the new clinical standard.

 However, unstandardised assessment protocols associated

 with non-fasting triglyceride measurement may lead to misclassification, with at-risk individuals being overlooked. 

A third type of triglyceride assessment, postprandial testing, is more controlled, yet historically has been difficult to implement 

due to the time and effort required to execute it. 

Here, we review differences in assessment, the underlying physiology and the pathophysiological relevance of elevated fasting, non-fasting and postprandial triglycerides.

 We also present data suggesting that there may be a distinct advantage of postprandial triglycerides, even over non-fasting triglycerides, for early detection 

of CVD risk and offer suggestions to make postprandial protocols more clinically feasible.

Overall, a growing body of epidemiological and clinical evidence suggests that the rise in triglycerides after a meal may be a more sensitive screening tool than fasting triglycerides for detecting disease risk and may be abnormal when other traditional risk factors (i.e. fasting triglycerides, HDL-C, glucose) are in the normal range.

Reference

J Nutr Sci. 2021 Sep 14;10:e75. doi: 10.1017/jns.2021.73

Fasting, non-fasting and postprandial triglycerides for screening cardiometabolic risk

Bryant H Keirns 1,*, Christina M Sciarrillo 1, Nicholas A Koemel 2,3, Sam R Emerson