Who would benefit most from postprandial lipid screening?

Abstract

BACKGROUND & AIMS\nIndividuals with fasting triglycerides (TG)\xa0<150\xa0mg/dL can experience a deleterious postprandial TG response ≥220\xa0mg/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.\n\n\nMETHODS\nWe conducted a secondary analysis of 7 studies from our laboratories featuring 156 disease-free participants (64\xa0M, 92\xa0F; age 18-70 years; BMI 18.5-30\xa0kg/m2). Participants observed a 10-12\xa0h overnight fast, after which they consumed an HFM (10-13\xa0kcal/kg body mass; 61-64% 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)\xa0<220\xa0mg/dL and the upper limit as the concentration which ≥90% of individuals presented PPTG ≥220\xa0mg/dL. Method 2 utilized receiver operating characteristic (ROC) curves and identified the lower limit as the fasting TG concentration where sensitivity was ≈95% and the upper limit as the concentration at which specificity was ≈95%.\n\n\nRESULTS\nIn Method 1, 90% of individuals with fasting TG\xa0>130\xa0mg/dL (>1.50\xa0mmol/L) exhibited PPTG ≥220\xa0mg/dL (≥2.50\xa0mmol/L), while 100% of individuals with fasting TG\xa0<66\xa0mg/dL (0.75\xa0mmol/L) had PPTG that did not exceed 220\xa0mg/dL (2.50\xa0mmol/L). In Method 2, when sensitivity was ≈95%, the corresponding fasting TG concentration was 70\xa0mg/dL (0.79\xa0mmol/L). When specificity was ≈95%, the corresponding fasting TG concentration was 114\xa0mg/dL (1.29\xa0mmol/L). Based on methods 1 and 2, there was a moderate positive association (r\xa0=\xa00.37, p\xa0<\xa00.004) between fasting and PPTG for individuals with fasting TG between 70 and 130\xa0mg/dL (0.79-1.50\xa0mmol/L), in which 24% exhibited PPTG ≥220\xa0mg/dL (≥2.50\xa0mmol/L) while 76% did not.\n\n\nCONCLUSIONS\nPostprandial TG testing is likely most useful for individuals with fasting TG concentrations between 70 and 130\xa0mg/dL (0.79-1.50\xa0mmol/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.