BOSTON (EGMN) – Nonfasting lipid status may be a better marker for impaired lipid metabolism than fasting lipids, according to a prospective study.

The findings suggest that patients need not deny themselves a good breakfast or lunch before having their blood drawn for plasma lipid testing.

Dr. István Reiber and Dr. Izabella Mezõ from the Szent György Hospital in Székesfehérvár, Hungary, compared fasting and postprandial lipid levels among 102 nondiabetic patients (44 men), and found that the only significant differences in any lipid parameters were between fasting and nonfasting triglycerides.

It is well known that there are no significant changes in total cholesterol and HDL cholesterol levels between the fasting and postprandial state.

In addition, recent study findings suggest that nonfasting triglyceride concentrations in plasma are more predictive of cardiovascular events than are conventional measures of fasting triglycerides, the investigators wrote in a scientific poster presented at a symposium sponsored by the International Atherosclerosis Society.

The study participants had never received lipid-lowering drugs. They underwent separate venous blood draws following an overnight fast, 3 hours after eating their usual breakfasts, and 3 hours after their usual lunches.

Overall, the total cholesterol in the fasting state was 5.51 mmol/L, compared with 5.48 mmol/L after breakfast, and 5.69 mmol/L after lunch, a difference that was not significant.

HDL levels also were comparable between the fasting and postprandial states, at 1.12 mmol/L, 1.14 mmol/L (breakfast), and 1.20 mmol/L (lunch), respectively. Triglyceride levels, however, were significantly higher after eating, rising from 2.21 mmol/L in the fasting state, to 2.31 mmol/L after breakfast, and 2.94 mmol/L after lunch.

The researchers also found that both postprandial triglyceride measures correlated significantly with fasting triglycerides. All volunteers who had fasting triglyceride levels below 1.5 mmol/L had postprandial triglyceride levels below 2.0 mmol/L.

In addition to being more convenient, allowing patients to have their lipids measured in a nonfasting state is preferable because after all, “atherosclerosis is a postprandial story,” the researchers wrote, referring to the fact that people are in a postprandial state at least 20 hours daily.

They noted that the U.S. National Heart, Lung, and Blood Institute’s Adult Treatment Panel III modified cholesterol guidelines allow the use of nonfasting measurements of total cholesterol and HDL to determine atherogenic cholesterol (total cholesterol minus HDL).

Lipid measures 2-4 hours after meals provide a better early predictor for cardiovascular disease than do fasting lipids, concluded the investigators, who advised therapeutic intervention whenever a patient has triglycerides higher than 2.0 mmol/L with elevated LDL and decreased HDL. Their suggested triglyceride treatment targets are fasting triglycerides lower than 1.0 mmol/L, or 2-4 hour postprandial triglycerides lower than 3.0 mmol/L.

Neither of the investigators disclosed relevant conflicts of interest.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

波士顿（EGMN）——根据一项前瞻性研究，非空腹血脂水平作为脂代谢异常的指标可能优于空腹血脂。

 

该研究结果表明，患者在抽血做血脂检测前无需拒吃一顿丰盛的早餐或午餐。

 

匈牙利赛克希费黑瓦尔市Szent György医院István Reiber 医生和 Dr. Izabella Mezõ医生在通过对102例非糖尿病患者（44位男性）比较空腹血脂与餐后血脂水平发现，在各项血脂指标中，仅空腹与非空腹甘油三酯水平之间的差异具有统计学意义。

 

众所周知，空腹与餐后的总胆固醇和高密度脂蛋白（HDL）胆固醇水平之间无显著差别。

 

另外，在由国际动脉粥样硬化学会主办的一次研讨会上，有研究者在一篇科学壁报中写道，其近期的研究结果显示，相对于空腹甘油三酯这一常规指标而言，血浆中的非空腹甘油三酯水平可更好地预测心血管事件。

 

研究中受试者均未接受过降脂药物治疗，分别在一整夜禁食、进食日常早餐后3h或日常午餐后3h抽取静脉血进行血脂检测。

 

总体而言，空腹状态下总胆固醇测定结果为5.51 mmol/L，与早餐后5.48 mmol/L和午餐后5.69 mmol/L相比，无显著差异。

 

空腹HDL水平与餐后水平相当，分别为1.12 mmol/L，1.14 mmol/L (早餐后)及1.20 mmol/L (午餐后)。然而，进食后甘油三酯水平显著升高，由空腹状态下的2.21 mmol/L升至2.31 mmol/L(早餐后)和2.94 mmol/L（午餐后）。

 

研究人员还发现，两项餐后甘油三酯指标与空腹甘油三酯之间均呈显著相关性。所有空腹甘油三酯水平低于1.5 mmol/L的自愿受试者餐后甘油三酯水平均低于2.0mmol/L。

 

研究者写道，除检测更为方便外，允许患者在非空腹状态下测定血脂也是一种较优的选择，原因在于毕竟“动脉粥样硬化是餐后发生的事”，研究者写道。 此说法是基于人们每天有至少20h处于餐后状态这一事实而言。

 

他们注意到，美国国家心、肺及血液研究所成人治疗计划III对胆固醇指南进行了修改，允许将总胆固醇和HDL的非空腹测定值用于确定致动脉粥样硬化的胆固醇水平（总胆固醇减去HDL）。

 

研究者推断，餐后2~4h的血脂水平作为心血管疾病早期预测因子优于空腹血脂水平。该研究者建议，无论患者何时出现甘油三酯水平高于2.0 mmol/L伴LDL水平升高和HDL水平下降，均对其进行干预治疗。他们提出的甘油三酯治疗目标为空腹甘油三酯水平低于1.0 mmol/L，或餐后2~4h甘油三酯水平低于3.0 mmol/L。

 

所有研究者宣称均无相关的利益冲突。

 

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