Non-fasting Lipid Research Articles

Do nonfasting lipid levels differ significantly from fasting lipid levels?

Do nonfasting lipid levels differ significantly from fasting lipid levels?

Fasting or Non-fasting Lipids for Atherosclerotic Cardiovascular Disease Risk Assessment and Treatment?

Dyslipidemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD); however, lipid testing for risk assessment and treatment surveillance has been underutilized. Several factors likely account for this, including the common practice of measuring lipid levels in the fasting state, which often necessitates that patients return for an additional visit. In this review, we evaluate potential advantages and cautions associated with measuring lipids in the non-fasting state. There is similar performance with the use of either fasting or non-fasting total cholesterol and HDL cholesterol in ASCVD risk assessment. Observational studies demonstrate that in comparison to fasting levels, non-fasting triglycerides are approximately 20% higher on average, although the magnitude of difference is subject to substantial inter-patient variability. Higher triglycerides can lead to the under-estimation of low-density lipoprotein cholesterol (LDL-C) by approximately 10mg/dL or more when calculated using the Friedewald equation. This is especially clinically relevant at low LDL-C levels, although a novel validated algorithm for LDL-C estimation largely overcomes this limitation. Non-fasting lipid assessment is reasonable in many clinical circumstances given that ASCVD risk prediction is similar using fasting or non-fasting lipid values and because LDL-C can be accurately estimated using modern methods. Allowing the option for non-fasting lipid assessment can reduce a barrier to lipid testing and can facilitate a more convenient assessment of ASCVD risk with the ultimate potential effect of reducing the global burden of ASCVD. However, certain patients such as those with severe hypertriglyceridemias or high-risk patients being treated to low LDL-C levels may still need fasting lipid panels performed for precise diagnosis and to standardize therapeutic monitoring.

The utility of body mass index as an indicator for lipid abnormalities in non-fasting children.

Many studies have reported the association between body mass index (BMI) and fasting lipid profiles in children. However, little information exists about the screening of dyslipidemia in the non-fasted state. This study assessed whether BMI can predict non-fasting lipid abnormalities in children. Using gender-separated analysis, 3895 boys and 3866 girls (aged 11-12 years) were investigated. Total cholesterol (TC), triglyceride (TG) and HDL-cholesterol (HDL-C) were measured, and non-HDL-C (=TC-[HDL-C]) was calculated. A BMI z-score was employed as the weight status. Gender-specific 95th percentiles of TC, TG and non-HDL-C were defined as "elevated", with the 5th percentiles of HDL-C defined as "reduced". TG and non-HDL-C were positively, and HDL-C was negatively correlated with the BMI z-score in both genders. Both obese (2<BMI z-score) and overweight (1<BMI z-score≤2) were associated with the risks of elevated TG, non-HDL-C and reduced HDL-C. In both genders, a receiver operating characteristic curve demonstrated that the utility of predicting the above lipid abnormalities was moderate; the areas under the curve ranged from 0.60 to 0.70. The optimal cut-off for the BMI z-score for predicting elevated TG, non-HDL-C and reduced HDL-C were 0.52, 0.55 and 0.51 in boys and 0.34, 0.38 and 0.35 in girls, respectively. The BMI could be an indicator of abnormalities of non-fasting TG, non-HDL-C and HDL-C in both genders.

Fasting and Non-Fasting Lipid Profile among Health Care Workers at Teaching Hospital Batticaloa SriLanka

Requesting patients to come with long fasting state (12 - 14 hours) for lipid profile measurements are a major inconvenience. However, most blood tests, even glycemic management, can be done in a non-fasting state, for example by requesting an HbA1C. It is understandable that when we order lipid profile test, laboratories are very rigid on fasting (12 - 14 h) or refuse to do the test if fasting is not enough. To answer these delusions, we conducted a cross-sectional study among the health care workers at Teaching Hospital Batticaloa, SriLanka, after an overnight fast (12 - 14 hours) blood taken for lipid profile. Following weeks, we collected blood from the same healthcare workers, after breakfast (2 - 4 hours after meal). In this study, measurements of fasting lipid profile, including high-density lipoproteins (HDL), low-density lipoproteins (LDL), total cholesterol (TC), triglyceride (TG) and non-HDL significantly (p < 0.05) differ from non-fasting lipid profile measurement. The mean difference in lipid profile in fasting versus non-fasting among healthcare workers was 34.13 mg/dl for TG, -5.65 mg/dl for total TC, -1.94 mg/dl for HDL-cholesterol, 3.71 mg/dl for non-HDL and 12.3 mg/dl for LDL-cholesterol. This momentous change of different meanings does not play any significant role in cardiovascular risk assessment. However, a patient with a family history of the premature atherosclerotic cardiovascular disease (ASCVD), or familial hyperlipidemia, screening and follow-up should preferably be performed with fasting.

Comparison of fasting and non-fasting lipid profiles in a large cohort of patients presenting at a community hospital

ObjectiveTo compare the fasting and non-fasting lipid profile including ApoB in a cohort of patients from a community setting. Our purpose was to determine the proportion of results that could be explained by the known biological variation in the fasting state and to examine the additional impact of non-fasting on these same lipid parameters. Methods1093 adult outpatients with fasting lipid requests were recruited from February to September 2016 at the blood collection sites of the Moncton Hospital. Participants were asked to come back in the next 3–4days after having eaten a regular breakfast to have their blood drawn for a non-fasting lipid profile. Results91.6% of patients in this study had a change in total cholesterol that fell within the biological variation expected for this parameter. Similar results were seen for HDL-C (94.3%) non-HDL-C (88.8%) and ApoB (93.0%). A smaller number of patients fell within the biological variation expected for TG (78.8%) and LDL-C (74.6%). An average TG increase of 0.3mmol/L was observed in fed patients no matter the level of fasting TG. A gradual widening in the range of change in TG concentration was observed as fasting TG increased. Similar results were seen in diabetic patients. ConclusionOutside of LDL-C and TG, little changes were seen in lipid parameters in the postprandial state. A large part of these changes could be explained by the biological variation. We observed a gradual widening in the range of increase in TG for patients with higher fasting TG. Non-HDL-C and ApoB should be the treatment target of choice for patients in the non-fasting state.

Reference Intervals for Non-Fasting CVD Lipids and Inflammation Markers in Pregnant Indigenous Australian Women.

Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and provides some health services to pregnant Indigenous women. Three hundred and ninety-nine non-fasting samples provided by the study participants (206 pregnancies and 175 women) have been used to construct reference intervals for CVD biomarkers during this critical time. A pragmatic design was used, in that women were not excluded for the presence of chronic or acute health states. Percentile bands for non-linear relationships were constructed according to the methods of Wright and Royston (2008), using the xriml package in StataIC 13.1. Serum cholesterol, triglycerides, cystatin-C and alkaline phosphatase increased as gestational age progressed, with little change seen in high-sensitivity C-Reactive Protein and γ glutamyl transferase. Values provided in the reference intervals are consistent with findings from other research projects. These reference intervals will form a basis with which future CVD biomarkers for pregnant Indigenous Australian women can be compared.

Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need.

In August 2016, the National Heart, Lung, and Blood Institute convened a scientific forum with 18 investigators active in the field of population health disparities. The purpose was to discuss heart, lung, and sleep disorders in children and adolescents of American Indian/Alaska Native (AI/AN)

P636Risk of misclassification with a non-fasting lipid profile in secondary cardiovascular prevention

P636Risk of misclassification with a non-fasting lipid profile in secondary cardiovascular prevention

Risk of misclassification with a non-fasting lipid profile in secondary cardiovascular prevention

AimsRoutinely fasting is not necessary for measuring the lipid profile according to the latest European consensus. However, LDL-C tends to be lower in the non-fasting state with risk of misclassification. The extent of misclassification in secondary cardiovascular prevention with a non-fasting lipid profile was investigated. Methods and results329 patients on lipid lowering therapy for secondary cardiovascular prevention measured a fasting and non-fasting lipid profile. Cut-off values for LDL-C, non-HDL-C and apolipoprotein B were set at <1.8mmol/l, <2.6mmol/l and <0.8g/l, respectively. Study outcomes were net misclassification with non-fasting LDL-C (calculated using the Friedewald formula), direct LDL-C, non-HDL-C and apolipoprotein B. Net misclassification <10% was considered clinically irrelevant. Mean age was 68.3±8.5years and the majority were men (79%). Non-fasting measurements resulted in lower LDL-C (−0.2±0.4mmol/l, P<0.001), direct LDL-C (−0.1±0.2mmol/l, P=0.001), non-HDL-C (−0.1±0.4mmol/l, P=0.004) and apolipoprotein B (−0.02±0.10g/l, P=0.004). 36.0% of the patients reached a fasting LDL-C target of <1.8mmol/l with a significant net misclassification of 10.7% (95% CI 6.4–15.0%) in the non-fasting state. In the non-fasting state net misclassification with direct LDL-C was 5.7% (95% CI 2.1–9.2%), 4.0% (95% CI 1.0–7.4%) with non-HDL-C and 4.1% (95% CI 1.1–9.1%) with apolipoprotein B. ConclusionUse of non-fasting LDL-C as treatment target in secondary cardiovascular prevention resulted in significant misclassification with subsequent risk of undertreatment, whereas non-fasting direct LDL-C, non-HDL-C and apolipoprotein B are reliable parameters.

Comparision of non-fasting with fasting blood lipid testing in in-hospital patients

Objective To explore the feasibility of the application of non fasting blood lipid in the hospitalized population. Methods Self-control study was used. 608 patients(aged 20~86 years old) were enrolled from April 2015 to October 2016 in lipid center of FuWai hospital. Fasting sample and non-fasting sample(1~4 h after breakfast) were collected from every patient and lipid profile including TG (triglyceride), TC (total cholesterol), HDL-C (high density lipoprotein cholesterol) and LDL-C (low density lipoprotein cholesterol) were measured in clinical laboratory. The results of two tests were compared using the Wilcoxon signed-rank test. Results The differences between non-fasting and fasting lipid test were + 0.47 mmol/l (+ 30%) for TG, -0.03 mmol/l (-2.8%) for HDL-C, -0.09 mmol/l (-3%) for LDL-C and -0.24 mmol/l (-8.7%) for calculated LDL-C (P 4.5 mmol/L and the whole (0.07 vs. 0.09), but the level of non-fasting LDL-C using formula method wassignificantly different between TG> 4.5 mmol/L and the whole (0.66 Vs. 0.24), andthe drops were 34.9% vs. 8.7%. Conclusion Non-fasting lipid test could be an effective routine method for lipid evaluation in the hospitalized population.(Chin J Lab Med, 2017, 40: 431-435) Key words: Cardiovascular disease; Triglycerides; Blood chemical analysis

Pre-pregnancy weight status, early pregnancy lipid profile and blood pressure course during pregnancy: The ABCD study.

ObjectiveAlthough pre-pregnancy weight status and early pregnancy lipid profile are known to influence blood pressure course during pregnancy, little is known about how these two factors interact. The association between pre-pregnancy weight status and blood pressure course during pregnancy was assessed in the prospective ABCD study and the role (independent/mediating/moderating) of early pregnancy lipid profile in this association was determined.MethodsWe included 2500 normal weight (<25 kg/m2) and 600 overweight (≥25 kg/m2) women from the prospective ABCD-study with available measurements of non-fasting early pregnancy lipids [median (IQR): 13 (12–14) weeks of gestation] and blood pressure during pregnancy [mean (SD) = 10 (2.3)]. Lipids (triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B and free fatty acids) were divided into tertiles. Multilevel piecewise linear spline models were used to describe the course of systolic and diastolic blood pressure (SBP/DBP) in four time periods during gestation for overweight and normal weight women.ResultsBoth SBP (5.3 mmHg) and DBP (3.9 mmHg) were higher in overweight compared to normal weight women and this difference remained the same over all four time periods. The difference in SBP and DBP was not mediated or moderated by the lipid profile. Lipid profile had an independent positive effect on both SBP (range 1.3–2.2 mmHg) and DBP (0.8–1.1 mmHg), but did not change blood pressure course.ConclusionsBoth pre-pregnancy weight status and early pregnancy lipid profile independently increase blood pressure during pregnancy. Improving pre-pregnancy weight status and early pregnancy lipid profile might result in a healthier blood pressure course during pregnancy.

Abstract 08: Preterm Delivery and Maternal Cardiovascular Risk Factor Trajectories across the Life Course

Introduction: Preterm delivery (&lt;37 weeks) predicts 2 to 3-fold greater risk of cardiovascular disease in mothers. Development of subclinical cardiovascular risk in these women prior to and following pregnancy is not well understood. Hypothesis: Women who deliver preterm have an adverse cardiovascular health profile even prior to pregnancy. Methods: Linked data from the population-based, longitudinal HUNT study (1984-2008) and the Medical Birth Registry of Norway (1967-2012) yielded clinical measurements and pregnancy outcomes for 23,179 parous women. Women had up to 3 measurements of body mass index, waist circumference, blood pressure, non-fasting lipids and glucose, and high-sensitivity C-reactive protein (hs-CRP) during a follow-up period between 20 years before first birth to 41 years after first birth. We used mixed effects linear spline models, adjusting for age, pre-pregnancy smoking, education, and time since last meal, to compare risk factor trajectories for women with preterm versus term/postterm first births. Results: Women with a preterm first birth (n=1,402, 6%) had significantly higher triglyceride (Figure 1 A) and glucose levels prior to pregnancy. They also experienced steeper increases in systolic and diastolic blood pressure, non-HDL cholesterol, triglycerides, and hs-CRP from first birth to age 50 compared to women who delivered at term/post-term (Figure 1 A,B). Measures of adiposity were similar throughout the life course. Conclusions: These results are consistent with the hypothesis that preterm birth is an early marker of cardiometabolic impairment. A history of preterm birth may predict high cardiovascular risk well before the development of traditional risk factors.

COMPARISON OF THE NOVEL METHOD VERSUS THE FRIEDEWALD EQUATION IN ESTIMATING LOW-DENSITY LIPOPROTEIN-CHOLESTEROL BASED ON FASTING STATUS

Background: New recommendations favoring non-fasting lipid assessment may impact accuracy of low-density lipoprotein-cholesterol (LDL-C) estimation, especially at low levels. The novel method (LDL-CN) of LDL-C estimation, using a flexible 180-cell approach, may offer an advantage in non-fasting

Clinical application of non-fasting lipid parameters

Clinical application of non-fasting lipid parameters

Prenatal Docosahexaenoic Acid Supplementation Does Not Affect Nonfasting Serum Lipid and Glucose Concentrations of Offspring at 4 Years of Age in a Follow-Up of a Randomized Controlled Clinical Trial in Mexico

Docosahexaenoic acid (DHA) has regulatory effects on lipid and glucose metabolism. Differences in DHA availability during specific developmental windows may program metabolic changes. We investigated the effects of maternal DHA supplementation during pregnancy on the nonfasting serum lipid and glucose concentrations of offspring at 4 y of age. We used data from the Prenatal Omega-3 Fatty Acid Supplementation, Growth, and Development trial, a double-blind randomized controlled trial conducted in Mexico. Pregnant women were supplemented daily with 400 mg DHA or placebo from 18-22 wk of gestation to delivery. The primary outcomes of the trial were offspring growth and neurological development. Nonfasting blood samples were obtained from the offspring at 4 y of age. We analyzed serum total, HDL, non-HDL, and LDL cholesterol; the total-to-HDL cholesterol ratio; apolipoprotein B (apoB); triglycerides; glucose; and insulin as secondary outcomes and compared their concentrations between treatment groups. Data from 524 offspring were available. The women were compliant with the intervention based on pill counts and changes in cord blood and breast milk DHA concentrations. None of the between-group differences (DHA compared with placebo), adjusted for maternal height and time since last food intake, were significant (P range 0.27-0.83). Means (95% CIs) were as follows: total cholesterol (TC), 1.73 mg/dL (-2.63, 6.09 mg/dL); HDL cholesterol, 0.66 mg/dL (-1.07, 2.39 mg/dL); non-HDL cholesterol, 1.77 mg/dL (-1.83, 5.37 mg/dL); LDL cholesterol, 1.62 mg/dL (-2.21, 5.45 mg/dL); TC:HDL ratio, 0.01 (-0.09, 0.11); apoB, -0.15 mg/dL (-2.78, 2.48 mg/dL); triglycerides, 0.21 mg/dL (-10.93, 10.52 mg/dL); glucose, -0.67 mg/dL (-2.46, 1.11 mg/dL); and insulin, 0.62 μU/mL (-0.88, 2.11 μU/mL). Prenatal DHA supplementation does not affect nonfasting serum lipid and glucose concentrations of offspring at 4 y of age. This trial was registered at clinicaltrials.gov as NCT00646360.

Is it time to abandon fasting for routine lipid testing?

Yes. The time has come to change the way we think about fasting before routine lipid testing. We now have robust evidence supporting the routine use of nonfasting lipid testing. Fasting lipid testing is rarely needed, but may be considered for patients with very high triglycerides or before starting

Comparison between fasting and nonfasting lipid profile in patients receiving treatment with statin therapy

Objectives The aim of this study was to assess the effect of ordinary meal on the lipid profile of patients receiving statin therapy. Background The lipid profile is an essential investigation for the patient who comes to cardiology outpatient clinic. Numerous guidelines recommend sampling in the fasting state for cardiovascular risk assessment. Fasting for 12–14 h is not only cumbersome and unpleasant for patients, but may result in limited compliance to disease monitoring and treatment. Patients and methods This study was performed on 100 patients with dyslipidemia receiving statin therapy whose doses had not changed for 2 or more months (group I), and 100 patients with dyslipidemia not receiving statin therapy (group II). Lipid profile was determined for fasting and postprandial statuses. Results The lipid profile parameters in both groups in fasting and postprandial statuses were compared. In group I, the mean fasting serum triglyceride level was 176.21 mg/dl and mean postprandial serum triglyceride level was 213.49 mg/dl (P = 0.0001); the mean fasting low-density lipoprotein (LDL) level was 161.19 mg/dl and mean postprandial LDL was 159.25 mg/dl (P = 0.184). In group II, the mean fasting serum triglyceride level was 231.06 mg/dl and mean postprandial triglyceride level was 284.60 mg/dl (P = 0.005); the mean fasting LDL was 185.18 mg/dl and mean postprandial LDL was 181.32 mg/dl (P = 0.871). Conclusion Finally, from this study we found that there is no significant clinical difference between fasting and nonfasting levels of total cholesterol, high-density lipoprotein, and LDL. Thus, we can use the nonfasting tests to follow-up the dyslipidemic patients.

Noncommunicable disease in rural India: Are we seriously underestimating the risk? The Nallampatti noncommunicable disease study.

Aim:To assess the prevalence of noncommunicable diseases in a true rural farming population in South India and compare the data with the landmark contemporary Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.Methods:Local Ethics Committee approval and informed consent was obtained from all participants. Inclusion criteria were participants, aged ≥20 and ≤85 years, from Nallampatti, a classical farming village from Tamil Nadu state, India. All participants were administered a detailed questionnaire, had anthropometric measurements including height, weight, and waist circumference. Bloods were drawn for random blood glucose, glycated hemoglobin (HbA1c), nonfasting lipid profile, Cystatin C, uric acid, and hemoglobin. All participants had carotid intima-media thickness (CIMT) done by high-resolution B-mode carotid ultrasound.Results:More than 50% of the population had either diabetes or prediabetes based on HbA1c. Nearly, 40% of the population had hypertension with suboptimal control in those with known hypertension. Nearly, a third of the population had dyslipidemia, elevated cystatin C levels, and abnormal CIMT. The burden was higher than the comparable ICMR-INDIAB study in rural Tamil Nadu.Conclusion:One-third to one-half of this rural farming population is at risk of cardiovascular disease, with poor control of preexisting cardiovascular risk factors. Current Indian data may underestimate the risk in different ethnic populations and regions of India. Long-term follow-up of this cohort for the incident cardiovascular disease will shed light on the true cardiovascular risk in a typical South Indian rural farming population.

Impaired ApoB-Lipoprotein and Triglyceride Metabolism in Obese Adolescents With Polycystic Ovary Syndrome.

Adolescents with polycystic ovary syndrome (PCOS) have atherogenic dyslipidemia and increased cardiovascular disease (CVD) risk, and this is exacerbated in obesity. To determine and compare fasting and nonfasting lipid and apolipoprotein (Apo)B-lipoprotein metabolism in 3 groups of adolescent girls: healthy-weight controls, obese without PCOS (obese-control), and obese with PCOS (obese-PCOS). Participants aged 12 to 17 years were recruited for this cross-sectional study from a pediatric weight management clinic and the local community in Alberta, Canada. Plasma lipids and ApoB lipoproteins, including triglycerides (TGs) and ApoB100- and ApoB48-lipoproteins, were measured in the fasted and postprandial state following a high-fat meal. Obese-control (n = 12) and obese-PCOS (n = 18) groups had twofold higher concentrations of fasting plasma TG and ApoB100- and ApoB48-lipoprotein remnants compared to healthy-weight controls (n = 10) (ApoB48-lipoproteins: 19.32 ± 2.10, 24.02 ± 4.28, and 8.95 ± 1.05 μg/mL, respectively; P < 0.001). The obese-PCOS group had 50% higher fasting plasma TG level compared to the obese-control group. The postprandial response was higher in both obese-controls and obese-PCOS subjects compared with healthy-weight controls in plasma TG area under the curve (AUC) (1028.0 ± 83.67, 1587.01 ± 259.6, and 615.42 ± 76.42 μg/mL⋅h, respectively; P < 0.01) and ApoB48(AUC) (191.30 ± 19.06, 238.8 ± 37.73, and 96.58 ± 9.17 μg/mL⋅h, respectively; P < 0.0001). Nonfasting plasma TG(AUC) and ApoB48(AUC) were positively correlated with free testosterone (r = 0.38; P < 0.001 and r = 0.33; P < 0.05, respectively), and these relationships were highly associated with insulin and body mass index. Adolescent girls with obesity and PCOS have elevated fasting and postprandial plasma TG and ApoB-lipoprotein remnants, providing evidence of early subclinical CVD risk, and these indices are highly associated with impaired insulin metabolism and hyperandrogenemia.

Proportion of adults fasting for lipid testing relative to guideline changes in Alberta

BackgroundGuidelines have historically recommended measuring lipid profile tests in a fasting state. However, in April 2011 and 2014, the Canadian city of Calgary and its province of Alberta, respectively, have changed their lipid guidelines to allow testing for individuals in any fasting state; several years prior to the release of the 2016 Canadian Cardiovascular Society and Hypertension Canada guidelines. The purpose of this study was to document the proportion of individuals in Calgary who fasted for a lipid encounter in relation to the change in various guidelines and policies. MethodsCounts were collected each month per gender from January 1, 2010 to June 30, 2016 for community-based adults ≥18years old who fasted (≥8h) or did not fast (<8h) for a lipid encounter. ResultsDuring the study period, 793,719 community-based lipid profiles were performed, 590,174 in a fasting state. The proportion of adults who fasted declined from 98.59%±0.379% (mean±SD) in 2010 to 41.65%±1.295% (mean±SD) in 2016. However, a marked decline in the proportion of adults fasting for a lipid encounter was not observed until February 2015, which coincided with the release of Alberta's Toward Optimized Practice Clinical Practice Guidelines. ConclusionThis documentation of individuals fasting for a lipid encounter may assist other jurisdictions in Canada with the new nonfasting lipid guideline changes. We recommend releasing provincial clinical practice guidelines, in addition to laboratory bulletins and continuing medical education presentations, regarding the new nonfasting lipid recommendations in other jurisdictions to ensure community patients are aware of this change.