A Standardized Triglyceride and Carbohydrate Challenge

Abstract

OBJECTIVE -A standardized method of assessing postprandial triglyceride changes is not available. We evaluated an oral triglyceride tolerance test (OTTT) designed for routine clinical and research use. RESEARCH DESIGN AND METHODS-A 200-ml strawberry-flavored test drink (50 g fat, 50 g carbohydrate) was administered twice to 30 diabetic and 20 nondiabetic subjects. Venous plasma triglyceride and glucose levels were measured when fasting and every 2 h for 8 h after the drink. Fingerprick plasma triglyceride levels were measured when fasting and at 6 and 8 h after the drink.RESULTS -The drink was consumed within 3 min and well tolerated by all subjects. The median triglyceride rise at 6 h was similar in diabetic and nondiabetic subjects (0.23 vs. 0.42 mmol/l, NS) and correlated with glucose increase at 2 h (r ϭ 0.429, P ϭ 0.018 and r ϭ 0.509, P ϭ 0.026; respectively). Diabetic subjects had higher 6-h geometric mean (1 SD range) triglyceride levels (1. CONCLUSIONS -The OTTT permits simple evaluation of postchallenge triglyceride levels, is acceptable to subjects, and can be performed with capillary sampling. It could be used to monitor triglyceride-lowering therapies and to provide additional information concerning cardiovascular disease risk, particularly in diabetic subjects. Diabetes Care 27:89 -94, 2004P eople with type 2 diabetes have a two-to fourfold increased risk of coronary heart disease (CHD) compared with the general population (1) that is only partly explained by the addition of hyperglycemia to traditional CHD risk factors (2). In diabetes, a mixed fasting dyslipidemia is common, characterized by an increased LDL-to-HDL cholesterol ratio, an increase in small dense LDL particles, and elevated triglyceride levels (3). Although fasting triglyceride levels may be an independent risk factor for CHD (4), their exact contribution remains uncertain because of displacement in most analyses by HDL cholesterol (2). This has led some authors to suggest that part of the excess CHD risk seen in type 2 diabetes may related more to postprandial rather than fasting triglyceride levels (5).In the absence of a standardized triglyceride challenge, studies to date have used a variety of different test meals consisting of "everyday" foods such as dairy products, bacon, margarine, and eggs or liquid formulations. These have contained various amounts of fat (33-66%; up to 110 g), carbohydrate (14 -43%; up to 75 g), and protein (16 -20%; up to 46 g) and, occasionally, have had vitamin A added (6 -11). To facilitate routine triglyceride tolerance assessment, we have formulated an easily produced and palatable 200-ml test drink. This oral triglyceride tolerance test (OTTT) has been evaluated in subjects with and without type 2 diabetes. In addition, the possibility of using capillary fingerprick samples as a simple alternative to venepuncture for use in the community or in large-scale studies has been investigated. RESEARCH DESIGN AND METHODS -The study was approved by the Central Oxford Research Ethics Committee (COREC). A tot...

Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women

“…37 If postprandial triglycerides are biologically active in atherogenesis, measurement of fasting levels may provide an inadequate representation of vascular risk. In addition, despite the known strong correlation between fasting and postprandial levels of triglycerides, 29,32,38 our data suggest that postprandial levels are a more robust indicator of cardiovascular risk, perhaps because the greater variability of postprandial levels captures important information about an individual's metabolism. At a practical level, the use of nonfasting triglyceride levels and the availability of assays to directly measure LDL-C levels could allow patients to have blood for a lipid profile drawn without the need to return to the laboratory after an overnight fast.…”

Hypertriglyceridämie: prognostische Bedeutung und Therapiemöglichkeiten

“…Der postprandiale Triglyceridanstieg nach einer definierten Fett-Belastung wurde in vielen Studien dokumentiert. Dennoch liegt bisher kein standardisierter oraler Triglycerid-Toleranztest vor, der an einem größeren Kollektiv und hinsichtlich klinischer Ereignisse evaluiert wurde [32,46,67]. Laufende Studien testen daher den prognostischen Stellenwert des individuellen prostprandialen Triglyceridanstiegs.…”

Peripheral blood mononuclear cell gene expression and plasma protein profiles are differentially affected by glucose and lipid tolerance tests

“…This study addressed the hypothesis that the PBMC transcriptomic signature and the associated metabolic phenotype would be differentially regulated by lipid v. carbohydrate nutritional challenges (2) . An oral lipid tolerance test (OLTT) and a glucose tolerance test (OGTT) were completed in a 'lean' cohort of ten individuals selected from a representative sample of 200 healthy Irish adults aged 18-60 years (age: 24.6 SD 3.84 years, BMI: 24.5 SD 2.2 kg.m 2 ).…”

“…This study addressed the hypothesis that the PBMC transcriptomic signature and the associated metabolic phenotype would be differentially regulated by lipid v . carbohydrate nutritional challenges ( 2 ) .…”