Chemistry profiles in "wellness programs": test selection and participant outcomes.

Abstract

Insurers, employers, and individuals create demands for laboratory testing in "wellness programs." Tests chosen to identify cases deserving intervention included routine automated chemical tests plus high-density lipoprotein cholesterol, ferritin, and thyroid tests. Participants' unwarranted concerns were addressed with a personalized reporting schema. We tested 1338 individuals, identified 224 (16.7%) with significant abnormalities, and made phone contact follow-up with 193 (86%) of these six to 14 months later. Cholesterol results suggesting increased risk of heart disease were frequent, and were not studied. Interventions were initiated in 55 of the 193 followup cases (49 by physician and six by participants), including prescription of iron or thyroid hormone, counseling on dietary or alcohol intake, and repeat testing. For 58, there was medical advice without intervention; abnormal results were ignored by 79. Noteworthy participant anxiety was manifested in two of the 193 cases, both of whom were treated with iron. We conclude that 4% of the original 1338 participants potentially benefitted from intervention. Ferritin and thyroid tests initiated 33 (61%) of these 55 specific therapeutic interventions.

Low LDL-C and High HDL-C Levels Are Associated with Elevated Serum Transaminases amongst Adults in the United States: A Cross-sectional Study

“…Because males and females differ in both serum transaminases and lipid profiles [31] , we performed sub-group analyses comparing the associations between males and females. In general, the odds ratios in males tended to be larger than those in females at both low LDL-C (LDL-C ≤40, 41–70 mg/dL) and high HDL-C (HDL-C >100 mg/dL), but none of the gender differences reached statistical significance in formal tests of interaction (data not shown).…”

“…Similarly, female transaminase levels are generally lower than males [31] , so we performed a sensitivity analysis using a gender-specific ALT cutoff (47 U/L for male, 30 U/L for female) and AST cutoff of 33 U/L, the thresholds NHANES recommends [27] . An LDL-C less than 40 mg/dL was associated with an odds ratio of 3.3 (95% CI 1.9–5.8, p<0.001) for abnormal liver enzymes, although LDL-C between 41 and 70 mg/dL was not (adjusted odds ratio 1.2; 95% CI 0.8–1.8, p = 0.3).…”