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10
| 3 | 2009
Klinisk Biokemi i Norden
Despite the fact that most humans throughout the
entire day find themselves in the nonfasting or post-
prandial state, plasma lipids, lipoproteins, and apoli-
poproteins for cardiovascular risk prediction are usu-
ally measured in the fasting state (1-3). A main reason
for this is the increase in triglyceride levels seen
during a fat tolerance test, where patients typically
eat or drink 1g fat per kg body weight (4-6). However,
levels of lipids, lipoproteins, and apolipoproteins after
normal food intake only differ minimally from levels
in the fasting state (7-8), most likely because most
people during ordinary meals eat much less fat than
during a fat tolerance test. Furthermore, levels meas-
ured in the nonfasting state may be as good as levels
measured in the fasting state for cardiovascular risk
prediction (7-8). In fact, elevated levels of nonfasting
triglycerides as a marker of elevated remnant lipo-
protein cholesterol may even be better at predicting
elevated risk of cardiovascular disease than fasting
levels (9-11), possibly because atherogenesis partly is
a postprandial phenomenon (12).
In the context of previous knowledge, we review
recent developments in the importance of nonfas-
ting or postprandial hypertriglyceridemia for the
development of cardiovascular disease. We use the
words nonfasting and postprandial synonymously;
however, a nonfasting sample often implies a sample
taken at any time in relation to previous meals while
a postprandial sample can imply a sample taken at a
fixed time after a standard meal, such as after an oral
fat tolerance test (4-6).
Fasting and nonfasting triglyceride levels
In a cross-sectional sample of 10,300 individuals
from the Danish general population, the Copenhagen
General Population Study, plasma triglycerides
increased already 1 hour after the last meal and
stayed elevated for up to 7 hours (Figure 1)(9). In an
even larger sample from the same general population
Nonfasting triglycerides, remnant lipoproteins,
and cardiovascular disease
Anne Tybjærg-Hansen and Børge G. Nordestgaard
Departments of Clinical Biochemistry, Rigshospitalet and Herlev Hospital, Copenhagen
at-h@rh.regionh.dk
Figure 1.
Triglyceride levels and levels of remnant lipoprotein
cholesterol as a function of time since the last meal. Values
are means and 95% confidence intervals for participants in
the Copenhagen General Population Study. Modified from
Nordestgaard et al. JAMA 2007; 298: 299-308.
