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.
References
[1]
[1]Nordestgaard, B.G., Langsted, A., Mora, S., et al. (2016) Fasting Is Not Routinely Required for Determination of a Lipid Profile: Clinical and Laboratory Implications Including Flagging at Desirable Concentration Cut-Points—A Joint Consensus Statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal, 37, 1944-1958. https://doi.org/10.1093/eurheartj/ehw152
[2]
Langsted, A., Freiberg, J.J. and Nordestgaard, B.G. (2008) Fasting and Nonfasting Lipid Levels Influence of Normal Food Intake on Lipids, Lipoproteins, Apolipoproteins, and Cardiovascular Risk Prediction. Circulation, 118, 2047-2056. https://doi.org/10.1161/CIRCULATIONAHA.108.804146
[3]
Langsted, A., Freiberg, J.J. and Nordestgaard, B. (2008) Fasting and Non-Fasting Lipid Levels: Influence of Normal Food Intake on Lipids, Lipoproteins, Apolipoproteins, and Cardiovascular Risk Prediction. Circulation, 118, 2047-2056. https://doi.org/10.1161/CIRCULATIONAHA.108.804146
[4]
Langsted, A. and Nordestgaard, B.G. (2015) Nonfasting Lipid Profiles: The Way of the Future. Clinical Chemistry, 61, 1123-1125. https://doi.org/10.1373/clinchem.2015.243139
[5]
Mora, S., Rifai, N. and Buring, J.E. and Ridker, P. (2008) Fasting Compared with Nonfasting Lipids and Apolipoproteins for Predicting Incident Cardiovascular Events. Circulation, 118, 993-1001. https://doi.org/10.1161/CIRCULATIONAHA.108.777334
[6]
Langsted, A. and Nordestgaard, B. (2011) Nonfasting Lipids, Lipoproteins, and Apolipoproteins in Individuals with and without Diabetes: 58,434 Individuals from the Copenhagen General Population Study. Clinical Chemistry, 57, 482-489. https://doi.org/10.1373/clinchem.2010.157164
[7]
Nayor, M. and Vasan, R.S. (2016) Recent Update to the Us Cholesterol Treatment Guidelines: A Comparison with International Guidelines. Circulation, 133, 1795-1806. https://doi.org/10.1161/CIRCULATIONAHA.116.021407
[8]
Nordestgaard, B. (2017) A Test in Context: Lipid Profile, Fasting Versus Nonfasting. Journal of the American College of Cardiology, 70, 1637. https://doi.org/10.1016/j.jacc.2017.08.006
[9]
Yang, D., Cai, Q., Qi, X. and Zhou, Y. (2018) Postprandial Lipid Concentrations and Daytime Biological Variation of Lipids in a Healthy Chinese Population. Annals of Laboratory Medicine, 38, 431-439. https://doi.org/10.3343/alm.2018.38.5.431
[10]
Marcovina, S.M., Gaur, V.P. and Albers, J. (1994) Biological Variability of Cholesterol, Triglyceride, Low- and High-Density Lipoprotein Cholesterol, Lipoprotein (a), and Apolipoproteins A-I and B. Clinical Chemistry, 40, 574-578.
[11]
Nigam, P.K. (2011) Serum Lipid Profile: Fasting or Non-Fasting? Indian Journal of Clinical Biochemistry, 26, 96-97. https://doi.org/10.1007/s12291-010-0095-x
[12]
Jellinger, P.S., Handelsman, Y., Rosenblit, P.D., Bloomgarden, Z.T., Fonseca, V.A., Garber, A.J., et al. (2017) American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease. Endocrine Practice, 23, 1-87. http://journals.aace.com/doi/10.4158/EP171764.APPGL https://doi.org/10.4158/EP171764.APPGL
[13]
National Institute of Health (2001) NCEP Cholesterol Guidelines. [NCEP] National Cholesterol Education Program, 329, 925-929.
[14]
Bansal, S., Buring, J.E., Rifai, N., Mora, S. and Sacks, et al. (2007) Fasting Compared with Nonfasting Triglycerides and Risk of Cardiovascular Events in Women. JAMA, 298, 309-316. https://doi.org/10.1001/jama.298.3.309
[15]
Nordestgaard, B.G., Benn, M. and Schnohr, P. (2007) Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women. JAMA, 298, 299-308. https://doi.org/10.1001/jama.298.3.299
[16]
Farukhi, Z. and Mora, S. (2016) Re-Assessing the Role of Non-Fasting Lipids; A Change in Perspective. Annals of Translational Medicine, 4, 431-431. http://atm.amegroups.com/article/view/12394/12864 https://doi.org/10.21037/atm.2016.11.15
[17]
Driver, S.L., Martin, S.S., Gluckman, T.J., Clary, J.M., Blumenthal, R.S. and Stone, N.J. (2016) Fasting or Nonfasting Lipid Measurements It Depends on the Question. Journal of the American College of Cardiology, 67, 1227-1234. https://doi.org/10.1016/j.jacc.2015.12.047
[18]
Sniderman, A., Tremblay, A., Bergeron, J., et al. (2007) Diagnosis of Type III Hyperlipoproteinemia from Plasma Total Cholesterol, triglYceride, and Apolipoprotein B. Journal of Clinical Lipidology, 1, 256-263. https://doi.org/10.1016/j.jacl.2007.07.006
[19]
Blom, D.J. and O’Neill, F.H.M.A. (2005) Screening for Dysbetalipoproteinemia by Plasma Cholesterol and Apolipoprotein B Concentrations. Clinical Chemistry, 51, 904-907. https://doi.org/10.1373/clinchem.2004.047001
