Who would benefit most from postprandial lipid screening?

Background & aims: Individuals with fasting triglycerides (TG) <150 mg/dL can experience a deleterious postprandial TG response 220 mg/dL to a high-fat meal (HFM). The purpose of this study was to identify individuals based on fasting TG that would benefit most from additional postprandial screening. Methods: We conducted a secondary analysis of 7 studies from our laboratories featuring 156 diseasefree participants (64 M, 92 F; age 18e70 years; BMI 18.5e30 kg/m2). Participants observed a 10e12 h overnight fast, after which they consumed an HFM (10e13 kcal/kg body mass; 61e64% kcal from fat). Two methods were used to identify lower and upper fasting TG cut points. Method 1 identified the lower limit as the TG concentration at which 90% of individuals presented peak postprandial TG (PPTG) <220 mg/dL and the upper limit as the concentration which 90% of individuals presented PPTG 220 mg/dL. Method 2 utilized receiver operating characteristic (ROC) curves and identified the lower limit as the fasting TG concentration where sensitivity was z95% and the upper limit as the concentration at which specificity was z95%. Results: In Method 1, 90% of individuals with fasting TG >130 mg/dL (>1.50 mmol/L) exhibited PPTG 220 mg/dL ( 2.50 mmol/L), while 100% of individuals with fasting TG <66 mg/dL (0.75 mmol/L) had PPTG that did not exceed 220 mg/dL (2.50 mmol/L). In Method 2, when sensitivity was z95%, the corresponding fasting TG concentration was 70 mg/dL (0.79 mmol/L). When specificity was z95%, the corresponding fasting TG concentration was 114 mg/dL (1.29 mmol/L). Based on methods 1 and 2, there was a moderate positive association (r ¼ 0.37, p < 0.004) between fasting and PPTG for individuals with fasting TG between 70 and 130 mg/dL (0.79e1.50 mmol/L), in which 24% exhibited PPTG 220 mg/dL ( 2.50 mmol/L) while 76% did not. Conclusions: Postprandial TG testing is likely most useful for individuals with fasting TG concentrations between 70 and 130 mg/dL (0.79e1.50 mmol/L). Outside of this range, postprandial TG responses are largely predictable. Establishing a specific patient group for which postprandial TG testing is most useful may lead to earlier risk detection in these individuals.