Diabetes Mellitus Department, Tzanio General Hospital, Athens, Greece.
Internal Medicine Department, Kimi General Hospital, Kimi, Greece.
Curr Vasc Pharmacol. 2018;16(4):385-392. doi: 10.2174/1570161115666170529084621.
Enhanced postprandial lipaemia has been reported in patients with obesity, hypertension, metabolic syndrome and type 2 diabetes mellitus (T2DM). We compared 2 oral fat meal tests (LIPOLD: 149g of fat, 56g of carbohydrates and 11.7g of proteins administrated per 2m2 of body surface) and LIPOTEST: 75g of fat, 25g of carbohydrates and 10g of protein with the addition of 15g common sugar) with regard to changes in triglycerides (TGs) as well as other cardiometabolic parameters between baseline and 4 h after the meals.
We studied 21 men [median age (interquartile range; IQR) = 65 (16) years] with well-controlled T2DM [median glycated haemoglobin (HbA1c) (IQR) = 6.6 (0.9) %]. All participants performed the meals with 1 week interval between the 2 meals.
Median (IQR) TG differences in mg/dl were 86 (100) and 46 (60) for LIPOLD and LIPOTEST meals, respectively, whereas the % differences in TGs were 105 (105) and 48 (55), respectively. The differences (in mg/dl and %) between TGs before ingesting the test meal and after 4h were significant for both LIPOLD and LIPOTEST meals (p = 0.003 for mg/dl differences and p = 0.005 for % differences). Patients who had a positive response to the LIPOLD meal (i.e. TGs > 220 mg/dl at 4 h) also had increased postprandial TGs with LIPOTEST. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) correlated with TG differences (in mg/dl) following the LIPOLD meal consumption (Spearman's rho = (+) 0.527, p = 0.02). C-peptide correlated with TG differences (in mg/dl) following the LIPOTEST meal consumption (Spearman's rho = (+) 0.538, p = 0.032). There were no differences in TGs and glucose response postprandially in both testing meals according to body mass index (except for TGs between tertile 21.3-24.5 and 25-26.8 kg/m2, p=0.046, in LPOTEST group) and body surface area.
An oral fat tolerance test (OFTT), which contains 75g fat, and represents the everyday habits of Western societies, could provide additional information regarding the postprandial state of the individuals with well-controlled T2DM. The consumption of meals with very high fat content may lead to over diagnosing PPL. TG differences after the consumption of a high fat meal correlated with HOMA-IR. This may be useful to evaluate the role of HOMA-IR in T2DM patients. A standardized the OFTT will help clinicians to better define postprandial TG abnormalities, leading to more appropriate therapeutic options to improve postprandial dysmetabolism.
超重、高血压、代谢综合征和 2 型糖尿病（T2DM）患者的餐后血脂水平升高。我们比较了两种口服脂肪餐试验（LIPOLD：每 2m2 体表面积给予 149g 脂肪、56g 碳水化合物和 11.7g 蛋白质；LIPOTEST：给予 75g 脂肪、25g 碳水化合物和 10g 蛋白质，并添加 15g 普通糖）与餐后 4 小时内甘油三酯（TGs）以及其他心血管代谢参数的变化。
我们研究了 21 名血糖控制良好的 T2DM 男性患者[中位数（四分位距；IQR）年龄=65（16）岁]。所有参与者在一周的间隔内进行了两次膳食。
LIPOLD 和 LIPOTEST 餐的 TG 差异中位数（mg/dl）分别为 86（100）和 46（60），而 TG 的%差异分别为 105（105）和 48（55）。LIPOLD 和 LIPOTEST 餐在餐前和餐后 4 小时之间的 TG 差异（mg/dl 和%）均有统计学意义（mg/dl 差异 p=0.003，%差异 p=0.005）。对 LIPOLD 餐有阳性反应（即 4 小时 TG > 220mg/dl）的患者在接受 LIPOTEST 餐后 TG 也升高。稳态模型评估的胰岛素抵抗（HOMA-IR）与 LIPOLD 餐后 TG 差异（mg/dl）相关（Spearman's rho=（+）0.527，p=0.02）。C-肽与 LIPOTEST 餐后 TG 差异（mg/dl）相关（Spearman's rho=（+）0.538，p=0.032）。在两种测试餐中，根据体重指数（BMI）（除了 LPOTEST 组中 BMI 为 21.3-24.5 和 25-26.8kg/m2 时的 TG 差异，p=0.046）和体表面积，餐后 TG 和葡萄糖反应无差异。
含有 75g 脂肪的口服脂肪耐量试验（OFTT）可以提供有关血糖控制良好的 T2DM 患者餐后状态的额外信息。食用高脂肪含量的膳食可能会导致 PPL 的过度诊断。高脂肪餐后的 TG 差异与 HOMA-IR 相关。这可能有助于评估 HOMA-IR 在 T2DM 患者中的作用。标准化的 OFTT 将有助于临床医生更好地定义餐后 TG 异常，从而选择更合适的治疗方法来改善餐后代谢异常。
