Xie Yingying, Guo Liling, Chen Hao, Xu Jin, Qu Peiliu, Zhu Liyuan, Tan Yangrong, Zhang Miao, Wen Tie, Liu Ling
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China.
Front Nutr. 2023 Mar 2;10:1037270. doi: 10.3389/fnut.2023.1037270. eCollection 2023.
According to the 2021 consensus statement about triglyceride (TG)-rich lipoproteins and their remnants from the European Atherosclerosis Society (EAS), fasting TG level < 1.2 mmol/L is regarded as optimal, otherwise considered as non-optimal TG (NoTG). However, the postprandial cut-off value after a daily meal corresponding to a fasting TG level of 1.2 mmol/L has not been explored.
Six hundred and eighteen inpatients aged 18 to 70 were recruited in this study. Among them, 219 subjects had fasting TG levels < 1.2 mmol/L (i.e., OTG group), and 399 subjects had fasting TG levels ≥ 1.2 mmol/L (i.e., NoTG group). Serum levels of blood lipids, including calculated non-high-density lipoprotein cholesterol (non-HDL-C) and remnant cholesterol (RC), were monitored at 0, 2, and 4 h after a daily Chinese breakfast according to their dietary habits. Receiver operating characteristic (ROC) curve analysis was used to determine the postprandial cut-off value corresponding to the fasting TG level of 1.2 mmol/L. Kappa statistics were performed to determine the consistency between fasting and postprandial cut-off values in determining whether TG was optimal. Univariate and multivariate logistic regression analyses were conducted to evaluate the associations between NoTG and potential confounders. Subgroup analyses were performed to explore the association between postprandial TG levels at 4h (pTG4h) and NoTG in greater detail.
Postprandial levels of TG and RC significantly elevated and peaked at 4h after a daily breakfast in two groups ( < 0.05). The optimal cut-off value at 4h corresponding to fasting TG of 1.2 mmol/L was 1.56 mmol/L. According to the fasting cut-off value, the percentage of patients with NoTG was 64.6% in the fasting state while increasing obviously to 73.3-78.4% at 2 and 4h, respectively, after a daily Chinese breakfast. According to the postprandial cut-off value, the percentage of patients with NoTG at 4h after a daily Chinese breakfast was 62.6% which was close to 64.6% in the fasting state. The Kappa coefficient was 0.551, indicating a moderate consistency between the fasting and postprandial cut-off values in the diagnosis of NoTG. Moreover, the subjects with NoTG determined by the postprandial TG cut-off value had an obviously higher postprandial level of RC (1.2 vs. 0.8 mmol/L) and percentage of HRC (37.1 vs. 32.1%) than those determined by the fasting TG cut-off value. Multivariate logistic regression analyses demonstrated that except for BMI, pTG4h emerged as an independent predictor of not. Subgroup analyses revealed that the association between pTG4h and NoTG was consistent across subgroups.
Taken together, we for the first time determined TG 1.56 mmol/L as the postprandial cut-off value corresponding to fasting TG 1.2 mmol/L in Chinese subjects. This could make it more convenient to determine whether TG is optimal or not in the fasting or postprandial state.
根据欧洲动脉粥样硬化学会（EAS）2021年关于富含甘油三酯（TG）的脂蛋白及其残粒的共识声明，空腹TG水平<1.2 mmol/L被视为最佳水平，否则被视为非最佳TG（NoTG）。然而，尚未探讨与空腹TG水平1.2 mmol/L相对应的每日餐后餐后临界值。
本研究招募了618名年龄在18至70岁之间的住院患者。其中，219名受试者的空腹TG水平<1.2 mmol/L（即OTG组），399名受试者的空腹TG水平≥1.2 mmol/L（即NoTG组）。根据他们的饮食习惯，在每日中餐早餐后0、2和4小时监测血脂水平，包括计算得出的非高密度脂蛋白胆固醇（non-HDL-C）和残粒胆固醇（RC）。采用受试者工作特征（ROC）曲线分析来确定与空腹TG水平1.2 mmol/L相对应的餐后临界值。进行Kappa统计以确定空腹和餐后临界值在确定TG是否最佳方面的一致性。进行单因素和多因素逻辑回归分析以评估NoTG与潜在混杂因素之间的关联。进行亚组分析以更详细地探讨4小时餐后TG水平（pTG4h）与NoTG之间的关联。
两组患者每日早餐后TG和RC的餐后水平均显著升高，并在4小时达到峰值（<0.05）。与空腹TG 1.2 mmol/L相对应的4小时最佳临界值为1.56 mmol/L。根据空腹临界值，空腹状态下NoTG患者的百分比为64.6%，而在每日中餐早餐后2小时和4小时分别明显增加至73.3% - 78.4%。根据餐后临界值，每日中餐早餐后4小时NoTG患者的百分比为62.6%，接近空腹状态下的64.6%。Kappa系数为0.551，表明空腹和餐后临界值在NoTG诊断中具有中等一致性。此外，通过餐后TG临界值确定为NoTG的受试者的餐后RC水平（1.2 vs. 0.8 mmol/L）和HRC百分比（37.1 vs. 32.1%）明显高于通过空腹TG临界值确定的受试者。多因素逻辑回归分析表明，除BMI外，pTG4h是not的独立预测因素。亚组分析显示，pTG4h与NoTG之间的关联在各亚组中是一致的。
综上所述，我们首次确定TG 1.56 mmol/L为中国受试者中与空腹TG 1.2 mmol/L相对应的餐后临界值。这可以使在空腹或餐后状态下更方便地确定TG是否最佳。
