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Lipids in Health and Disease Sep 2017One of the limitations for ranking foods and meals for healthiness on the basis of the glycaemic index (GI) is that the GI is subject to manipulation by addition of fat.... (Review)
Review
One of the limitations for ranking foods and meals for healthiness on the basis of the glycaemic index (GI) is that the GI is subject to manipulation by addition of fat. Postprandial lipemia, defined as a rise in circulating triglyceride containing lipoproteins following consumption of a meal, has been recognised as a risk factor for the development of cardiovascular disease and other chronic diseases. Many non-modifiable factors (pathological conditions, genetic background, age, sex and menopausal status) and life-style factors (physical activity, smoking, alcohol and medication use, dietary choices) may modulate postprandial lipemia. The structure and the composition of a food or a meal consumed also plays an important role in the rate of postprandial appearance and clearance of triglycerides in the blood. However, a major difficulty in grading foods, meals and diets according to their potential to elevate postprandial triglyceride levels has been the lack of a standardised marker that takes into consideration both the general characteristics of the food and the food's fat composition and quantity. The release rate of lipids from the food matrix during digestion also has an important role in determining the postprandial lipemic effects of a food product. This article reviews the factors that have been shown to influence postprandial lipemia with a view to develop a novel index for ranking foods according to their healthiness. This index should take into consideration not only the glycaemic but also lipemic responses.
Topics: Aging; Animals; Blood Pressure; Exercise; Fatty Acids; Female; Food; Humans; Hyperlipidemias; Insulin Resistance; Lipids; Male; Menopause; Nutrigenomics; Obesity; Postprandial Period; Smoking; Triglycerides
PubMed: 28923057
DOI: 10.1186/s12944-017-0568-5 -
Advances in Laboratory Medicine Apr 2023Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical...
Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested.
PubMed: 37359904
DOI: 10.1515/almed-2023-0003 -
Biochemia Medica 2014In the clinical laboratory setting, interferences can be a significant source of laboratory errors with potential to cause serious harm for the patient. After hemolysis,... (Review)
Review
In the clinical laboratory setting, interferences can be a significant source of laboratory errors with potential to cause serious harm for the patient. After hemolysis, lipemia is the most frequent endogenous interference that can influence results of various laboratory methods by several mechanisms. The most common preanalytical cause of lipemic samples is inadequate time of blood sampling after the meal or parenteral administration of synthetic lipid emulsions. Although the best way of detecting the degree of lipemia is measuring lipemic index on analytical platforms, laboratory experts should be aware of its problems, like false positive results and lack of standardization between manufacturers. Unlike for other interferences, lipemia can be removed and measurement can be done in a clear sample. However, a protocol for removing lipids from the sample has to be chosen carefully, since it is dependent on the analytes that have to be determined. Investigation of lipemia interference is an obligation of manufacturers of laboratory reagents; however, several literature findings report lack of verification of the declared data. Moreover, the acceptance criteria currently used by the most manufacturers are not based on biological variation and need to be revised. Written procedures for detection of lipemia, removing lipemia interference and reporting results from lipemic samples should be available to laboratory staff in order to standardize the procedure, reduce errors and increase patient safety.
Topics: Blood Chemical Analysis; Diagnostic Errors; Hemolysis; Humans; Hyperlipidemias; Lipids
PubMed: 24627715
DOI: 10.11613/BM.2014.008 -
The British Journal of Nutrition Nov 2016Research points to postprandial glucose and TAG measures as preferable assessments of cardiovascular risk as compared with fasting values. Although elevated postprandial... (Comparative Study)
Comparative Study Review
Research points to postprandial glucose and TAG measures as preferable assessments of cardiovascular risk as compared with fasting values. Although elevated postprandial glycaemic and lipaemic responses are thought to substantially increase chronic disease risk, postprandial glycaemia and lipaemia have historically only been considered separately. However, carbohydrates and fats can generally 'compete' for clearance from the stomach, small intestine, bloodstream and within the peripheral cell. Further, there are previous data demonstrating that the addition of carbohydrate to a high-fat meal blunts the postprandial lipaemic response, and the addition of fat to a high-carbohydrate meal blunts the postprandial glycaemic response. Thus, postprandial glycaemia and lipaemia are interrelated. The purpose of this brief review is 2-fold: first, to review the current evidence implicating postprandial glycaemia and lipaemia in chronic disease risk, and, second, to examine the possible utility of a single postprandial glycaemic and lipaemic summative value, which will be referred to as the metabolic load index. The potential benefits of the metabolic load index extend to the clinician, patient and researcher.
Topics: Algorithms; Biomarkers; Blood Glucose; Cardiovascular Diseases; Early Diagnosis; Energy Metabolism; Evidence-Based Medicine; Glycated Hemoglobin; Humans; Hyperglycemia; Hyperlipidemias; Hypertriglyceridemia; Models, Cardiovascular; Postprandial Period; Risk Factors; Triglycerides
PubMed: 27774915
DOI: 10.1017/S0007114516003585 -
Frontiers in Nutrition 2022Due to the frequency of meal ingestion, individuals spend the majority of the day, ~18 h, in a status of post-prandial (PP) stress. Remnant-like lipoprotein particles...
BACKGROUND AND OBJECTIVE
Due to the frequency of meal ingestion, individuals spend the majority of the day, ~18 h, in a status of post-prandial (PP) stress. Remnant-like lipoprotein particles (RLPs) are predominant in PP phase playing an important role in the development of atherosclerosis. Endothelial progenitor cells (EPCs) have been suggested to play a role in vessel wall homeostasis and in reducing atherosclerosis. However, there is no information about peripheral blood EPCs number following PP stress. We investigated the association between circulating EPCs levels and extent of PP lipemia in healthy subjects following a high-fat meal.
MATERIALS AND METHODS
A total of 84 healthy subjects (42 men, 42 women) aged 17-55 years were included in the study. PP lipemic response of subjects was determined by Oral Fat-Loading Test (OFLT). All the subjects were classified on the basis of their plasma TG levels after PP lipemic stressors in categories 1 (low), 2 (moderate), and 3 (high). Circulating EPCs numbers were measured by the flow cytometry method.
RESULTS
There was a significant difference in terms of lipid parameters between men and women: high-density lipoprotein cholesterol (HDL-C) was significantly lower in men than in women ( < 0.001). Total cholesterol (TC) ( = 0.004), low-density lipoprotein cholesterol (LDL-C) ( < 0.001), triglyceride (TG) ( < 0.001), and TG-AUC ( < 0.001) were significantly higher in men than in women. There was no significant difference between the genders in terms of CD34KDR and CD34KDRCD133cell number and MMP-9 levels. Vascular endothelial growth factor (VEGF) levels were significantly higher in men than women ( = 0.004). TC, LDL-C, and TG were significantly higher in the 3rd category than 1st and 2nd categories ( < 0.001) in women. Age, body mass index (BMI), fat rate, TG, TC, and LDL-C were significantly higher in the 3rd category than 1st category ( < 0.001, = 0.002, = 0.002, = 0.01, = 0.007, = 0.004; respectively), in men. Circulating numbers of EPCs in men were significantly higher in the PP hyperlipidemia group than in the low TG levels category, independently from age ( < 0.05). Circulating EPC levels showed a positive correlation with OFLT response in men ( = 0.414, < 0.05). Also, OFLT response showed a strong positive correlation with fasting TG levels ( = 0.930, < 0.001). EPC levels in categories of women were not different.
CONCLUSION
Increased EPCs levels in subjects with different PP hyperlipidemia may be associated with a response to endothelial injury, related to increased atherogenic remnant particles at the PP phase.
PubMed: 35237643
DOI: 10.3389/fnut.2022.822131 -
Turkish Journal of Emergency Medicine 2023Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study...
OBJECTIVE
Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG.
METHODS
This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded.
RESULTS
Forty-seven patients were included in the study. The level of triglyceride decreases at the 24 h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis ( = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703-0.940]; < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL.
CONCLUSION
Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.
PubMed: 37169033
DOI: 10.4103/tjem.tjem_276_22 -
Biochemia Medica Feb 2023In order to deliver high quality results, detection and elimination of possible analytical interferences, such as lipaemia, is crucial. The aim of this study is to...
INTRODUCTION
In order to deliver high quality results, detection and elimination of possible analytical interferences, such as lipaemia, is crucial. The aim of this study is to evaluate the efficacy of high-speed centrifugation in eliminating lipaemic interference and to define own lipaemic index (LI) for the studied biochemical analytes.
MATERIALS AND METHODS
Evaluated analytes were: albumin, alkaline phosphatase, alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), calcium, creatinine, gamma-glutamyltransferase (GGT), glucose, phosphates, total proteins, urea and total bilirubin. Those analytes and LIs have been analysed in duplicate in the Roche Diagnostics-c8000 analyser in samples centrifuged at 3000 rpm/10 minutes in the SL16 (Thermo Scientific, Waltham, USA) centrifuge and according to an own high-speed centrifugation protocol (12,900 rpm/15 minutes) in the MicroCL17R (Thermo Scientific, Waltham, USA) centrifuge. Lipaemia has been measured in each sample. The efficiency of high-speed centrifugation is verified by the Wilcoxon test (P < 0.05). In cases where significant differences are observed, our own LI is calculated. For ALT and AST, it is verified by McNemar test (P < 0.05. For creatinine, both Wilcoxon and McNemar test were applied.
RESULTS
There were statistically significant differences in analyte concentration before and after high-speed centrifugation for: albumin, creatinine, GGT, glucose, phosphates, urea and total bilirrubin. Own LI is calculated. McNemar test shows statistically significant diferences in the proportion of delivered results before and after high-speed centrifugation in ALT, AST and creatinine.
CONCLUSIONS
This study confirms the efficacy of high-speed centrifugation protocol for all the considered analytes, excepting calcium, alkaline phosphatase and total proteins.
Topics: Humans; Calcium; Creatinine; Alkaline Phosphatase; Centrifugation; Hyperlipidemias; Glucose; Alanine Transaminase; Albumins; Phosphates
PubMed: 36627977
DOI: 10.11613/BM.2023.010703 -
The Journal of Applied Laboratory... Mar 2020The Roche Cobas chemistry analyzer's hemolysis index (HI) check function can directly report hemoglobin (Hb) concentrations. We aimed to validate the HI check function...
BACKGROUND
The Roche Cobas chemistry analyzer's hemolysis index (HI) check function can directly report hemoglobin (Hb) concentrations. We aimed to validate the HI check function for the measurement of plasma cell-free Hb.
METHODS
Plasma samples (6 μl) were taken by the analyzer and diluted in normal saline to measure the absorbance for Hb at 570 and 600 nm. Hb concentrations were calculated based on the molar extinction coefficient. Imprecision, lower limit of quantification (LLOQ), and analytical measurement range (AMR) of the assay were evaluated. The accuracy was determined by comparing the results between the new method and an existing spectrophotometric method. We further studied interference of icterus and lipemia and carryover. The performance of the assay in proficiency testing was also evaluated. The reference range was transferred from the existing method.
RESULTS
Within-run and total CVs were 1.7%-4.2% and 2.1%-7.0%, respectively (n = 20). The LLOQ was 11 mg/dL (CV = 8.1%) with the upper limit of AMR of 506 mg/dL. The results of the new method correlated well with the existing reference assay: Y (new method) = 0.974 x (reference method) + 4.9, r = 0.9990, n = 52. Bilirubin with a concentration up to 60 mg/dL and lipemic index up to 389 did not show significant interference. No significant carryover was detected. The average standard deviation index in proficiency testing was 0.03 ± 0.29. The reference range was <22 mg/dL.
CONCLUSIONS
Plasma cell-free Hb measurement using the HI check function meets the analytical requirements of the plasma cell-free Hb assays. It is simple and cost-effective.
Topics: Automation, Laboratory; Bilirubin; Hematologic Tests; Hemoglobins; Hemolysis; Humans; Laboratory Proficiency Testing; Reference Values; Reproducibility of Results; Sensitivity and Specificity
PubMed: 32445381
DOI: 10.1093/jalm/jfz006 -
Journal of Endocrinological... Jan 2022COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C,...
PURPOSE
COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity.
METHODS
We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity.
RESULTS
Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted.
CONCLUSIONS
A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
Topics: Adolescent; COVID-19; Child; Child, Preschool; Euthyroid Sick Syndromes; Female; Humans; Italy; Male; Prognosis; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Systemic Inflammatory Response Syndrome; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 34312809
DOI: 10.1007/s40618-021-01647-9 -
Practical Laboratory Medicine Aug 2017The aims of this study were to identify the causes of severe lipemia in an academic medical center patient population and to determine the relationship between lipemia...
OBJECTIVES
The aims of this study were to identify the causes of severe lipemia in an academic medical center patient population and to determine the relationship between lipemia and hemolysis.
DESIGN AND METHODS
Retrospective study was done on the data from the core clinical laboratory at an academic medical center. Lipemic indices were available for all chemistry specimens analyzed over a 16-month period (n=552,029 specimens) and for serum/plasma triglycerides concentrations ordered for clinical purposes over a 16-year period (n=393,085 specimens). Analysis was performed on Roche Diagnostics cobas 8000 analyzers. Extensive chart review was done for all specimens with lipemic index greater than 500 (severely lipemic) and for all specimens with serum/plasma triglycerides greater than 2000 mg/dL. We also determined the relationship between lipemia and hemolysis.
RESULTS
The most frequent suspected causes of very high lipemic index (>500) were found to be lipid-containing intravenous infusions (54.4% of total; fat emulsions for parenteral nutrition - 47%; propofol -7.4%) and diabetes mellitus (25% of total, mainly type 2). The most frequent suspected causes of very elevated serum/plasma triglycerides (>2000 mg/dL) was diabetes mellitus (64%, mainly type 2) and hyperlipidemia (16.9%). The frequency of hemolysis increased with increasing lipemic index.
CONCLUSIONS
Intravenous lipid infusions and type 2 diabetes were the most common causes of severe lipemia in this study at an academic medical center. Given that iatrogenic factors are the most common cause of severe lipemia, education and intervention may be helpful in reducing frequency of severe lipemia in patient specimens.
PubMed: 28856220
DOI: 10.1016/j.plabm.2017.02.001