Fasting Blood Triglyceride Levels: Current Guidelines
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In medicine, hypertriglyceridemia denotes high(hyper-) blood levels (-emia) of triglycerides. As a part of lipid management, it has become a major medical problem. This website is intended to allow you to become an informed patient who can manage your own care, ask the right questions, insist on adequate management and information, and seek an optimal outcome for yourself. Perhaps it will even help the health professionals who are giving care to better understand and, hopefully, incorporate into their practice the nutritional approach to high blood triglycerides.
Please note that this website is not intended for “most people”. It is written for those who want to stand out in self-health care. If you are such a person, we strongly advise that you give serious thought to all of the suggestions about how to improve you blood lipid profile, triglycerides in particular. If you are tempted to think the suggestions are too complicated or too simplistic, or biased, we assure you they are not.
The NCEP advises that adults have their blood lipids checked at least once every five years, starting at age 20. However, if you are over 40 you should get your triglycerides tested at least once a year. Diabetics must have their triglycerides measured every three (3) months. In May, 2001, the U.S. National Cholesterol Education Program (NCEP), a division of the National Institutes of Health (NIH), released recommendations on who should be treated for elevated triglyceride levels.
The NCEP recommendations ("consensus statements") are the products of independent, non-Federal panels of experts and are based on the panels' assessments of medical knowledge available at the time the statements were made.
Therefore, they provide "snapshots in time" of the state of knowledge of the topics (new knowledge, however, is inevitably accumulating through medical research).
It should be noted, however, that the usually quoted "normal" blood lipid levels do change as they depend upon the levels found in the majority of the population as well as upon what... health officials decide is normal.
Therefore, the declared "normal" triglyceride levels -- that your doctor will use to tell you whether your various serum/blood levels are "normal" -- do NOT necessarily mean "healthy" levels.
Here is the American Cholesterol Education Program Expert Panel’s current policy on fasting blood triglyceride levels in adults:
less than 150 mg/dL (<1.7mmol/L) Normal
150 - 199 mg/dL (1.7–2.3 mmol/L) Borderline-high
200 - 499 mg/dL (2.3–5.64 mmol/L) High
higher than 500 mg/dL (>5.64 mmol/L) Very high
Here are the Canadian guidelines on fasting blood triglyceride levels in adults:
less than 2.0 mmol/L (<177.2mg/dL) Optimal
2.0 - 2.5 mmol/L (177.2 - 221.5 mg/dL) Acceptable
higher than 2.5 mmol/L (>221.5 mg/dL) Compromised
According to some European guidelines, blood triglyceride levels in adults should be categorized as follows:
less than 1.7 mmol/L (<150.1mg/dL) Norisk
between 1.7 - 2.3 mmol/L (150.1 -203.1 mg/dL) Suspect
fasting1.7 - 2.3 mmol/L (151.1 - 203.1 mg/dL) Requiring attention and intervention
2.3 - 4.6 mmol/L (203.1 - 407.1mg/dL)
with high LDL cholesterol (greater than 4.1 mmol/L, or 160mg/dL) Requiring aggressive treatment
The following "normal" blood triglyceride reference ranges are based on someone's age:
Age "Normal"Triglyceride Range
10 - 29years 53 - 104mg/dL, or 0.6 - 1.2 mmol/L
30 - 39years 55 - 115mg/dL, or 0.6 - 1.3 mmol/L
40 - 49years 66 - 139mg/dL, or 0.7 - 1.6 mmol/L
50 - 59 75 - 163mg/dL, or 0.8 - 1.8 mmol/L
60 - 69 78 - 158mg/dL, or 0.9 - 1.8 mmol/L
> 70 years 83 - 141mg/dL, or 0.94 - 1.6 mmol/L
Here is another example of the "normal range" of blood triglycerides based on gender and age. Many health professionals find it quite accurate:
Adult Males Upper level: 130 mg/dL + age; Maximum: 200mg/dL, or 2.3 mmol/L
Adult Females Lower level: 80 mg/dL + age; Maximum: 165 mg/dL, or 1.9mmol/L
Adult Males and Females Lower level: Your age
Adult Males and Females Below 100 mg/dL, or 1.1 mmol/L: Ideal levelKeep in mind, these are only guidelines. The ranges were developed based on the entire population and may not apply to individuals.
PLEASE NOTE: Fasting values should be based on two serial measurements of serum (blood) triglycerides. Serial measurements are important because of intra individual triglyceride variability which is 5 times that ofcholesterol.TRIGLYCERIne%20%20Full%20of%20Health%20Inc_files/return_to_top.gif
Healthy and Beneficial Blood Triglyceride Levels
As the "optimal" levels reflect health, the IDEAL (i.e. beneficial) blood triglyceride levels for cardiovascular health seem to be the levels between 70 mg/dL and100 mg/dL, or 0.8 - 1.1 mmol/L. The average triglyceride level in the United States is 134 mg/dL, or 1.5 mmol/L and is considerably higher than triglyceride levels below 100 mg/dL, or 1.1 mmol/L commonly observed in countries where heart disease rates are low.
Although medical establishments consider blood triglyceride levels of10 - 150 mg/dL, or 0.1 - 1.7 mmol/L normal, or good,according to many experts, desirable or favorable fasting blood triglyceride levels should be 50 - 150 milligrams per deciliter(mg/dL), or 0.6 - 1.7 milli moles per liter (mmol/L) of blood.
"Normal", however, does NOT necessarily mean "healthy" as it may include both healthy and many unhealthy people. We want "healthy", not just "normal" serum triglyceride (and other lipid) levels.
Therefore, in order to avoid future cardiovascular health problems, the "ideal" or beneficial (healthy) range of trigycerides should be much tighter than the often quoted "normal" triglyceride range referred to by your doctor that is below 150 mg/dL, or 1.7 mmol/L.
This is important as elevations of the blood triglycerides, particularly in association with decreased HDL-"good" cholesterol, outside this range are the key marker for heart disease and stroke.
"Research shows that levels above 100 mg/dl significantly increase your risk for heart attack," says Bruce Holub, PhD, nutrition researcher at the University of Guelph in Ontario, Canada.
For each mmol/L increase in triglycerides - which translates into 88.5mg/dL - the risk of coronary artery disease (CAD) increases by 37 percent in women and 14 percent in men.
All else being equal, a man with a triglyceride level of 300 mg/dL would have a risk of cardiovascular events roughly 28 percent higher than that of an otherwise comparable man who has a level of 100 mg/dL (a meta-analysis by John Hokanson and Melissa Austin, 1996).
Therefore, for every percentage your triglyceride level drops, so can your chance of heart disease or stroke.TRIGLYCERIne%20%20Full%20of%20Health%20Inc_files/return_to_top.gif
True Baseline Triglyceride Measurement
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The test for triglycerides - using a blood sample drawn from a veinor a fingertip - should be done after an overnight fasting when noextra triglycerides from a recent meal are present as they are being sent from the gut to body's fat tissue for storage. In practice, however, that way of obtaining a true baseline triglyceride measurement is often given no more than lip service.
As opposed to circulating HDL-"good" and LDL-"bad" cholesterol, triglyceride blood concentrations change significantly with food intake. Whenever you eat a meal that contains fat, your triglyceride levels rise. The degree of the increase depends on the baseline level.
If you have not been properly fasting when the blood sample was drawn, your physician may dismiss your elevated triglyceridesreading as… insignificant. For example, if your triglyceride level is about50 mg/dL, or 0.6 mmol/L after eating a classic fast-food "meal" of a hamburger, French fries, and milkshake, your triglycerides may increase by15 percent to 20 percent.
In other words, the triglyceride level may rise to 70 mg/dL (0.8mmol/L), 80 mg/dL (0.9 mmol/L), or perhaps 90 mg/dL (1.0 mmol/L) – but still will remain within the optimal range (below 100 mg/dL, or 1.1mmol/L).
If your baseline triglyceride level is greater than 200 mg/dL, or 2.3mmol/L
- that high-fat junk "meal" could catapult your triglycerides to 300mg/dL (3.4 mmol/L), 400 mg/dL (4.5 mmol/L), or even 500 mg/dL (5.6mmol/L), and this elevation may be prolonged for several hours beyond the normal eight-hour clearance period.
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Stay Alert and Ask Questions
The most common cause of an elevated triglyceride level is a non-fasting specimen. When itcomes to health care, you need to stay alert, ask questions, and ultimately rely on yourself for important health care decisions.
By applying these guidelines, you will be able to take control of your health care, just as we all should do.
Unfortunately, your doctor may have you take the blood test without informing you of all factors that might affect the results.
You never know when even a “highly regarded” doctor might be rushed or inexperienced, or simply overly comfortable with a procedure, then end up taking a short cut at your expense, recommending a drug or an uncomfortable, invasive procedure based solely on a suspect or false test result.
The lesson: Always ask your doctor for specifics regarding factors that can create false positive or false negative test results.
Nothing, except water, is allowed from bedtime until you get your triglyceride blood work done next morning when a lab opens. As far as a blood test determining triglyceride levels is concerned, for 12 to 14hours before the test, only water (no coffee!) is permitted.
Overnight fasting is essential for an accurate measurement of blood triglycerides!
In addition, alcohol should not be consumed for the 24hours just before the test.
You are also not supposed to take any vitamin supplements 24hours prior to your fasting blood work. If you are currently on antihistamines, antibiotics or cortisone treatment only, you need to call the lab or your doctor for more information on how to proceed.
Anything taken in, other than water, during that time can elevate the blood triglycerides as they change dramatically in response to meals. Without the proper fasting, they can easily be high enough to prompt your doctor to prescribe drugs.
However, even fasting levels may vary considerably day to day. Therefore modest changes in fasting triglycerides measured on different days are not considered to be abnormal. TRIGLYCERIne%20%20Full%20of%20Health%20Inc_files/return_to_top.gif
"It Turned Out to Be a False Result"
My blood triglyceride level was alarmingly high 497 mg/dL (milligrams per deciliter of blood).(…)
It turned out to be a false result. A nurse sent to my home by my life insurance company had taken my blood sample just a few hours after I ate lunch.
For an accurate triglyceride reading, even more so than for an accurate blood cholesterol reading, it's important to fast for at least 12 hours before having blood drawn.
(…) a meal that is rich in fat is a meal that is rich in triglycerides, and it will cause a dramatic short-term spike in your blood triglyceride levels.
When my doctor drew my blood after an overnight fast during my annual physical a few months later, my triglyceride level was 97 [mg/dL].
- Larry Lindner, Tufts University School of Nutrition Science& Policy.
Variability in Triglyceride Measurements
After a weekend of beer and pizza, Monday morning blood work readings tend to be higher than onthe other days; therefore, take your weekend activities into account when having your test for blood triglycerides done. Due to alack of standardized measurement, however, variability in triglyceride measurements may occur. Daily concentrations of blood triglycerides vary more than the concentrations of most other metabolites and can be affected especially by:
- previous alcohol (ethanol) consumptiondehydration, and other factors, such as some drugs and ascorbic acid/vitamin C (they can decrease triglyceride measurements).
Another factor that affects triglyceride measurement is postural change; the level can vary by as much as 15 percent, depending on whether your were standing or supine when the blood was drawn, because of associated shifts in plasma volume.
Yet another factor is laboratory variability, which can range between 5percent and 10 percent on a daily basis.
Finally, intra individual variability can be another 5 percent to 10percent.
Those variations, however, will not matter as much in those who have an optimal baseline triglyceride value as they will in people who have an elevated value, in whom the variability will tend to be much more dramatic.
It should also be noted that test for blood (serum) triglycerides should not be performed on specimens collected between 24 hours and 8weeks after myocardial infarction (heart attack), as levels will be lower than usual.
However, lipid profiles are best avoided following acute myocardialinfarct, for up to 3 months, although cholesterol can be measured in thefirst 24 hours.
As a rule, variability in triglycerides measurement can be decreased if you are instructed to
- fast overnight for at least twelve (12) hours abstain from alcohol for two (2) days, and consume two cups (473 mL) of water one (1) hour before the collection of blood.
In particular, the importance of the two-day abstinence from alcohol is based on significant alterations in the plasma fatty acid pattern that persist twenty-four (24) hours after the consumption of alcohol and elevations in triglycerides observed as late as nine (9) hours after the consumption of alcohol with dinner. (J Chromatogram 1992;579:13–24; Alcohol1998;33:403–10).
What you should do then?
First, before having blood drawn for a triglyceride check, fast -preferably overnight - several (12-14) hours. Fasting is essential for triglycerides (it is not necessary to measure cholesterol though).
Second, have the blood test repeated to be sure your measurement is accurate. And ask your doctor for specifics regarding factors that can create false positive or false negative test results.
Third, tell your physician to also measure LDL and HDL cholesterol. Triglyceride measurement should be accompanied by a complete lipoprotein cholesterol determination.TRIGLYCERIne%20%20Full%20of%20Health%20Inc_files/return_to_top.gif
Standard Fasting Lipid/Lipoprotein Profile
In assessing the risk of heart disease, standard medicine targets mainly total blood cholesterol levels and LDL-"bad" cholesterol. However, people with high cholesterol often have high triglycerides, especially when there is no another disorder present.
Therefore, the type of standard, conventional medical treatment used to lower cholesterol
HERE AREYOUR RESULTS Check these various components in your fasting blood lipid profile. They are considered important indicators of your risk of having a heart disease. It is obviously best to be at the high end of the "good" HDL cholesterol range (> 80 mg/dL), and the low-end of the "bad" LDL cholesterol (< 100 mg/dL) and triglycerides range (< 100 mg/dL isIDEAL).
TRIGLYCERIne%20%20Full%20of%20Health%20Inc_files/arrowdown.gif LIPID LEVEL LEVEL LEVEL SHOULD BE . ...
Total Cholesterol(TC) DESIRABLE Under < 200mg/dL
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