Maximal post‐prandial triglyceride increase reflects post‐prandial hypertriglyceridaemia and is associated with the insulin resistance syndrome

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Abstract
SUMMARY Aims  To assess the value of maximal post‐prandial triglyceride increase after a high fat, low carbohydrate (CHO) test meal, as index of post‐prandial hypertriglyceridaemia and its relation with insulin resistance.Methods  Fifty non‐diabetic subjects, 22 male and 28 female, aged 52.1 ± 4.5 and 56.9 ± 3.8 years, were studied. Glucose, insulin and triglycerides were measured fasting and 1, 2, 3 and 4 h after a meal consisting of 40 g fat, 19 g protein and 10 g CHO. Insulin resistance was calculated according to the HOMA model.Results  The maximal triglyceride increment occurred during the 4th hour. Its absolute value (Δ‐TG) and the per cent increase over the fasting value (PTI), were considered appropriate for the evaluation of the post‐prandial triglyceride response. Both Δ‐TG and PTI were strongly correlated with triglycerides incremental area in males and females, r = 0.797 and r = 0.700, P < 0.01 and r = 0.805 and r = 0.774, P < 0.001, respectively, and thus they can be used as indices of the post‐prandial triglyceride response. No correlation was found between fasting triglyceride and triglyceride incremental area or Δ‐TG. Thus, post‐prandial hypertriglyceridaemia can occur irrespectively of the fasting triglyceride concentrations. A weak correlation was found between PTI and insulin resistance in females, r = 0.384, P < 0.05, but not in males, r = 0.224, P > 0.05. However further analysis by quartiles of PTI showed similar insulin resistance levels in the first three quartiles and a significant increase in the 4th, both for males and females, 4th vs. 3rd quartile 7.4 ± 3.6 vs. 2.2 ± 0.7 and 6.4 ± 2.4 vs. 2.2 ± 0.6, respectively. The 4th quartile corresponds to a PTI ≥ 80%.Conclusions  PTI after the high fat, low CHO test meal used, consistently reflects post‐prandial hypertriglyceridaemia, is easily measured and it is not predicted by fasting triglycerides. A PTI ≥ 80% is associated with a significant increase of insulin resistance, and might therefore be considered the cut‐off point for an abnormal post‐prandial hypertriglyceridaemic response, at least in relation with insulin resistance. Such response could be added to the abnormalities of the insulin resistance syndrome, as an independent parameter.