Fasting status modifies the association between triglyceride and all-cause mortality: A cohort study

Both fasting and non-fasting levels of triglyceride have been shown positively associated with all-cause mortality. It is unknown whether fasting status modifies this association. This study aimed to address this question.

This study included 34,512 US adults (27,036 fasting and 7476 nonfasting participants). All-cause mortality was ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios of triglyceride for mortality.

This cohort was followed up for a mean of 13.0 years. During the follow-up, 8491 all-cause deaths were recorded. A 1-natural-log-unit increase in triglyceride was associated with an 8% higher multivariate-adjusted risk of all-cause mortality. Interaction analyses showed that fasting status interacted with triglyceride in predicting all-cause mortality. Sub-analyses showed that a 1-natural-log-unit increase in triglyceride was associated with a 17% higher multivariate-adjusted risk of all-cause mortality in the nonfasting subcohort; however, there lacked such an association in the fasting sub-cohort. Similarly, high (200-499 mg/dL) and very high levels of triglyceride (≥500 mg/dL) were associated with higher all-cause mortality risks compared with low normal triglyceride (<100 mg/dL) only in the nonfasting subcohort.

This study found that, compared to fasting triglyceride, nonfasting triglyceride was more sensitive in predicting all-cause mortality. This study supports the initiatives by some guidelines to recommend the use of nonfasting triglycerides for risk assessment.