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How to define fasting (in a biochemical setting)

How to define fasting (in a biochemical setting). Mads Nybo Dept. of Clinical Biochemistry Rigshospitalet. How to define fasting. General aspects Scientific evidence for the need of fasting Definition in medical journals Definition at Dept.s of Clinical Biochemistry Conclusion (?).

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How to define fasting (in a biochemical setting)

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  1. How to define fasting(in a biochemical setting) Mads Nybo Dept. of Clinical Biochemistry Rigshospitalet

  2. How to define fasting • General aspects • Scientific evidence for the need of fasting • Definition in medical journals • Definition at Dept.s of Clinical Biochemistry • Conclusion (?)

  3. Danish Medical Compendium, 15th ed. • Fasting 10-16 hours prior to sampling • No explicit physical activity in the hours before sampling • No smoking

  4. Fasting variables • Duration of fasting (6-16 hours) • Liquid intake (incl. coffee, tea and alcohol) • Physical activity (strenous, moderate, resting time?) • Smoking

  5. Literature search 98.9% of all fasting samples (220.898 analyses) were for lipid or glucose analysis (Odense University Hospital, 2003)

  6. Literature search • Statland, Winkel & Bokelund in the 70’es • Alström T et al. SJCLI 1993 Renewed guidelines, stating that 1) only intake of water after 22 pm is allowed 2) physical activity must not be strenous the day before, and only limited (15 minutes by foot) at the day of sampling 3) only one drink of alcohol the day before sampling Not mentioned Smoking, amount of water, literature references

  7. Literature search (extract) • Wide variety between fasting and noon sampling • Increase in Triglycerides! • Smoking associated increase in e.g. adrenalin, cortisol, FFA • Triglycerides both in- and decrease described • Most analyses normalised after 15 minutes of rest • Though not for strenous exercise, e.g. decrease in P-Glucose up to 12 hours after! • 200 ml coffee can cause an 0.5 mmol/L increase in P-Glucose • Significant decrease in P-Glucose 20 hours after moderate alcohol intake

  8. Articles with fasting patients Well-defined fasting Insuff. definition Undefi-ned Clinical Chemistry 46 6.5 23.9 69.6 Clin Chem Lab Med 53 3.8 28.3 67.9 Scand J Clin Lab Invest 37 10.8 18.9 70.3 Diabetes 201 9.0 41.2 49.8 Fasting definition in medical journal

  9. Questionnaire • Questionnaire concerning fasting variables to elucidate the national definition • 20 Dept. of Clinical Biochemistry • Reply from 16 • Very few comparable!

  10. Fasting variable – Duration of fasting

  11. Fasting variable – Alcohol intake

  12. Fasting variable – Coffee intake • )

  13. Fasting variable – Smoking

  14. Conclusions • Fasting do influence the analysis results – especially Triglycerides and Glucose • Lack of harmonisation of fasting in the literature and among Dept.s of Clinical Biochemistry • This could indeed have clinical relevance (diagnostics, monitoring), and a united fasting definition is thus needed

  15. Future aspects to be dealt with • Consensus on these aspects – a Nordic guideline? (Nordic Clinical Biochemistry regime?) • Information to the clinicians (no matter what the conclusions may be!) • Scientific awareness on the aspect (e.g. in journals)

  16. However … • Does a fasting person represent his normal self?? • And should analysis not requiring fasting thus be preferred?

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