Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

  • Lima-Oliveira, Gabriel (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona) ;
  • Salvagno, Gian Luca (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona) ;
  • Lippi, Giuseppe (Laboratory of Clinical Chemistry and Hematology, Department of Pathology and Laboratory Medicine, Academic Hospital of Parma) ;
  • Gelati, Matteo (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona) ;
  • Montagnana, Martina (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona) ;
  • Danese, Elisa (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona) ;
  • Picheth, Geraldo (Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology Federal University of Parana) ;
  • Guidi, Gian Cesare (Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona)
  • Published : 2012.07.01
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Abstract

Background: Preanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing. Methods: We studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter. Results: One hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), alkaline phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels. Conclusions: A significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting.

Keywords

References

  1. Lippi G, Lima-Oliveira G, Salvagno GL, Montagnana M, Gelati M, Picheth G, et al. Influence of a light meal on routine haematological tests. Blood Transfus 2010;8:94-9.
  2. Lima-Oliveira G, Salvagno GL, Lippi G, Montagnana M, Scartezini M, Picheth G, et al. Elimination of the venous stasis error for routine coagulation testing by transillumination. Clin Chim Acta 2011;412:1482-4. https://doi.org/10.1016/j.cca.2011.04.008
  3. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Scartezini M, Guidi GC, et al. Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing. Int J Lab Hematol 2011;33:457-62.
  4. Loh TP, Saw S, Chai V, Sethi SK. Impact of phlebotomy decision support application on sample collection errors and laboratory efficiency. Clin Chim Acta 2011;412:393-5. https://doi.org/10.1016/j.cca.2010.10.022
  5. Lippi G, Lima-Oliveira G, Nazer SC, Moreira ML, Souza RF, Salvagno GL, et al. Suitability of a transport box for blood sample shipment over a long period. Clin Biochem 2011;44:1028-9. https://doi.org/10.1016/j.clinbiochem.2011.05.028
  6. Young DS. Effects of preanalytical variables on clinical laboratory tests. 3rd ed. Washington, DC: AACC Press, 2007.
  7. Hallworth M, Hyde K, Cumming A, Peake I. The future for clinical scientists in laboratory medicine. Clin Lab Haematol 2002;24:197-204. https://doi.org/10.1046/j.1365-2257.2002.00455.x
  8. Clinical Laboratory Standards Institute. Procedures for the collection of diagnostic blood specimens by venipuncture. 6th ed. CLSI H3-A6 document. Wayne, PA: Clinical Laboratory Standards Institute, 2007.
  9. Guder WG, Narayanan S, Wisser H, Zawta B. Diagnostic samples: from the patient to the laboratory: the impact of preanalytical variables on the quality of laboratory results. 4th ed. New York: Wiley-Blackwell, 2009.
  10. Clinical Laboratory Standards Institute. Procedures for the handling and processing of blood specimens for common laboratory tests. 4th ed. CLSI H18-A4 document. Wayne, PA: Clinical Laboratory Standards Institute, 2010.
  11. Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biological variation: pros, cons and progress. Scand J Clin Lab Invest 1999;59:491-500. https://doi.org/10.1080/00365519950185229
  12. Guidi GC and Lippi G. Laboratory medicine in the 2000s: programmed death or rebirth? Clin Chem Lab Med 2006;44:913-7.
  13. Pagni A and Plebani M. The laboratory and the general practitioner. Clin Chim Acta 1999;280:13-24. https://doi.org/10.1016/S0009-8981(98)00194-6
  14. Johnson CD, Mole DR, Pestridge A. Postprandial alkaline tide: does it exist? Digestion 1995;56:100-6. https://doi.org/10.1159/000201228
  15. Batterham RL, Cowley MA, Small CJ, Herzog H, Cohen MA, Dakin CL, et al. Gut hormone PYY(3-36) physiologically inhibits food intake. Nature 2002;418:650-4. https://doi.org/10.1038/nature00887
  16. Korbonits M, Blaine D, Elia M, Powell-Tuck J. Metabolic and hormonal changes during the refeeding period of prolonged fasting. Eur J Endocrinol 2007;157:157-66. https://doi.org/10.1530/EJE-06-0740
  17. Cohn JS, McNamara JR, Cohn SD, Ordovas JM, Schaefer EJ. Postprandial plasma lipoprotein changes in human subjects of different ages. J Lipid Res 1988;29:469-79.
  18. De Feo P, Horber FF, Haymond MW. Meal stimulation of albumin synthesis: a significant contributor to whole body protein synthesis in humans. Am J Physiol 1992;263:E794-9. https://doi.org/10.1152/ajpcell.1992.263.4.C794
  19. Caso G, Feiner J, Mileva I, Bryan LJ, Kelly P, Autio K, et al. Response of albumin synthesis to oral nutrients in young and elderly subjects. Am J Clin Nutr 2007;85:446-51. https://doi.org/10.1093/ajcn/85.2.446
  20. Hunter KA, Ballmer PE, Anderson SE, Broom J, Garlick PJ, McNurlan MA. Acute stimulation of albumin synthesis rate with oral meal feeding in healthy subjects measured with [ring-2H5]phenylalanine. Clin Sci (Lond) 1995;88:235-42.
  21. Jefferson LS. Lilly Lecture 1979: role of insulin in the regulation of protein synthesis. Diabetes 1980;29:487-96. https://doi.org/10.2337/diab.29.6.487
  22. Ryan MC, Abbasi F, Lamendola C, Carter S, McLaughlin TL. Serum alanine aminotransferase levels decrease further with carbohydrate than fat restriction in insulin-resistant adults. Diabetes Care 2007;30:1075-80. https://doi.org/10.2337/dc06-2169
  23. Meyer BH, Scholtz HE, Schall R, Müller FO, Hundt HK, Maree JS. The effect of fasting on total serum bilirubin concentrations. Br J Clin Pharmacol 1995;39:169-71. https://doi.org/10.1111/j.1365-2125.1995.tb04424.x
  24. Cowan RE and Thompson RP. Fatty acids and the control of bilirubin levels in blood. Med Hypotheses 1983;11:343-51. https://doi.org/10.1016/0306-9877(83)90097-X
  25. Al-Rubeaan K, Siddiqui K, Abu Risheh K, Hamsirani R, Alzekri A, Alaseem A, et al. Correlation between serum electrolytes and fasting glucose and Hb1Ac in Saudi diabetic patients. Biol Trace Elem Res 2011;144:463-8. https://doi.org/10.1007/s12011-011-9144-4
  26. Rohrscheib M, Tzamaloukas AH, Ing TS, Siamopoulos KC, Elisaf MS, Murata HG. Serum potassium concentration in hyperglycemia of chronic dialysis. Adv Perit Dial 2005;21:102-5.
  27. Gozansky DM and Herman RH. Water and sodium retention in the fasted and refed human. Am J Clin Nutr 1971;24:869-71. https://doi.org/10.1093/ajcn/24.7.869
  28. Bloom WL. Inhibition of salt excretion by carbohydrate. Arch Intern Med 1962;109:26-32. https://doi.org/10.1001/archinte.1962.03620130028004
  29. Fernandez-Real JM, Lopez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes 2002;51:2348-54. https://doi.org/10.2337/diabetes.51.8.2348
  30. Ricos C, Cava F, Garcia-Lario JV, Hernandez A, Iglesias N, Jimenez CV, et al. The reference change value: a proposal to interpret laboratory reports in serial testing based on biological variation. Scand J Clin Lab Invest 2004;64:175-84. https://doi.org/10.1080/00365510410004885
  31. Westgard J. Desirable Biological Variation Database Specifications. http://www.westgard.com/biodatabase1.htm (Updated on Jan 2012).
  32. Cembrowski GS, Tran DV, Higgins TN. The use of serial patient blood gas, electrolyte and glucose results to derive biologic variation: a new tool to assess the acceptability of intensive care unit testing. Clin Chem Lab Med 2010;48:1447-54.
  33. Plebani M and Lippi G. Biological variation and reference change values: an essential piece of the puzzle of laboratory testing. Clin Chem Lab Med 2012;50:189-90
  34. Boldt J. Use of albumin: an update. Br J Anaesth 2010;104:276-84. https://doi.org/10.1093/bja/aep393
  35. Kestenbaum B and Belozeroff V. Mineral metabolism disturbances in patients with chronic kidney disease. Eur J Clin Invest 2007;37:607-22. https://doi.org/10.1111/j.1365-2362.2007.01840.x
  36. Locatelli F, Cannata-Andía JB, Drüeke TB, Hörl WH, Fouque D, Heimburger O, et al. Management of disturbances of calcium and phosphate metabolism in chronic renal insufficiency, with emphasis on the control of hyperphosphataemia. Nephrol Dial Transplant 2002;17:723-31. https://doi.org/10.1093/ndt/17.5.723
  37. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607-17. https://doi.org/10.1053/ajkd.1998.v31.pm9531176
  38. Young EW, Akiba T, Albert JM, McCarthy JT, Kerr PG, Mendelssohn DC, et al. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:34-8. https://doi.org/10.1016/S0272-6386(04)01103-5
  39. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(S3):S1-201.
  40. Ferrari P, Singer R, Agarwal A, Hurn A, Townsend MA, Chubb P. Serum phosphate is an important determinant of corrected serum calcium in end-stage kidney disease. Nephrology (Carlton) 2009;14:383-8.

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