Published 7th January 2025
Postprandial lipidemia and long-term health: The evidence
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As part of the testing phase, ZOE Members eat standardized test muffins that contain precise amounts of fat and sugar.
A few hours after eating, they extract a small blood sample and send it to us. We can assess how well they clear lipids from their blood after a meal by comparing their results with those of thousands of other members.
In this article, we’ll review some of the evidence underpinning our lipid test and explain how postprandial lipemia influences long-term health.
To diagnose hyperlipidemia, clinicians measure fasting lipids. However, because lipids are cleared from the blood slowly, we spend most of our time in a postprandial state.
Therefore, fasting measures don’t always accurately capture the full picture for lipid metabolism. The idea that postprandial lipemia is important isn’t new — it was first posited in 1979 that "atherogenesis may occur during the postprandial period."
Huge variety
In ZOE’s PREDICT study, which used data from more than 1,000 participants, we found significant interindividual variation in blood fat clearance after an identical test meal. This variation was even observed in identical twins.
In another study using the same dataset, we showed that postprandial lipemia was a strong determinant of systemic inflammation — even greater than postprandial glycemia.
Specifically, it was linked to increased levels of glycoprotein acetyls (GlycA).
Interestingly, this study also found that people with higher microbial diversity and lower visceral fat mass had a reduced inflammatory response.
Evidence from epidemiological studies
In this section, we’ll outline two large-scale studies that demonstrate a relationship between postprandial lipidemia and cardiovascular risk.
Women's Health Study
This study, which involved 26,509 participants, was designed to "determine the association of triglyceride levels (fasting vs nonfasting) and risk of future cardiovascular events."
At enrollment, participants provided a blood sample. Of these, 20,118 women had their blood taken in a fasted state, whereas 6,391 had eaten within 8 hours of the blood draw.
After around 11 years of follow-up, the scientists found that non-fasted triglyceride levels had a stronger relationship with cardiovascular events than fasted triglyceride levels.
When they stratified the data by time of last meal, they found that blood taken 2 and 4 hours after eating "had the strongest association with cardiovascular events."
Copenhagen City Heart Study
This study recruited 7,587 women and 6,394 men aged 20–93 and followed them for a maximum of 28 years.
As with the previous study, participants with higher levels of triglycerides in their blood after eating had an increased risk of myocardial infarction, ischemic heart disease, and death.
The authors write:
"Increased levels of non-fasting triglycerides may indicate the presence of increased levels of atherogenic remnant lipoproteins."
Increase, peak, or duration?
While the evidence is strong that the magnitude of postprandial lipemia is linked to cardiovascular risk, it wasn’t initially clear whether the total increase, peak, or duration of the response was most important.
In another ZOE study, we delved into the PREDICT data to draw a clearer picture.
We assessed the relationship between triacylglycerol levels and various cardiovascular risk-associated factors 4 and 6 hours after a standardized meal.
These factors were atherogenic lipoprotein remodeling, XL-VLDL particle concentrations, and levels of GlycA.
After adjustment, we found that the total, peak, and duration of postprandial lipidemia at both 4 and 6 hours were strongly correlated with markers of atherogenic lipoprotein remodeling and GlycA.
However, the strongest correlation was observed for the 6-hour triacylglycerol increase from fasting.
Summary
Understanding the impact of postprandial lipidemia on long-term health underscores the importance of dietary and lifestyle interventions aimed at optimising postprandial lipid metabolism.
By adopting healthy eating habits, such as consuming a balanced diet low in saturated fats and refined carbohydrates, combined with regular physical activity, individuals can help mitigate the risk of chronic diseases associated with elevated postprandial lipids.
Ultimately, addressing postprandial lipidemia offers a valuable avenue for improving long-term health outcomes and reducing the burden of cardiovascular disease and other metabolic disorders.
