Low Fasting Serum Triglyceride Level as a Precocious Marker of Autoimmune Disorders

Silvia Iannello, MD, Antonina Cavaleri, MD, Paolina Milazzo, MD, Santi Cantarella, MD, Francesco Belfiore, MD

Disclosures

Medscape General Medicine. 2003;5(3) 

In This Article

Abstract and Introduction

The authors recently reported the occurrence of low fasting serum triglyceride (TG) and high free fatty acid (FFA) levels in idiopathic pulmonary fibrosis. TG estimation in diverse groups of patients with autoimmune disease or hyperactive immune response confirmed the occurrence of a similar decrease of TG. In some patients, serum FFA level was also evaluated. TG value in lean and obese patients was compared with that in lean (n = 108) and obese (n = 208) control subjects without autoimmune disease. In patients affected by autoimmune chronic thyroiditis with enhanced concentration of antithyroglobulin antibodies and without thyroidal failure (n = 24), lean and obese patients had reduced TG (-69/%, P < .01 and -52%, P < .0001, respectively). Both lean and obese patients affected by chronic active B or C hepatitis (n = 26), with autoantibodies and without signs of hepatic insufficiency or cirrhosis, presented reduced TG (-57%, P < .01 and -61%, P < .001, respectively). A marked TG decrease (-73%, P < .001) was observed in the lean patients affected by lupus-like syndrome (n = 7). The lean and obese patients with systemic lupus erythematosus or rheumatoid arthritis (n = 11) showed TG decrease (-66%, P < .01 and -55%, P < .05, respectively). In patients affected by anamnestic allergy or atopic dermatitis/asthma (n = 66), both lean and obese, TGs were reduced (-67%, P < .0001 and -62%, P < .001, respectively). In isolated cases of diverse autoimmune diseases (scleroderma, APECED [autoimmune polyendocrinopathy, candidiasis, and ectodermal dystrophy], urticaria or urticarial vasculitis, Reiter or Sjogren syndromes, ulcerative colitis or Crohn's disease, multiple sclerosis or Guillain-Barré syndrome) (n = 14), decreased TG was also observed both in the lean and obese subjects (-59%, P < .01 and -57%, P < .01, respectively). Concerning FFA (n = 69), value in lean patients (n = 22) vs that in lean controls (n = 18) was increased (520 ± 31 vs 299 ± 30 mcEq/L, +74%, P < .001), whereas value in obese patients (n = 18) vs that in obese control subjects (n = 11) was decreased (542 ± 34 vs 774 ± 62, -30%, P < .01). This opposite behavior of FFA in lean and obese patients needs to be confirmed. Data in this study seem to indicate that low TG value may be a precocious marker of autoimmunity or immune system hyperreactivity.

The occurrence of low fasting serum TG and high FFA levels was recently reported in chronic interstitial or fibrosing pulmonary disease.[1] Forty-four patients with fibrosing pulmonary disease, compared with 110 control subjects, showed a 61% reduction of TG (P < .001) and a 63% increase of serum FFA (P < .01).[1] In the presence of pulmonary fibrosis, TG levels were also low in patients with type 2 diabetes (-53%, P < .001) and in obese subjects (-69%, P < .01),[1] despite the known fact that TGs are often elevated in diabetes and obesity. The mechanisms of this change remain to be clarified.[1]

This datum prompted the authors to systematically estimate TG value in all patients with several autoimmune diseases or hyperactive immune response. In some patients, serum FFA level was also evaluated. The results of these observations are reported here.

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