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

Results

Data obtained in lean and obese control subjects are shown in Table 1 . The changes between these lean and obese subjects are statistically significant for BMI, TG, and FFA. Concerning the diabetic control groups, mean value of TG was 2.13 ± 0.52 and 2.20 ± 0.17 mmol/L in lean and obese diabetic subjects, respectively. Results obtained in patients as compared with control subjects are shown in Tables 1-7.

(a) Concerning chronic autoimmune thyroiditis, the lean and obese patients had a reduced TG level (-69% and -52%, respectively) compared with TG value of the lean and obese control subjects without autoimmune disease ( Table 1 and Table 2 ). The FFA value showed an increase (+73%) in the lean patients and a slight statistically significant decrease (-27%) in the obese patients ( Table 1 and Table 2 ).

(b) In the patients affected by chronic thyreopathies without autoantibodies, TG and FFA were not changed in the lean patients, whereas in the obese patients, a slight (but statistically significant) decrease of TG (-26%) and FFA (-27%) was observed ( Table 1 and Table 3 ). In evaluating this datum, it should be considered that the absence of autoantibodies does not necessarily exclude an autoimmune disease. Indeed, it is known that a percentage of autoimmune patients do not present autoantibodies, if they are screened in the phase preceding the appearance of autoantibodies. Both patient groups presented nearly normal values of total cholesterol.

(c) The results in patients affected by chronic active B or C hepatitis (a group of patients older than their control subjects), without signs of hepatic insufficiency or cirrhosis, are shown in Table 1 and Table 4 . Both the lean and obese patients showed reduced values of TG (-57% and -61%, respectively). In the obese patients, a reduced FFA level (-51%) was recorded. These patients presented nearly normal values of total cholesterol.

(d) The results in the patients affected by lupus-like syndrome (who were prevailingly lean), compared with their control subjects, are shown in Table 1 and Table 5 . A marked decrease of TG (-73%) and increase (+74%) of FFA value were observed.

(e) The results in the patients affected by SLE or rheumatoid arthritis, compared with their control subjects, are shown in Table 1 and Table 6 . In the lean patients, decrease of TG (-66%) and increase of FFA (+100%) values were observed. In the obese patients (in whom assay of FFA could not been performed), TG value was decreased (-55%).

(f) The results in the patients affected by anamnestic allergy or atopic dermatitis/asthma (who were younger subjects than their controls) are shown in Table 1 and Table 7 . In the lean patients, reduced value of TG (-67%) and increased value of FFA (+52%) were observed. In the obese patients, a reduced value of TG (-62%) was also observed, whereas the value of FFA remained unchanged.

(g) The results in patients affected by other autoimmune diseases (scleroderma, APECED, urticaria or urticarial vasculitis, Reiter or Sjogren syndromes, ulcerative proctocolitis or Crohn's disease, and chronic multiple sclerosis or Guillain-Barré syndrome) compared with lean and obese control subjects, are discussed above. In the lean and obese subjects, decreased value of TG was observed (-59% and -57%, respectively). In the lean patients, FFA value was increased (+90%). (In the obese patients, FFA assay could not be performed).

It is noteworthy that the lowest TG values were observed in the patients affected by lupus-like syndrome (0.43 ± 0.05 mmol/L), in 1 female patient (21 years old) with a chronic active type B hepatitis, myalgia, and strong familiarity for type B hepatitis (TG = 0.26), in 1 female patient (50 years old) affected by scleroderma (TG = 0.41), and in 2 female patients with autoimmune thyroiditis: one (36 years old) with rheumatologic complaints who developed a severe autoimmune thyroiditis following a twin pregnancy (TG = 0.30) and another (34 years old) with elevated titer of thyroidal autoantibodies (TG = 0.20). A very low value of TG was also evidenced in an adult female patient with chronic multiple sclerosis (TG = 0.26).

The low TG values were confirmed for some patients in various determinations, repeated after 2-3 months. Concerning the FFA level, data obtained when all the lean patients were compared with the lean control subjects, and all the obese patients were compared with the obese controls are as follows: (a) value in the lean patients (n = 22) vs that in the lean controls (n = 18) was increased (520 ± 31 vs 299 ± 30 mcEq/L, +74%, P < .001 in both statistical calculations); (b) value in the obese patients (n = 18) vs that in the obese control subjects (n = 11) was decreased (542 ± 34 vs 774 ± 62 mcEq/L, -30%, P < .01 in both statistical calculations). Obviously, this opposite behavior of FFA in lean and obese patients needs to be confirmed in a larger series of patients with autoimmune disorder or hyperreactivity of the immune system. FFA values obtained in the lean and obese control subjects in this study were very close to that reported in a previous metabolic study.[4] No correlation existed between TG and FFA values.

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