A Standardized Triglyceride and Carbohydrate Challenge: Response to Thanopoulou, Karamanos, and Roussi

We welcome the comments by Thanopoulou, Karamanos, and Roussi (1), who emphasize the unmet need for a standardized method to assess triglyceride tolerance. In the absence of an acceptable test meal that could readily be made available worldwide, our oral triglyceride tolerance test (OTTT) (2) provides a practical solution for the reproducible evaluation of postchallenge triglyceride tolerance in diabetic and nondiabetic subjects. The incorporation of 50 g of carbohydrate in the OTTT makes it more akin to everyday meals in that fat is usually ingested with carbohydrate and thus more likely to reflect the daily postprandial situation than an isolated fat load. We agree that careful interpretation and reporting of the lipid profiles observed is essential, particularly given the well-recognized close association between fasting and postchallenge triglyceride levels. The routine use of a standardized challenge such as the OTTT would permit more comparable data to be obtained for both clinical and trial-related evaluations of triglyceride tolerance. This in turn would allow for more precise determination of the relative importance of postchallenge triglyceride levels on clinical outcomes and the potential impact of therapies that might differentially affect them.