Identifying an Optimal Cut Point for the Diagnosis of XXXX in the Nonfasting State.

@entity1 @entity2298 @entity101 @entity6 @entity1674 @entity299 @entity65 @entity165 @entity1851
BACKGROUND: Nonfasting @entity1674 are similar or superior to fasting @entity1674 at predicting @entity65 . However, diagnostic cut points are based on fasting @entity1674 . We examined the optimal cut point for increased nonfasting @entity1674 . METHODS: We obtained baseline nonfasting (<8 h since last meal) samples from 6391 @entity1 in the @entity1 's Health Study who were followed prospectively for  <=17 years. The optimal diagnostic threshold for nonfasting @entity1674 , determined by logistic regression models by use of c-statistics and the Youden index (sum of sensitivity and specificity minus 1), was used to calculate hazard ratios (HRs) for incident @entity65 . Performance was compared to thresholds recommended by the @entity299 ( @entity299 ) and European guidelines. RESULTS: The optimal threshold was 175 mg/dL (1.98 mmol/L), with a c-statistic of 0.656, statistically better than the @entity299 cut point of 200 mg/dL (c-statistic 0.628). For nonfasting @entity1674 above and below 175 mg/dL, after adjusting for age, @entity101 , smoking, hormone use, and menopausal status, the HR for @entity65 was 1.88 (95% CI 1.52-2.33, P < 0.001), and for @entity1674 measured at 0-4 and 4-8 h since the last meal, 2.05 (1.54- 2.74) and 1.68 (1.21-2.32), respectively. We validated performance of this optimal cut point by use of 10-fold cross-validation and bootstrapping of multivariable models that included standard risk factors plus total and HDL @entity165 , @entity6 , body mass index, and @entity1851 . CONCLUSIONS: In this study of middle-aged and older apparently healthy @entity1 , we identified a diagnostic threshold for nonfasting @entity2298 of 175 mg/dL (1.98 mmol/L), with the potential to more accurately identify cases than the currently recommended @entity299 cut point.
