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Clinical · Bloodwork · continued

Fasting versus non-fasting and which tests care posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.

BW
bac_waterTL2Regular18 May 2026#31

Picking up post #30: that is the part I would want checked first.

Source for the fasting versus non-fasting figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.

Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.

8 likes 2mo
SZ
s.zamoraTL220 May 2026#32
j.fonseca, post #1: Fasting versus non-fasting and which tests care Writing it up because I had to work it out twice and would rather nobody else did. Fasting versus non-fasting: what I expected, what I found, and the gap between them. I am posting the gap rather than a theory about it. My theories about gaps like this one have not held up well. Go to post

On post #30 — agreed on the reasoning, with one qualification.

Practical note on fasting versus non-fasting: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.

19 likes in reply to #1 2mo
TD
titration_diaryTL3Regular22 May 2026#33

Fasting state, time of day, recent exercise and hydration all move several common analytes. Standardising the conditions matters more than the interval between draws.

0 likes 2mo
IG
i.guerreroTL223 May 2026 · edited#34

A request rather than an answer: could whoever has the primary source for fasting versus non-fasting post it? I have seen the claim three times this month and each version had lost a qualifier.

0 likes 2mo
EF
e.ferreiraTL3Regular25 May 2026#35
bac_water, post #31: Picking up post #30: that is the part I would want checked first. Source for the fasting versus non-fasting figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is. Reading the surrounding paragraph is worth the two minutes. The authors are more… Go to post

Adding the measurement that post #32 says would settle it.

What would change my mind on fasting versus non-fasting is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.

4 likes in reply to #31 2mo
AJ
a.jansenTL226 May 2026#36

A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line.

13 likes 2mo
DB
dr_bhattacharyaTL3Physician28 May 2026#37

Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason.

27 likes 2mo
TD
t.duarteTL229 May 2026#38
b.okonkwo, post #25: Two things can be true about fasting versus non-fasting at once: the mechanism is plausible and the evidence for the size of the effect is thin. Most of the argument here is people defending the first against attacks on the second. Go to post

I changed my mind about fasting versus non-fasting after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.

0 likes in reply to #25 2mo
LG
lc_gradientTL3Analytical chemist31 May 2026#39

I would rather this thread reach "we do not know" about fasting versus non-fasting than reach a confident answer that nobody can support when asked.

18 likes 2mo
DV
d.vukovicTL22 Jun 2026#40

Analytical imprecision: any measurement has an error margin. A small difference in consecutive tests is usually measurement noise, not a real change. Knowing the imprecision helps distinguish noise from signal.

0 likes 2mo
JR
j.restrepoTL23 Jun 2026#41
dr_bhattacharya, post #37: Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason. Go to post

Post #39 put the caveat in the right place and I want to underline it.

Where the fasting versus non-fasting discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on.

12 likes in reply to #37 2mo
OF
outline_firstTL3Wiki editor5 Jun 2026 · edited#42

Fasting state: some lab tests require fasting; others do not. Lipids on a fasting draw differ from lipids on a fed draw. Always note whether the test was fasting when comparing results.

I am describing what is, rather than arguing for what should be.

4 likes 2mo
SO
se.okaforTL26 Jun 2026#43

My position on fasting versus non-fasting is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

0 likes 2mo
SB
sharps_binTL2Regular8 Jun 2026#44

The arithmetic in post #43 is right; the assumption feeding it is the part to check.

Worth stating the null on fasting versus non-fasting before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.

26 likes 2mo
IB
i.boatengTL29 Jun 2026#45
a.jansen, post #36: A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line. Go to post

Following, with nothing to contribute beyond having asked the same thing elsewhere.

8 likes in reply to #36 2mo
TD
titration_diaryTL3Regular11 Jun 2026#46
hana.sato, post #27: Where I part company with post #25, and it is a narrow parting. Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same. I have separated what I observed from what I concluded, which does not… Go to post

Post #43 is the version of this I will quote in future. One addition.

Glycaemic markers integrate over different periods. A point glucose and a longer-term marker disagreeing is not a contradiction; it is two different questions.

The short answer was in the first line; everything after is the working.

2 likes in reply to #27 2mo
HF
h.falkTL212 Jun 2026#47

I read the earlier replies on fasting versus non-fasting twice before writing this, because I had assumed the opposite and wanted to be sure I was disagreeing with what was said rather than what I expected.

0 likes 2mo
EF
e.ferreiraTL3Regular14 Jun 2026#48

The honest answer on fasting versus non-fasting is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.

Most people get the first two right and then argue about the fourth.

19 likes 1mo
HC
h.castellanosTL215 Jun 2026#49

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

4 likes 1mo
FE
footnote_entryTL3Regular17 Jun 2026#50
i.boateng, post #45: Following, with nothing to contribute beyond having asked the same thing elsewhere. Go to post

Reframing fasting versus non-fasting slightly, because I think the disagreement is about the question rather than the answer. If the question is "does it happen", yes. If it is "how often", nobody here knows.

0 likes in reply to #45 1mo
SS
steady_stateTL3Regular18 Jun 2026#51
z.szabo, post #3: Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason. Scoping that to what I have actually seen rather than what I have read. Go to post

Fasting versus non-fasting: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.

1 like in reply to #3 1mo
SV
s.vukovicTL220 Jun 2026#52

Everything in post #48 holds. The case it does not cover is the one I have.

Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason.

The general case is well covered; this is the awkward specific one.

7 likes 1mo
NE
n.ekstromTL2Regular21 Jun 2026#53

Two questions I would want answered before drawing anything from the fasting versus non-fasting data above: how were the cases selected, and what happened to the ones that dropped out.

24 likes 1mo
CC
c.castellanosTL223 Jun 2026#54

A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line.

0 likes 1mo
DH
dietitian_hollisTL3Dietitian24 Jun 2026#55

Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason.

3 likes 1mo
EH
e.halonenTL225 Jun 2026#56

What I want from this fasting versus non-fasting thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.

11 likes 1mo
JW
journalclub_wrenTL3Regular27 Jun 2026#57

Sensible. I would want the same detail before I acted on it either.

32 likes 1mo
YA
y.asanteTL228 Jun 2026 · edited#58
e.ferreira, post #35: Adding the measurement that post #32 says would settle it. What would change my mind on fasting versus non-fasting is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more. Go to post

Posting my fasting versus non-fasting numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.

0 likes in reply to #35 30d
B
BirkelandTL3Regular30 Jun 2026#59

Glycaemic markers integrate over different periods. A point glucose and a longer-term marker disagreeing is not a contradiction; it is two different questions.

One of those cases where knowing the mechanism does not help the decision.

6 likes 28d
AK
a.kravchenkoTL21 Jul 2026#60

Having read the whole fasting versus non-fasting thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.

16 likes 27d