Evaluation of total lipids using enzymatic methods for the normalization of persistent organic pollutant levels in serum

The human exposure to persistent organic pollutants (POPs) is conveniently assessed through analysis of blood serum or plasma and the POPs concentrations are traditionally expressed on a lipid weight basis. Enzymatic determinations of total lipid (TL) content in serum, which imply the measurement of individual lipid classes, such as triglycerides (TG), cholesterol (CHOL) and phospholipid (PL), use small amounts of serum/plasma (b100 μl). These have also become a more precise and less laborious alternative for the gravimetric lipid determinations which were preferred in the past. However, PL are not routinely measured in most clinical laboratories and therefore, TL values are often predicted from formulas based on measurements of only TG and CHOL. In the present study, a large data set (n=483) from Belgian, Swedish and Norwegian populations was used to compute a new formula for TL [TL=1.33⁎TG+1.12⁎CHOL+1.48 (g/l)] by means of multiple linear regression. A very good correlation (r=0.949, pb0.001) was found between TL values calculated with the proposed formula and TL values obtained by summation of TG, CHOL and PL. Statistically different values of TL were computed when different previously published formulas were compared, which can have a strong influence on the calculation of lipid-normalized concentrations of POPs. Nevertheless, TL values derived using a mathematical formula which includes only TG and CHOL will be less accurate than TL values obtained by summation of TG, CHOL and PL, which should be the calculation method of choice if PL measurements are available.