Can you interpret the laboratory results of a 54-year-old male with blood urea nitrogen (BUN) 8 mg/dL, fasting glucose 144 mg/dL, triglycerides 209 mg/dL, very-low-density lipoprotein (VLDL) 41.8 mg/dL, and vitamin D 20.9 ng/mL?

Laboratory Interpretation for 54-Year-Old Male

This patient demonstrates multiple metabolic abnormalities requiring immediate intervention: impaired fasting glucose indicating prediabetes, moderate hypertriglyceridemia with elevated VLDL-C, and vitamin D insufficiency—all of which substantially increase cardiovascular and diabetes risk.

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Blood Urea Nitrogen (BUN): 8 mg/dL

• This value is at the lower end of the normal range (7–25 mg/dL) and does not indicate renal dysfunction 1
• Low-normal BUN may reflect adequate hydration status or reduced protein intake, but requires correlation with serum creatinine and eGFR to fully assess kidney function 1
• In the absence of elevated creatinine, this BUN level has no immediate clinical significance 1

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Fasting Glucose: 144 mg/dL

• This level meets diagnostic criteria for prediabetes (100–125 mg/dL) and approaches the diabetes threshold (≥126 mg/dL), placing the patient at very high risk for progression to type 2 diabetes 2
• Even fasting glucose levels in the high-normal range (95–99 mg/dL) independently predict cardiovascular events; at 144 mg/dL, this patient's risk is substantially elevated 3
• Fasting glucose ≥91 mg/dL combined with triglycerides ≥150 mg/dL (as in this patient with TG 209 mg/dL) confers an 8.23-fold increased hazard ratio for incident diabetes compared to lower levels 4
• Confirm the diagnosis with a repeat fasting glucose or HbA1c measurement; if HbA1c is 5.7–6.4%, prediabetes is confirmed; if ≥6.5%, diabetes is diagnosed 2

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Triglycerides: 209 mg/dL

• This level represents moderate hypertriglyceridemia (175–499 mg/dL) and significantly increases atherosclerotic cardiovascular disease (ASCVD) risk 2
• Elevated triglycerides are a marker of increased cholesterol content in triglyceride-rich lipoproteins (VLDL and remnants), which are directly atherogenic 2
• The combination of fasting glucose 144 mg/dL and triglycerides 209 mg/dL creates a synergistic metabolic risk profile characteristic of insulin resistance and metabolic syndrome 2
• Initiate aggressive lifestyle modification: very low-fat diet, elimination of refined carbohydrates and alcohol, omega-3 fatty acid supplementation (2–4 g/day), and weight reduction 2
• If triglycerides remain >200 mg/dL after 3 months of lifestyle intervention, consider fibrate therapy (fenofibrate preferred) to reduce ASCVD risk 2

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VLDL Cholesterol: 41.8 mg/dL

• VLDL-C is calculated as triglycerides ÷ 5 (209 ÷ 5 = 41.8 mg/dL), representing the cholesterol content of triglyceride-rich VLDL particles 5
• This calculation is valid because triglycerides are <400 mg/dL; above that threshold, direct LDL-C measurement is required 5
• VLDL-C is an atherogenic lipoprotein that contributes to cardiovascular risk independently of LDL-C 5
• Non-HDL cholesterol (total cholesterol minus HDL-C) equals LDL-C plus VLDL-C and captures the total burden of atherogenic lipoproteins; this is a superior predictor of cardiovascular events than LDL-C alone, especially when triglycerides are elevated 5
• To fully assess lipid risk, obtain a complete fasting lipid panel including total cholesterol, LDL-C, and HDL-C 6

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Vitamin D: 20.9 ng/mL

• This level indicates vitamin D insufficiency (defined as 20–29 ng/mL); optimal levels are ≥30 ng/mL 7
• Vitamin D insufficiency may amplify the metabolic risk conferred by elevated triglycerides and impaired glucose tolerance 7
• Both very low (<20 ng/mL) and very high (>50 ng/mL) vitamin D levels strengthen the association between elevated TG/HDL ratio and insulin resistance, impaired glucose tolerance, and diabetes 7
• Initiate vitamin D3 supplementation 1,000–2,000 IU daily to achieve a target level of 30–50 ng/mL, which may help mitigate metabolic risk 7
• Recheck vitamin D level in 3 months after supplementation to confirm adequacy 7

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Integrated Risk Assessment & Management Plan

Metabolic Syndrome Evaluation

• This patient likely meets criteria for metabolic syndrome based on elevated triglycerides (≥150 mg/dL) and impaired fasting glucose (≥100 mg/dL); confirm by measuring waist circumference (≥102 cm in men), blood pressure (≥130/85 mmHg), and HDL-C (<40 mg/dL in men) 2
• Metabolic syndrome substantially increases risk of both type 2 diabetes and cardiovascular disease 2

Immediate Interventions

• Lifestyle modification is the cornerstone of therapy: target 7–10% body weight loss through calorie restriction, minimum 150 minutes/week moderate-intensity aerobic exercise, and dietary changes (saturated fat <7% of calories, eliminate trans fats, increase soluble fiber to 10–25 g/day) 6
• Obtain a complete fasting lipid panel to calculate LDL-C, non-HDL-C, and assess need for statin therapy 6
• If LDL-C is ≥190 mg/dL, initiate high-intensity statin therapy immediately regardless of other risk factors 6
• If LDL-C is 70–189 mg/dL, calculate 10-year ASCVD risk; if ≥7.5%, initiate moderate- to high-intensity statin therapy 6

Follow-Up Monitoring

• Repeat fasting glucose or obtain HbA1c in 1–3 months to confirm prediabetes or diagnose diabetes 2
• Recheck fasting lipid panel 6–12 weeks after initiating lifestyle changes or statin therapy 6
• Monitor vitamin D level in 3 months after supplementation 7
• Screen for hypertension, measure waist circumference, and assess for other metabolic syndrome components 2

Diabetes Prevention

• If prediabetes is confirmed (fasting glucose 100–125 mg/dL or HbA1c 5.7–6.4%), consider metformin 850 mg twice daily in addition to intensive lifestyle intervention, especially if BMI ≥35 kg/m², age <60 years, or history of gestational diabetes 2
• Intensive lifestyle intervention (7% weight loss, 150 min/week physical activity) reduces diabetes incidence by 58% in high-risk individuals 2

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Key Clinical Pitfalls to Avoid

• Do not dismiss fasting glucose of 144 mg/dL as "borderline"—this level confers substantial diabetes and cardiovascular risk and mandates aggressive intervention 4, 3
• Do not treat triglycerides in isolation—always assess the complete lipid profile and calculate non-HDL-C to capture total atherogenic burden 5, 6
• Do not overlook the synergistic risk of combined impaired fasting glucose and hypertriglyceridemia, which multiplies diabetes risk 8-fold 4
• Do not assume low-normal BUN indicates good health—it must be interpreted with creatinine and eGFR to exclude renal dysfunction 1
• Do not supplement vitamin D to supraphysiologic levels (>50 ng/mL)—both deficiency and excess may worsen metabolic outcomes 7