Adherence to Pre-analytical Fasting Guidelines in a Nationally Representative Sample in the United States

Abstract

Background: The definition of fasting, the manner in which it is communicated to clients, and the methods employed for its evaluation exhibit variations across health professionals. Similarly, the perceived significance of adhering to fasting and the factors linked with it demonstrate diversity among lay people. Notably, while extensive research has been conducted on compliance with pre operative fasting guidelines, there exists a notable gap in the literature concerning adherence to fasting protocols specifically designed for preparatory measures preceding laboratory examinations. Objectives: To identify factors associated with adherence to pre-analytical fasting guidelines in non-institutionalized civilian population. Methods: In National Health and Nutrition Examination Survey, participants aged 12 and older who were assigned to a morning session for laboratory examination were asked to fast for 9 hours. Fasting status of participants in morning sessions in 3 waves (2013-2014, 2015-2016 and 2017 2018) of the survey were pooled and analyzed against demographics and behaviors, using t-tests and Chi-square test at a significance level of 0.05. Results: Of 9,200 participants (mean age=45; female=51.6%; White=35.6%), 92.8% adhered to 9 hour fasting guidelines. In bivariate analyses, adherence was significantly greater among females (d=1.3%; χ2=5.32; p=0.02); Hispanics (d=2.4%; χ2=14.96; p<0.01); non-US born people (d=1.7%; χ2=7.52; p<0.01); people with family income ≥USD 20,000 (d=2.7%; χ2=16.43; p<0.01); those who graduated high-school (d=1.6%; χ2=4.61; p=0.03); people who never used marijuana (d=2.1%; χ2=10.06; p<0.01); those who smoked <100 cigarettes in life (d=1.9%; χ2=10.63; p<0.01). Age, perceived health status, dietary intake, physical activity, average sleep, and alcohol usage were not associated with fasting adherence. Conclusions: Gender, race, county of birth, family income, educational qualifications, marijuana usage, and smoke habits were identified as factors to improve adherence to pre-analytical fasting guidelines. These associated factors also provide more insights into factors that can be leveraged to design effective intermittent fasting interventions. Keywords: Adherence, Laboratory examinations, Pre-analytical fasting guidelines