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Hypertriglyceridemia is an elevation of triglyceride levels in the bloodstream.
Hypertriglyceridemia is a condition characterized by elevated triglyceride levels. Triglycerides are the chemical form in which more than 90% of dietary fat and body fat exist. There are two sources of triglycerides: they are either obtained from the diet (dietary triglycerides) or manufactured by the body itself in the liver. They circulate constantly with all the lipoprotein carriers of the blood. The most important lipoproteins are:
A blood cholesterol test usually reports on both cholesterol and triglyceride levels. The American Heart Association endorses the National Cholesterol Education Program (NCEP), a division of the National Institutes of Health (NIH), and its guidelines
(Illustration by GGS Information Services/Thomson Gale.).
for the detection of high cholesterol. The following are considered normal results:
Hypertriglyceridemia is a common disorder in the United States. It is made worse by uncontrolled diabetes mellitus, obesity, cirrhosis of the liver and sedentary habits, all of which are more common in industrialized countries than in developing nations. The condition generally occurs in people who have low protein and high carbohydrate diets, but also has genetic causes, not very well-defined. One inherited form is “familial hypertriglyceridemia”, affecting about 1 out of 300 individuals in the United States. Hypertriglyceridemia can also result from a disorder of lipoprotein metabolism (dyslipidemia). Triglyceride levels increase gradually in men until about age 50 years and then decline slightly. In women they continue to increase with age.
In 2001, the National Cholesterol Education Program (NCEP) released recommendations on triglyceride levels that should determine whether hypertriglyceridemia treatment is required or not:
In the Fredrickson classification of hyperlipide-mias, the general term for elevated lipids in the blood, hypertriglyceridemia is classified as four different types:
When levels exceed 150 mg>dL, health care practitioners will recommend a diet aimed at lowering levels.
Most foods contain several different types of fats and some kinds are better, not only to reduce fat during a hypertriglyceridemia diet, but for improving overall health. The four main types of fats are:
Unsaturated, monounsaturated and polyunsaturated fats are considered better than others to lower your risk of heart disease since they lower the total and LDL cholesterol levels. Omega-3 fatty acids may be especially beneficial to the heart. They appear to decrease the risk of coronary artery disease and may also protect against irregular heartbeats and help lower blood pressure levels. Saturated and trans fats are considered less healthy because they can increase the risk of heart disease by increasing total and LDL cholesterol levels. Tips to limit fat in the diet are accordingly focused on reducing foods high in saturated and trans fats. For example, the Mayo Clinic offers the following:
The function of a hypertriglyceridemia diet is to bring triglyceride levels back to normal recommended levels (less than 150 mg/dL).
The benefits of normal triglyceride levels are numerous. Triglycerides carry fat-soluble vitamins A, D, E and K to where they are required, they help the synthesis of some hormones and protect cell membranes. The fat tissues in which they are stored also cushion and protect organs such as the kidneys and provide thermal insulation.
The National Heart, Lung and Blood Institute (NHLBI), through its National Cholesterol Education Program (NCEP), recommends that the triglycerides of diabetic individuals should be checked regularly. Diabetes can increase triglycerides significantly, especially when blood sugar is out of control. Healthy adults over 40 should get their triglycerides tested at least once a year, and more often if levels are high until they reach the desirable level.
Fat restriction should be carefully evaluated. When reducing fat intake results in a required weight loss, triglyceride levels usually improve. When they are severely elevated (>1000 mg/dL), a low-fat diet will decrease chylomicron and VLDL. However, when triglycerides are only moderately elevated, a low-fat diet will increase them and may also decrease HDL levels.
Triglycerides do not cause complications until elevations of 1000 mg/dL or more are reached. There is a risk of chylomicronemia syndrome when levels are 800 mg/dL or higher. The syndrome causes recurrent episodes of abdominal pain that may be accompanied by nausea and vomiting. Extreme elevations of triglycerides, usually greater than 1000 mg/dL, may cause an inflammation of the pancreas (pancreatitis). The pancreas is the organ that makes insulin and substances to help digest food and pancreatitis is accordingly a serious disorder. People with hypertriglyceridemia are also at risk for fatty liver, the accumulation of fat in liver cells. Triglyceride levels of 4000 mg/dL or higher, may cause a condition known as lipemia retinalis, in which eye examination reveals retinal blood vessels that have a pale pink, milky appearance.
Women with elevated triglycerides before conception may develop severe hypertriglyceridemia with levels well above 1000 mg/dL, and the associated risk of pancreatitis. These women require counseling for diet, exercise, and weight management before becoming pregnant and should be monitored closely during their pregnancies.
The NCEP triglyceride recommendation of less than 150 mg/dL per day has recently been challenged. Cardiologists at the University of Maryland Medical Center have presented evidence that the recommended level may still represent a significant risk for heart disease. Their study suggests that less than 100 mg/ dL would be more appropriate.
American Heart Association. American Heart Association Low-Fat, Low-Cholesterol Cookbook, 3rd Edition: Delicious Recipes to Help Lower Your Cholesterol. New York, NY: Clarkson Potter, 2005.
Freeman, M. W., Junge, C. E. Harvard Medical School Guide to Lowering Your Cholesterol. New York, NY: McGraw-Hill, 2005.
Kowalski, R. E. The New 8-Week Cholesterol Cure: The Ultimate Program for Preventing Heart Disease. New York, NY: Collins, 2002.
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McGowan, M. P. 50 Ways to Lower Cholesterol. New York, NY: McGraw-Hill, 2002.
Mierzejewski, A. Bring Your Triglycerides Down Naturally: A Drug-Free Solution to High Blood Lipids. Peterborough, ON: Full of Health Inc., 2006.
American Heart Association (AHA). 7272 Greenville Avenue, Dallas, TX 75231. 1-800-242-8721. <www.americanheart.org>.
Center for Disease Control (CDC). Division for Heart Disease and Stroke Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341-3717. 770-488-2424. <www.cdc.gov/cholesterol/faqs.htm>.
National Heart Lung and Blood Institute (NHLBI). P.O. Box 30105, Bethesda, MD 20824-0105. 301-592-8573. <www.nhlbi.nih.gov>.
Nutrition.gov. USDA National Agricultural Library, Food and Nutrition Information Center, Nutrition.gov Staff, 10301 Baltimore Avenue, Beltsville, MD 20705-2351. <www.nutrition.gov>.
Monique Laberge, Ph.D.