Manual of Clinical Nutrition

Manual of Clinical Nutrition Management III- 70 Copyright © 2013 Compass Group, Inc.

HYPERTRIGLYCERIDEMIA

Discussion

Elevated serum triglyceride levels are positively correlated with the risk for coronary heart disease (1). This
relationship is complex and may be explained by the association between high triglyceride levels, low levels
of high-density lipoprotein (HDL) cholesterol, and unusually atherogenic forms of low-density lipoprotein
(LDL) cholesterol. A high triglyceride level may also reflect an increased level of triglyceride-rich
lipoproteins, known as very low-density lipoproteins, which have atherogenic effects (1).

The National Cholesterol Education Program Adult Treatment Panel III (ATP III) developed a classification
system for triglyceride levels to facilitate cholesterol management. The classification system and guidelines
for cholesterol management are presented in “Medical Nutrition Therapy for Disorders of Lipid Metabolism”
in Section IC (1).

Triglyceride Category Serum Triglycerides (mg/dL)

Normal <150

Borderline-high 150 - 199

High 200 - 499

Very high > 500

Causes of hypertriglyceridemia include:
 obesity
 excessive alcohol intake
 uncontrolled type 1 diabetes mellitus
 type 2 diabetes mellitus (degree often parallels obesity)
 nephrotic syndrome
 thiazide diuretics
 beta adrenergic blocking agents
 hypothyroidism
 chronic renal disease
 obstructive liver disease

Nutrition Assessment and Diagnosis

Medical nutrition therapy is indicated in patients who have triglyceride levels greater than 150 mg/dL (Grade
III)* (1,2). As part of the nutrition assessment, the patient’s lipid panel, which includes total cholesterol, LDL
cholesterol, and HDL cholesterol, should be comprehensively evaluated. Individuals who have
hyperlipidemia secondary to familial disorders or other diseases such as diabetes often have borderline-high
or high triglyceride levels (1). Causes of hypertriglyceridemia should be evaluated and nutrition intervention
targeted to promote optimal nutrition and metabolic outcomes. Complementary drug therapy that includes
LDL-lowering medications, fibrates, or nicotinic acid is indicated to prevent acute pancreatitis or abdominal
pain when triglyceride levels are very high (> 500 mg/dL) (1).

Nutrition Intervention (1-2)

An energy-controlled, cardioprotective dietary pattern that avoids extremes in carbohydrate and fat intake,
limits alcohol and refined sugar, increases the intake of complex carbohydrates, and includes physical activity
should be used for patients who have elevated triglycerides (> 15 0 mg/dL) (Grade III) (2). Weight loss of 7% to
10% of body weight should be encouraged, if indicated. Lifestyle changes that lower triglyceride levels
include (Grade III) (2):
 control of body weight
 diet low in saturated fat and cholesterol
 regular exercise
 limiting alcohol intake
 restriction or dietary modification of simple and refined sugars