Manual of Clinical Nutrition

Hypertriglyceridemia

Manual of Clinical Nutrition Management III- 71 Copyright © 2013 Compass Group, Inc.

The ideal macronutrient composition for lowering triglyceride levels in patients who have
hypertriglyceridemia is unclear (Grade III) (2). The dietitian should refer to the ATP III guidelines for the
suggested nutrition and lifestyle interventions based on the triglyceride level and therapy goals (Grade II) (1,2). A
very low-fat diet (<15% of energy) in addition to lifestyle changes reduces triglyceride levles and the risk of
pancreatitis in persons who have very high triglycerides (> 500 mg/dL) (Grade II) (2).

Table III-19: Recommendations for Elevated Triglyceride Levels
Triglyceride Level ATP III Recommendations (1)
Borderline-high (150- 199
mg/dL)

 weight reduction

 increased physical activity

High (200-499 mg/dL) (^)  weight reduction
 increased physical activity
 drug therapy (LDL-lowering drugs and/or nicotinic acid or fibrates)
Very high (>500 mg/dL) (^)  very low-fat diet (<15% of energy intake) to prevent acute pancreatitis
 weight reduction
 increased physical activity
 drug therapy (LDL lowering-drugs and/or nicotinic acid or fibrates)
Elevated Triglycerides and Eicosapentaenoic Acid/Docosahexaenoic Acid (EPA/DHA) Supplements
High doses of supplemental EPA/DHA lower triglyceride levels in patients who have elevated triglycerides. If
a patient has a high triglyceride level (>200 mg/dL) that is refractory to other lifestyle therapies, physician-
prescribed supplemental EPA/DHA capsules (2 to 4 g) can be considered (Grade II) (2). Refer to the discussion of
omega-3 fatty acids in Section C: “Medical Nutrition Therapy for Disorders of Lipid Metabolism”.
*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.
References

1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection,
   Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285: 2486-2497.


2. Disorders in Lipid Metabolism Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence Analysis
   Library. Academy of Nutrition and Dietetics; 2011. Available at: http://www.andevidencelibrary.com. Accessed January 15, 2013.