High triglyceride life style modification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

In patients with hypertriglyceridemia dietary management can be initiated before or in combination with triglyceride lowering medications. Lifestyle modification with dietary control, exercise, smoking cessation and decrease in alcohol consumption helps in weight reduction. The weight loss in turn results in a mild-to-moderate decrease in triglyceride levels (about 22%) and an increase in HDL cholesterol (about 9%)

Dietary management

• In patients with triglyceride levels of > 1000 mg/dL a restriction of fat intake to no more than 10% of total calories intake should be tried. Fat restriction helps by causing weight loss and decreasing triglyceride (chylomicron and VLDL) levels.

• However, fat restriction should be done judiciously in patients of hypertriglyceridemia because of the following:
  • In overweight patients with moderately increased triglycerides, a very low-fat diet may inversely increase triglycerides and decrease HDL levels.
  • Sometimes in patients with isolated triglyceride elevation and stable weight, a further increase in triglyceride levels occur when started on low fat diet. In these groups of patients, addition of a monounsaturated or polyunsaturated fat lowers triglycerides and LDL-c and increases HDL-c.

• Dietary measures that can be helpful are-
  • Restricting the amount of simple carbohydrates (like fructose present in non-diet soda, fruit-juice, and corn syrup), as it can lead to postprandial hypertriglyceridemia
  • Decrease intake of foods rich in saturated fat and replace them with complex carbohydrates dietary fiber and monounsaturated and polyunsaturated fats
  • Avoiding large quantities of fruit juice and non-diet soda
  • Omega-3 fatty acids (fatty fishes with high Omega-3 fatty acids like sardines, herring, and mackerel) help in lowering triglycerides levels. When consumed in large amount > 10 g/d (1 pound of fish by weight) or if taken as capsule form, it can lower triglyceride by 40% or more.

Physical activity

• Current guidelines suggest for regular moderate-intensity physical activity for at least 30 minutes continuously at least 5 days/week, ideally all days in the week.

• A recent study indicated that cardiovascular exercise was therapeutic in approximately 31% of cases. The most probable benefit was to triglyceride levels, with 43% showing improvement; conversely 91% of test subjects did not exhibit a decrease in fasting plasma glucose or insulin resistance.

• Patients who have restrictions in performing exercises can reduce weight by following dietary modifications and daily walking schedule.

Cigarette smoking

Cigarette smoking is a risk factor for premature coronary disease and can shift the occurence by 10 years. Smoking cessation is associated with improvement in lipid levels despite the weight gain that often follows it.

Alcohol

Some studies have shown a reduced risk of atherosclerotic diseases with alcohol consumption. However, it may increase the risks for hypertension and stroke (haemorrhagic). Moderate alcohol intake (2 drinks/day for men and 1 drink/day for women) can be considered acceptable.

References

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