Triglycerides are fatty molecules, which are composed of three fatty acids linked to a molecule of glycerol. They make up about 95% of the fats in our diet. After absorption, triglycerides are linked with protein inside the intestinal cells, to form chylomicrons, which are the transport form of these molecules. Chylomicrons carry triglycerides to the cells for use as fuel and for storage in fat cells.

High triglyceride levels are associated with a set of conditions, together called the ‘metabolic syndrome’. It comprises hyperglycemia, obesity in the abdominal area, hypertension, and low HDL (‘good cholesterol’) levels.

Triglycerides are used by the body as an efficient source of energy, but excessive amounts are carried to the fat cells for storage. High triglyceride levels are associated with low HDL levels, which are a risk factor for coronary heart disease because they promote atherosclerosis.

Causes of hypertriglyceridemia

• Obesity caused by habitual overeating leads to high triglyceride levels in blood in many cases.
• High carb diets are the worst offenders, especially when simple sugars are in excess, and in particular fructose, when it comes to pushing up triglyceride levels, in comparison to a high fat diet.
• Familial hypertriglyceridemia is caused by an autosomal dominant defect. It manifests in late puberty or early adulthood.
• Cirrhosis or liver disease resulting in liver damage.
• High carbohydrate diet especially if low in protein.
• Hypothyroidism, hyperglycemia, nephrotic syndrome.
• Medications – some diuretics, testosterone and estrogen, blood pressure lowering agents of some types.

Risk factors for hypertriglyceridemia

• The occurrence of a high triglyceride level is often associated with obesity, diabetes and high insulin levels, which aggravate the condition.
• Alcohol abuse
• The use of estrogen pills.
• Family history of hypertriglyceridemia.
• Family history of early heart attack (before the age of 50 years).
• Hypothyroidism

Complications

• High triglyceride levels cause arterial blockage, resulting in coronary heart disease, stroke and peripheral arterial disease.
• Pancreatitis can occur if the triglyceride level are very high.
• Obesity and diabetes are other complications.

Diagnosis

There are no symptoms of high triglyceride levels.  Diagnosis is by a blood test called the lipid profile, usually done after 8-12 hours of fasting. High triglyceride levels are often associated with high VLDL levels as well.

Prevention and Treatment

• Control factors which worsen the condition, such as alcoholism, obesity or high blood sugar.
• Quit smoking.
• One hour of physical exercise every day.
• Dietary modifications -  less sugar and animal fats, which are usually saturated, and push up cholesterol and triglycerides most of all kinds of fats,  more fruits and vegetables, to deliver soluble fiber, cholesterol less than 300 mg a day through the diet.
• Medication if triglyceride levels remain high despite lifestyle modification – with fibrates, niacin or gemfibrozil.
• Early detection by screening family members of a patient with familial hypertriglyceridemia, to ensure it is treated before complications arise.

References

• https://www.nlm.nih.gov/medlineplus/ency/article/000397.htm
• http://nature.berkeley.edu/hellerstein-lab/pdfs/MKH_COL_2002.pdf
• https://www.nlm.nih.gov/medlineplus/ency/article/003493.htm
• http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/EndocrinologyMetabolismDiabetes/clinical/Documents/Lipid_Brochure.pdf
• http://chfs.ky.gov/nr/rdonlyres/d33bac99-0423-4350-a0f2-6480fa812716/0/triglycerides.pdf