Definition and Overview

Contrary to popular belief, fats—and many of its types—are not entirely bad. In fact, they are important for metabolism and the regulation of body temperature, among others. One of these fats is triglycerides.

Triglyceride is one of the types of blood lipids, along with cholesterol. Also present in both plants and animals, it is formed by combining one molecule of glycerol and three molecules of fatty acids. Although it is also produced by the body via the liver, it is acquired in more amounts through food, wherein fats and carbohydrates are converted into triglyceride.

The main purpose of triglyceride is to store extra energy called calories. Calories are needed by the body’s cells to perform their normal functions.

When a person eats food, the carbohydrates are broken down and converted into glucose, which should be absorbed by the cells as fuel. Those that cannot are then converted into fat and are stored as triglycerides and kept in adipose tissues and fat cells.

If the body requires extra fuel due to a calorie deficit, the pancreatic lipase, an enzyme that holds the bond of molecules, breaks down triglycerides, eventually releasing the fatty acids. The broken-down fatty acids are then synthesized through the duodenum and small intestine, and delivered to different cells through the bloodstream.

For many years, however, triglycerides have been constantly linked to a variety of disorders including metabolic syndrome and heart disease. The exact problem is elevated triglyceride levels, a condition called hypertriglyceridemia. The body does not need a lot of blood lipid to function properly, which means cholesterol and triglycerides should be kept to a minimum. In fact, the normal range is no more than 150 mg/dL (milligrams per deciliter). The American Heart Association, meanwhile, considers 100 as the best number. It is still unclear, though, how this type of blood lipid boosts the risk of heart disease.

Causes of Condition

Many factors can lead to the increase of triglycerides level in the body and these include the following:

  • Diet - A diet that is composed of too much fat (especially trans fat), carbohydrates, and sugar is one of the common culprits of high triglyceride levels. Because of their very high calories, the body stores more fat.

  • Lack of exercise – A sedentary lifestyle, including sitting for prolonged periods of time, also increases the risk since the body is not maximizing its stored calories or fuel.

  • Metabolic syndrome – this is characterized by the appearance of many different types of conditions and symptoms that are associated with metabolism and fat storage. These include increased blood pressure, elevated bad cholesterol (low-density lipoprotein), high blood glucose, and high triglyceride.

  • Obesity – One of the classic signs of a metabolic syndrome is obesity. Now described as a very complex disorder, obesity is measured in many different ways including weight, body mass index, and waist-to-hip ratio. More specialists prefer the waist-to-hip ratio to determine obesity since they view central obesity (also known as visceral obesity), or fats that accumulate in the abdomen to be the most dangerous. Aside from being close to the vital organs that are necessary for metabolism, such as the liver and the pancreas, they also secrete their own hormones that can disrupt the normal metabolic process.

  • Medications – Certain medications especially those with steroids and birth control pills have been shown to increase weight.

  • Excessive alcohol – Most alcohol contain copious amounts of sugar, which is then broken down into glucose. When not in use, it is stored as fat.

  • Heredity - Hypertriglyceridemia can be familial or hereditary and can be due to a genetic defect. People with this disease tend to have a very high bad cholesterol level and are at a higher risk of developing a cardiovascular disease.

Key Symptoms

In general, an elevated triglyceride level does not exhibit any symptoms unless the problem is genetic, in which fatty deposits may become visible on the skin surface. Other symptoms, which are not specific to the condition, include nausea, pain in the belly, fever, and in most cases, acute pancreatitis.

Who to See and Treatments Available

A GP can diagnose a high triglyceride level through a series of tests such as:

  • APOE genotyping for those who have familial hypertriglyceridemia
  • Lipid profile test to assess different types of fats present in the blood
  • Fasting blood sugar to determine how effective the body is in synthesizing blood glucose
  • Triglyceride test to measure the level of triglyceride

All of these tests can be performed by simply drawing a blood sample from the vein. Fasting may be necessary in certain exams. A triglyceride level of 200 and above is already considered as high.

The best way to control triglycerides is to make lifestyle changes such as:

  • Cutting back on calories
  • Increasing the level of physical activity (e.g., walking for at least 30 minutes a day)
  • Replacing traditional fat with healthy ones such as polyunsaturated and monounsaturated
  • Avoiding or significantly cutting back on alcohol and smoking
  • Maintaining a healthy diet that is low in carbohydrates, fat, and sugar
  • Increasing intake of omega-3 fatty acids

If the triglyceride level is already very high (more than 500 mg/dL), the doctor may recommend medications that can be taken in combination with lifestyle changes. These drugs are called statins that reduce the risk of heart disease and stroke by as much as 35%. Although these medications are meant to lower bad cholesterol, they are just as effective in controlling triglyceride levels.

References:

  • Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2011;123:2292-2333

  • Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S; American Heart Association Clinical Lipidology, Thrombosis, and Prevention Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease. Circulation. 2011 May 24;123(20):2292-333. doi: 10.1161/CIR.0b013e3182160726. Epub 2011 Apr 18. No abstract available.

  • Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 213.

  • Stone NJ, Robinson JG, Lichtenstein AH, Goff DC Jr, Lloyd-Jones DM, Smith SC Jr, et al. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med. 2014 Mar 4;160(5):339-43.

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