Approach to Triglyceride Management in Youth
Ambika P Ashraf, MD, FAAP, FNLA
University of Alabama at Birmingham
Hypertriglyceridemia management in Youth depends on the etiology and serum level of triglycerides. Severe hypertriglyceridemia is usually due to monogenic mutations causing loss of function of the LPL complex (familial chylomicronemia syndrome), and rarely from secondary causes (multifactorial chylomicronemia). Severe hypertriglyceridemia can cause pancreatitis. Mild to moderate hypertriglyceridemia is polygenic which manifests in the presence of secondary factors such as insulin resistance, obesity, diabetes, or drugs. These patients present with combined hyperlipidemia (i.e., elevated triglycerides, low HDL, and elevated LDL) and have an increased risk for CVD. These patients require intense lifestyle management with avoidance of simple sugars, treatment of insulin resistance with weight loss, and statins if the non-HDL is persistently elevated. Triglyceride lowering agents (omega 3 fatty acids or fibrate) are used when serum triglyceride is >400 mg/dL to prevent pancreatitis. Patients with severe hypertriglyceridemia requires strict dietary fat restriction.