A timely reminder of the value of dietary change for reducing TG levels, especially in patients with visceral adiposity, was provided by Dr Michael Miller (Crescenz VAMC/Hospital, University of Pennsylvania, Philadelphia, USA). Weight loss of 5-10% of body weight can reduce TGs by 20%, a Mediterranean-style diet (vs high carbohydrate diet) by 10-15% and the addition of EPA/DHA by 5-10% per gram,1 Miller told delegates. He pointed out that natural pancreatic lipase inhibitors that can reduce TGs by 10-30% include ground cinnamon, unsweetened baking chocolate, red kidney beans, hazelnuts, pecan and cranberries. Dietary sources of EPA include Atlantic herring, farmed salmon, anchovies and Atlantic mackerel.
Turning to exercise, Miller presented results of a meta-analysis of studies showing changes in TG levels ranging from -3.0 to -22.1 mg/dL, and the combination of diet and exercise leading to TG reductions of -3.0 to -30.9 mg/dL.2 Well developed skeletal muscle has been associated with upregulation of enzymes involved in TG hydrolysis.
Miller drew attention to the detailed dietary recommendations in the recent ACC consensus on ASCVD risk reduction in patients with persistent hypertriglyceridaemia related to sugar, fat and alcohol restriction, aerobic activity and weight loss.3
“We don’t want to just place our patients on medications and forget about the importance of therapeutic lifestyle. It’s critically important to assess diet and lifestyle especially in patients who are hypertriglyceridaemic,” Miller concluded.
References
- Miller M, Stone N, Ballantyne CM et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association Circulation. 2011;123:2292-333
- Kelley GA, Kelley KS. Comparison of aerobic exercise, diet or both on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials ClinNutr2012;31:156-167
- Virani SS, Morris PB, Agarwala A et al. 2021 ACC Expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia. J Am Coll Cardiol 2021; Aug, 78 (9) 960–993