Weight Loss and Diet, Not Drugs, Are the Focus of New Statement on Triglycerides, Reports Clinical Nutrition Insight

Newswise — Philadelphia, Pa. (October 24, 2011) – Recently revised guidelines have set a new optimal range for triglycerides. For most patients with higher than optimal levels, lifestyle changes, not medications, are recommended as the primary means to lower triglycerides and achieve better cardiovascular health, according to a special article in the November issue of Clinical Nutrition Insight. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

An update and summary by the authors of revised guidelines provides dietitians and other professionals with a valuable clinical perspective on how the new recommendations should influence clinical practice. The article was written by Michael Miller, MD, of the University of Maryland; Penny M. Kris-Etherton, PhD, RD, of Penn State University; and Neil Stone, MD, of Northwestern University. To maximize access to this important practice-changing information, this issue of Clinical Nutrition Insight will be freely available at www.clinnutrinsight.com.

Weight Loss and Specific Diet Changes Can Lower Triglycerides—Without DrugsIssued earlier this year, the revised guidelines garnered attention by lowering the upper limit for the "optimal level" of triglycerides from 150 to 100 mg/dL. In their article, Drs. Miller, Kris-Etherton, and Stone highlight the role of weight loss, exercise, and dietary changes in achieving healthy triglyceride levels.

Obesity is a key contributor to hypertriglyceridemia—especially fat accumulations in the visceral region (around the abdominal organs). The revised guidelines reflect triglyceride levels in people with low visceral fat, as well as the levels associated with a reduced risk of diabetes and cardiovascular disease. Research suggests that weight loss is highly effective in lowering triglyceride levels: every kilogram (2.2 pounds) of weight loss is associated with a 1.5 mg/dL (about 1.9 percent) reduction in triglycerides.

The guidelines also recommend specific dietary changes to lower triglycerides, including reducing intake of simple carbohydrates, increasing dietary fiber, and restricting fructose. Evidence also supports the use of marine-derived omega-3 fatty acids (fish oil) and following a Mediterranean-style diet. "Optimization of nutrition-related practices can result in a marked triglyceride-lowering effect that ranges from 20 percent to as high as 50 percent or greater," Dr. Miller and co-authors write.

The authors emphasize that the guidelines do not recommend medications to reach the lower triglyceride levels now designated as optimal. They note that some subsequent reports have misinterpreted the original statement, which read in part: "An optimal triglyceride cut point is only intended to define one physiological parameter of cardiometabolic health. It does not represent a therapeutic target."

That reflects a lack of definitive evidence that reducing triglycerides lowers cardiovascular risk beyond that achieved by cholesterol-lowering treatment. Triglyceride lowering remains an appropriate focus of drug therapy for patients with very high fasting triglyceride levels associated with a high risk of pancreatitis: 500 mg/dL or higher.

Dr. Miller and colleagues hope their article will promote a clear understanding of the updated guidelines, along with the evidence behind the new triglyceride targets and the recommendations for meeting them. They call for further studies to clarify the role of triglyceride-lowering treatment in reducing cardiovascular risk: especially in the borderline-high and higher range, between 200 and 500 mg/dL.

About Clinical Nutrition InsightClinical Nutrition Insight is a newsletter designed to serve the clinical nutrition needs of physicians, registered dietitians, dietetic technicians, and other health care professionals with an interest in nutrition-related disorders.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).

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