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CMAJ • April 1, 2003; 168 (7)
© 2003 Canadian Medical Association or its licensors

Letters
Correspondance

Managing hypertriglyceridemia

Michelle A. Fung* and Jiri J. Frohlich{dagger}

*Clinical Fellow, Department of Endocrinology, Clinical Investigator Program, Vancouver, BC; {dagger}Professor, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC

We thank Kristen MacEachern and Joseph Mercola for their comments. We apologize for the error in our original article1 suggesting that hypertriglyceridemia be treated with a 10% fat diet (see correction in the Jan. 7, 2003, issue of CMAJ). The recommendation of a 10% fat diet was intended for treatment of chylomicronemia.

Mercola makes the valid point that low-fat diets generally lead to increases in fasting serum triglyceride levels. This issue has been extensively reviewed by Anderson and colleagues,2 who, using a formula developed by Mensink and Katan,3 calculated that depending on the presence or absence of fibre in a low-fat diet, there may be an increase of between 0.5 and 0.8 mmol/L in fasting serum triglycerides.

However, measured changes in fasting serum triglyceride levels, although small (less than 0.1 mmol/L), were in the opposite direction.4,5,6 Postprandial triglycerides decline with low-fat diets but increase with lower-carbohydrate, high-protein diets, which are higher in fat content.7 Postprandial remnant particles, particularly the triglyceride-rich particles, are the most atherogenic. This finding suggests that despite somewhat higher fasting serum triglyceride levels, the lower-fat diets may be preferable. In addition, if the sources of carbohydrates are foods with a low glycemic index (e.g., whole-wheat breads, cereals, grains and legumes) and if the amount of fibre in the diet is increased, these changes in triglyceride levels appear to have little clinical significance.

Another argument in favour of lower-fat diets is the epidemiologic data on the relation between diets higher in animal fats and risk of coronary artery disease. Lower-fat diets have been associated with a reduction in nonfatal cardiovascular events.8 Furthermore, there are indications that higher-fat diets may be associated with insulin resistance.9,10

Michelle A. Fung Clinical Fellow Department of Endocrinology Clinical Investigator Program Jiri J. Frohlich Professor Department of Pathology and Laboratory Medicine University of British Columbia Vancouver, BC

References

  1. Fung MA, Frohlich JJ. Common problems in the management of hypertriglyceridemia [published erratum appears in CMAJ 2003;168(1): 16]. CMAJ 2002;167(11):1261-6.[Free Full Text]
  2. Anderson J, Konz E, Jenkins D. Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr 2000;19:578-90.[Abstract/Free Full Text]
  3. Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 1992;12: 911-9.[Abstract/Free Full Text]
  4. Anderson J, Ward K. High-carbohydrate, high fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr 1979;32:2312-21.[Abstract/Free Full Text]
  5. Anderson J, Chen W, Sieling B. Hypolipidemia effects of high-carbohydrate diet, high-fiber diets. Metabolism 1980;29:551-8.[Medline]
  6. Anderson JW, Zeigler JA, Deakins DA, Floore TL, Dillon DW, Wood CL, et al. Metabolic effects of high-carbohydrate, high-fiber diets for insulin-dependent diabetic individuals. Am J Clin Nutr 1991;54:936-43.[Abstract/Free Full Text]
  7. Cohen J, Noakes T, Benade A. Serum triglyceride responses to fatty meals: effects of meal fat content. Am J Clin Nutr 1988;47:825-7.[Abstract/Free Full Text]
  8. Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002;360:1455-61.[Medline]
  9. OÍDea K, Traianedes K, Ireland P, Niall M, Sadler J, Hopper J, et al. The effects of diet differing in fat, carbohydrate, and fiber on carbohydrate and lipid metabolism in type II diabetes. J Am Diet Assoc 1989;89:1076-86.[Medline]
  10. Storlien LH, Kriketos AD, Jenkins AB, Baur LA, Pan DA, Tapsell LC, et al. Does dietary fat influence insulin action? Ann N Y Acad Sci 1997; 827: 287-301.[Medline]



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What is the optimal diet for prevention of coronary heart disease?
Michal R Pijak, et al.
CMAJ, 12 May 2003 [Full text]
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