Introduction: Hypertriglyceridemia (hyperTG) may increase the risk of cardiovascular disease and values above 1000 mg/dl are a risk factor for pancreatitis, including non-fasting measurements. The American Heart Association suggested that providers could use nonfasting triglycerides >200 mg/dl to identify hyperTG states. When an elevated result is observed, a fasting triglyceride measure may be reassessed, with exception for extreme levels (for example approximately 1000 mg/dl), when there is no need for repeat of fasting lipids prior to treatment.
Clinical case: Male, 41 years old, heavy smoker, medicated with prednisolone 5 mg/day for eczema, without other known diseases. Recent routine blood tests with hyperTG of 2714 mg/dl (with milky serum), hypercholesterolemia (388 mg/dl), without alteration of the hepatic profile, glycemia of 99 mg/dl and leukocytosis (11930×106/L). No family history of hyperTG. Asymptomatic, with no changes to the physical exam, with body mass index of 24.8 kg/m2. Copious meals and alcohol abuse in the past 2 days, although with fasting of 12 hours previous to testing. Reevaluation of blood tests 15 days later, after diet, alcohol restriction and maintaining prednisolone, the patient had no hyperTG (69 mg/dl), with hypercholesterolemia (213 mg/dl), hyperlipidemia (154 mg/dl), leukocytosis (15600×106/L), neutrophilia (9980×106/L), protein electrophoresis, total proteins and albumin without alterations, euthyroidism.
Discussion: Normally the triglyceride (TG) value reach a peak 3 to 6 hours after a high fat meal and declines to baseline after 10 hours of fasting. However, alcohol consumption increases the hepatic synthesis of fatty acids, decreasing their oxidation, leading to the production of TG. Thus, excessive alcohol consumption associated with high fat meals previous to blood tests may explain transient hyperTG in the first analytical evaluation. In addition, a concomitant dose of corticosteroids also increase TG, and the combination with alcohol consumption may have contributed to such a significant increase. In the second evaluation, the patient complied with low fat meals, avoiding alcohol consumption in the previous days, which may have contributed to TG value normalization without medication.
Conclusion: While some components of the lipid profile (total cholesterol and high-density lipoprotein cholesterol) are not affected by food, others, particularly the level of TG, may be. Although the risk for pancreatitis increases significantly with TG levels >1000 mg/dl, the background on which the measurement is done should be assessed, and if needed, TG levels should be reassessed, as shown.
18 May 2019 - 21 May 2019