Managing Hypertriglyceridemia with Diet Modifications/IN REPLY/EDITOR'S NOTE

摘要

Since the publication of the National Cholesterol Education Program (NCEP) final report in 2002, there have been six quality randomized controlled trials published showing the superiority of carbohydrate-controlled dieting over low-fat dieting in the management of triglyceride levels.2-6 In head-to-head comparisons with low-fat diet groups, carbohydrate-controlled groups consistently resulted in equal or superior weight loss. [...] for patients with lower degrees of triglyceride elevation (between 200 and 499 mg per dL [2.26 to 5.64 mmol per L]) the current treatment guidelines emphasize low-density lipoprotein (LDL)-cholesterol as the main target of therapy, followed by non-high-density lipoprotein cholesterol.1 The overwhelming literature on the benefit of statins recommends it as a first-line option in patients with no contraindications who are at moderate to high cardiovascular risk and have elevated LDL cholesterol levels. Two of the articles he cites involve severely obese patients randomized to carbohydrate-controlled diets or more traditionally recommended low-fat diets.4-5 Patients randomized to the low-fat diet, on average, failed to significantly alter their diets to reach the NCEP recommended goal of less than 30 percent of daily calories from fat.4-5 Another article compared patients in various dietary programs, but did not directly compare carbohydrate-controlled diets with a low-fat diet.6 Only one of these trials had a randomized group with hypertriglyceridemia at baseline (defined as greater than 200 mg per dL).4 Research suggests that the response to low-fat versus carbohydrate-controlled diets varies with the degree of hypertriglyceridemia, such that patients with lower degrees of triglyceride elevation respond more to a carbohydrate controlled diet, whereas patients with more pronounced triglyceride elevations respond more to a low-fat diet.2 A low-carbohydrate approach in the management of hypertriglyceridemia in certain patient populations is promising and should be studied further.