In a newly released scientific statement on triglycerides, the AHA recommends that 100 mg/dL replace 150 mg/dL as the upper limit for the “optimal level” for triglycerides. But, the statement acknowledges, the cut point should not be used as a therapeutic target for drug therapy, “because there is insufficient evidence that lowering triglyceride levels” can improve risk. Instead, the statement puts a large emphasis on lifestyle changes, especially with diet and exercise, to cut triglycerides and reduce risk.
The new statement “is not intended to serve as a specific guideline,” according to the AHA, but instead “will be of value” to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program, which will be available for public review and comment this fall and is expected to be published in the spring of 2012.
“The good news is that high triglycerides can, in large part, be reduced through major lifestyle changes,” said the chair of the committee, Michael Miller, in an AHA press release. “In contrast to cholesterol, where lifestyle measures are important but may not be the solution, high triglycerides are often quite responsive to lifestyle measures that include weight loss if overweight, changes in diet and regular physical activity.”
The statement includes specific recommendations for reducing added sugar, fructose, saturated fat, trans fat, and alcohol for those with elevated triglycerides. According to the statement, 31% of US adults have triglyceride levels greater than 150 mg/dL.
Here is the AHA press release:
Dietary, lifestyle changes can significantly reduce triglycerides
- Diet and lifestyle changes that include substituting healthy fats for unhealthy saturated and trans fats, engaging in regular physical activity and losing excess weight can reduce triglycerides – a blood fat – by 20 percent to 50 percent.
- New clinical recommendations include reducing the optimal triglyceride level from <150 mg/dL to <100 mg/dL, and performing non-fasting triglyceride testing as an initial screen.
DALLAS, April 18, 2011 — Dietary and lifestyle changes significantly reduce elevated triglycerides (a type of blood fat) — which is associated with heart, blood vessel and other diseases — according to an American Heart Association scientific statement.
Changes such as substituting healthy, unsaturated dietary fats for saturated ones, engaging in physical activity and losing excess weight can decrease triglycerides by 20 percent to 50 percent, according to the statement’s authors. The statement is published in Circulation: Journal of the American Heart Association.
“The good news is that high triglycerides can, in large part, be reduced through major lifestyle changes,” said Michael Miller, M.D., chair of the statement committee and professor of medicine in epidemiology and public health and director of the Center for Preventive Cardiology at the University of Maryland School of Medicine in Baltimore.
“In contrast to cholesterol, where lifestyle measures are important but may not be the solution, high triglycerides are often quite responsive to lifestyle measures that include weight loss if overweight, changes in diet and regular physical activity.”
Miller and co-authors analyzed more than 500 international studies from the past 30 years to formulate the scientific statement.
Recommended dietary changes for those outside the normal range of triglycerides include limiting:
- added sugar to less than 5 percent to 10 percent of calories consumed – about 100 calories per day for women and 150 calories per day for men.
- fructose from both processed foods and naturally occurring foods –less than 50 to 100 grams per day
- saturated fat to less than 7 percent of total calories
- trans fat to– less than 1 percent of total calories; and
- alcohol, especially if triglyceride levels are higher greater than 500 mg/dL
The amount of added sugars is not listed on the Nutrition Facts Panel of packaged foods, so it is hard to know exactly how much added sugar is in food. Because the majority of added sugar consumed by Americans comes from sugar-sweetened beverages, the American Heart Association recommends drinking no more than 36 ounces of sugar-sweetened beverages per week, based on a 2000-calorie-per-day diet. People with high triglycerides should also focus on eating more vegetables, fruits lower in fructose such as cantaloupe, grapefruit, strawberries, peaches, bananas, high fiber whole-grains and “healthier” unsaturated fats, especially omega-3 fatty acids found primarily in fatty fish like salmon, herring, sardines, lake trout, and albacore tuna.
All patients with triglyceride levels in the borderline to high range (150-199 mg/dL) or greater are also encouraged to incorporate physical activities of at least moderate intensity (such as brisk walking) for a total of at least 150 minutes per week, because these activities may contribute an additional 20-30 percent triglyceride-lowering effect. Combining all of these lifestyle measures is likely to have the most pronounced effect – 50 percent or greater in reducing triglyceride levels.
Triglyceride testing involves a simple blood sample, traditionally taken after a 12-hour fast. The authors suggest using non-fasting triglyceride testing as an initial screen. Although the cutoff for elevated triglycerides remains at 150 mg/dL, a new optimal level of 100 mg/dL has now been set to acknowledge the protective benefit of lifestyle in metabolic health. However, it is not a target for drug therapy because there has not been adequate study to show that drug therapy to lower triglycerides to this level is helpful. Many people can reduce their triglycerides as well as other metabolic risk factors such as blood sugar and blood pressure with diet, weight loss and increased physical activity.
“Triglycerides are an important barometer of metabolic health,” said Neil J. Stone, M.D., co-chair of the statement and professor of medicine in the Feinberg School of Medicine at Northwestern University in Chicago. “When the clinician sees an elevated triglyceride level, there needs to be an important conversation about risk factors and the need to eat less, eat smarter, and to move more on a daily basis to improve triglycerides and the metabolic profile.”
In the United States, nearly one-third (31 percent) of adults have elevated triglyceride levels (more than 150 mg/dL). The percentage varies by ethnicity, and is highest among Mexican-Americans at 36 percent. Whites have the second-highest rate at 33 percent, while blacks have the lowest at 16 percent. Of concern is that triglyceride levels continue to rise in young adults (aged 20-49) and this mirrors the increased rates of obesity and diabetes identified at earlier ages.
Co-authors are Christie Ballantyne, M.D.; Vera Bittner, M.D.; Michael H. Criqui, M.D., M.P.H.; Henry N. Ginsberg, M.D.; Anne Carol Goldberg, M.D.; William James Howard, M.D.; Marc S. Jacobson, M.D.; Penny M. Kris-Etherton, Ph.D., R.D.; Terry A. Lennie, Ph.D., R.N.; Moshe Levi, M.D.; Theodore Mazzone, M.D. and Subramanian Pennathur, M.D.
Author disclosures are on the manuscript.