High triglycerides in children
- High triglycerides is a reflection of obesity and high glycemic load in children as is true in adults. Triglyceride level goes up almost 20 years before one becomes diabetic and maybe considered a strong precursor and predictor of diabetes.
- In children with elevated triglycerides (TG), reduction of simple carbohydrate intake and weight loss are associated with decreased TG levels. Reduction of simple carbohydrate intake needs to be associated with increased intake of complex carbohydrates and reduced saturated fat intake.1
- When TG elevation is associated with obesity, decreased calorie intake and increased activity levels are of paramount importance. The CHILD 2 -TG diet is recommended as the primary diet therapy in this setting.1
- Children with fasting levels of TG 200 to 499 mg/dL after a trial of lifestyle/diet management should have non-HDL recalculated and be managed to a goal of < 145 mg/dL. Those with non-HDL > 145 mg/dL, after a trial of lifestyle/diet management and increased fish intake, may be considered for fish oil supplementation.1
- Medication therapy is rarely needed for children with elevated TG who respond well to weight loss and lifestyle changes. When TG levels exceed 500 mg/dL, patients are at risk for pancreatitis and require care in consultation with a lipid specialist. In adults, use of omega-3 fish oil has been shown to lower TG by 30–40 percent and to raise HDL by 6–17 percent. Experience with fish oil in children is limited to small case series with no safety concerns identified.1
- Children with average fasting levels of TG > 500 mg/dL or any single measurement > 1,000 mg/dL related to a primary hypertriglyceridemia should be treated in conjunction with a lipid specialist; the CHILD 2 TG diet should be started and use of fish oil, fibrate, or niacin to prevent pancreatitis should be considered.1
Sources
1. Daniels SR. Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Report from NHLBI.Bethesda,http://www.nhlbi.nih.gov/guidelines/cvd_ped/