What is the evidence supporting the reduction of saturated fats and refined carbohydrates in the management of hypertriglyceridemia (elevated triglycerides)?

From the Guidelines

Reducing saturated fats and refined carbohydrates is a crucial dietary approach for managing hypertriglyceridemia, as it can help lower triglyceride levels and reduce the risk of cardiovascular disease. According to the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease, reducing saturated fat intake to less than 6% of total caloric intake and optimizing carbohydrate intake can help improve cardiovascular health 1. This can be achieved by limiting saturated fat intake to less than 7% of total daily calories and minimizing consumption of refined carbohydrates, particularly those with high glycemic index.

Some key points to consider when implementing this dietary approach include:

• Avoiding foods like fatty meats, full-fat dairy, fried foods, white bread, pastries, sugary beverages, and processed snacks
• Focusing on consuming lean proteins, omega-3 rich fish (2-3 servings weekly), whole grains, fruits, vegetables, and healthy fats from sources like olive oil, avocados, and nuts
• Weight loss of 5-10% of body weight through caloric restriction and regular physical activity (150 minutes of moderate exercise weekly) can further reduce triglyceride levels by 20-30%
• Limiting alcohol consumption is also essential, as alcohol significantly impairs triglyceride clearance from the bloodstream and stimulates hepatic triglyceride production

The 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia also supports a diet that is low in simple and refined carbohydrates and saturated fats, and high in soluble fiber 1. Additionally, the Endocrine Society's 2013 guidelines on the diagnosis and management of hypertriglyceridemia recommend reduced intake of dietary fat and simple carbohydrates in combination with drug treatment to reduce the risk of pancreatitis in patients with severe to very severe hypertriglyceridemia 1.

Overall, reducing saturated fats and refined carbohydrates is a cornerstone dietary approach for managing hypertriglyceridemia, and should be implemented in conjunction with other lifestyle modifications, such as weight loss and regular physical activity, to help reduce triglyceride levels and improve cardiovascular health.

From the FDA Drug Label

Patients should be placed on an appropriate lipid-lowering diet before receiving fenofibrate tablets and should continue this diet during treatment with fenofibrate tablets. The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy.

The reduction of saturated fats and refined carbs is implied as part of a lipid-lowering diet for the management of hypertriglyceridemia, but the label does not explicitly state this. However, it does mention that dietary therapy is the initial treatment for dyslipidemia and that patients should be placed on an appropriate lipid-lowering diet before receiving fenofibrate tablets 2.

• Key points to consider in the management of hypertriglyceridemia include:
  • Dietary therapy
  • Addressing excess body weight and excess alcoholic intake
  • Physical exercise as an important ancillary measure
  • Treating diseases contributory to hyperlipidemia, such as hypothyroidism or diabetes mellitus.

From the Research

Reduction of Saturated Fats and Refined Carbs in Hypertriglyceridemia Management

• The management of hypertriglyceridemia involves dietary changes, including the reduction of saturated fats and refined carbohydrates, to lower cardiovascular risk 3.
• Lowering carbohydrate intake, especially refined carbohydrates, and increasing fat and protein intake can help lower triglyceride levels 3.
• Lifestyle modifications, such as reducing intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are effective ways to lower triglyceride levels 4.
• Dietary modification is an important aspect of managing hypertriglyceridemia, and correcting secondary causes, such as obesity and uncontrolled diabetes, is crucial before starting drug treatment 5.

Importance of Lifestyle Changes

• Lifestyle changes, including improved diet and increased physical activity, are effective triglyceride-lowering measures 6.
• Moderate- to high-intensity physical activity can lower triglyceride levels, improve body composition, and exercise capacity 3.
• Calculating a patient's 10-year risk of atherosclerotic cardiovascular disease is essential to determine the role of medications in managing hypertriglyceridemia 3.

Pharmacological Treatment

• Pharmacological treatment usually starts with statins, although associated triglyceride reductions are typically modest 6.
• Fibrates, niacin, and long-chain omega-3 fatty acids can be used to reduce triglyceride levels, especially in patients with severely elevated triglyceride levels 6, 7, 4.
• High-dose icosapent (purified eicosapentaenoic acid) can reduce cardiovascular mortality in patients with high triglyceride levels despite statin use 3.