From the Guidelines
Low triglyceride levels in a 20-year-old generally don't require specific treatment unless they're extremely low (below 40 mg/dL) or accompanied by symptoms. For most young adults with mildly low triglycerides, no intervention is necessary as this can be a normal variant or even beneficial for cardiovascular health, as suggested by observational studies and clinical trials that have consistently demonstrated the lowest risk of incident and recurrent CVD in association with the lowest fasting triglyceride levels 1. If the patient is experiencing symptoms like fatigue or has extremely low levels, I recommend a nutritional assessment and possibly increasing healthy fat intake through foods like avocados, nuts, olive oil, and fatty fish. Underlying causes should be investigated, including malnutrition, malabsorption disorders, hyperthyroidism, or certain medications. A comprehensive metabolic panel, thyroid function tests, and nutritional assessments may be warranted. Low triglycerides themselves aren't typically harmful but may indicate an underlying condition requiring attention. Triglycerides are fat molecules that serve as an energy source for the body, and their levels naturally fluctuate based on recent meals, exercise, and metabolic factors. Most clinical concern focuses on elevated triglycerides rather than low levels, as high triglycerides are associated with cardiovascular risk, as outlined in the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 2, 3. Key considerations include:
- Investigating underlying causes of low triglycerides
- Assessing for symptoms and adjusting diet accordingly
- Monitoring for potential cardiovascular risk factors
- Following guidelines for management of blood cholesterol levels.
From the Research
Implications of Low Triglycerides
The implications of low triglycerides in a 20-year-old are not explicitly discussed in the provided studies. However, some studies discuss the risks associated with high triglyceride levels and the treatment options for hypertriglyceridemia.
Risks Associated with High Triglyceride Levels
- Hypertriglyceridemia is associated with an increased risk of cardiovascular disease 4, 5, 6
- Severely elevated triglyceride levels increase the risk of pancreatitis 4
- High triglyceride levels are a marker of atherogenic small dense LDL and excess baseline and residual cardiovascular disease risk even after statin therapy 6
Treatment Options for Hypertriglyceridemia
- Dietary changes and physical activity to lower cardiovascular risk 4
- Lowering carbohydrate intake and increasing fat and protein intake can lower triglyceride levels 4
- Moderate- to high-intensity physical activity can lower triglyceride levels 4
- Medications such as statins, fibrates, omega-3 fatty acids, and niacin can be used to lower triglyceride levels 4, 5, 6
Low Triglyceride Levels
- One study discusses a case of excessively low cholesterol and triglyceride levels in an apparently healthy patient, which was found to be due to analytical interference by vitamin C 7
- There is no discussion of the implications of low triglyceride levels in a 20-year-old in the provided studies.
Calculation of LDL-Cholesterol
- A new equation for calculation of low-density lipoprotein cholesterol in patients with normolipidemia and/or hypertriglyceridemia has been developed, which can accurately calculate LDL-C levels in patients with TG levels up to 800 mg/dL 8