What are the dietary and lifestyle recommendations for a 40-year-old woman with hypertriglyceridemia?

Dietary and Lifestyle Management for Triglycerides in the 200s

For a 40-year-old woman with triglycerides in the 200s (moderate hypertriglyceridemia), prioritize weight loss of 5-10% if overweight, eliminate added sugars and alcohol, increase physical activity to 150 minutes weekly, and consume fatty fish twice weekly—these lifestyle changes alone can reduce triglycerides by 20-50%. 1

Immediate Dietary Changes

Weight Management

• Target 5-10% body weight reduction if overweight, which produces a 20% decrease in triglycerides 1
• In some patients, weight loss can reduce triglyceride levels by up to 50-70% 1
• For every kilogram lost, triglycerides decrease by approximately 1.5-1.9 mg/dL 1

Sugar and Carbohydrate Restrictions

• Restrict added sugars to less than 6% of total daily calories 2, 1
• Eliminate all sugar-sweetened beverages completely 1
• Replace refined grains with fiber-rich whole grains 1
• Low-carbohydrate diets are more effective than low-fat diets for lowering triglycerides 1

Fat Intake Modifications

• Limit total fat to 30-35% of total daily calories 1
• Restrict saturated fats to less than 7% of total calories 2, 1
• Eliminate trans fatty acids completely 1
• Consume at least 2 servings per week (8+ ounces) of fatty fish (salmon, trout, sardines, anchovies) 2, 1

Alcohol Restriction

• Limit alcohol to no more than 1 drink per day 2
• Even 1 ounce of alcohol daily increases triglycerides by 5-10% 1
• For severe hypertriglyceridemia (≥500 mg/dL), complete abstinence is mandatory 1

Fiber and Protein

• Increase soluble fiber to greater than 10 grams per day 1
• Increase protein intake from lean sources, as higher-protein diets are associated with greater triglyceride reduction 1

Physical Activity Requirements

• Engage in at least 150 minutes per week of moderate-intensity aerobic activity (such as brisk walking) 2, 1
• Alternatively, 75 minutes per week of vigorous aerobic activity 1
• Regular aerobic exercise reduces triglycerides by approximately 11% 1
• If weight loss is needed, accumulate 60-90 minutes of moderate-intensity activity on most days 2

Additional Lifestyle Factors

Smoking Cessation

• Do not smoke and avoid environmental tobacco smoke 2
• Provide counseling and nicotine replacement if needed 2

Secondary Causes to Address

• Optimize glycemic control if diabetic, as poor glucose control is often the primary driver of elevated triglycerides 1
• Screen for and treat hypothyroidism 1
• Review medications that may raise triglycerides (thiazide diuretics, beta-blockers, estrogen therapy, corticosteroids) 1

When to Consider Medication

• If triglycerides remain above 200 mg/dL after 3 months of optimized lifestyle modifications, consider statin therapy if 10-year cardiovascular risk is ≥7.5% 2, 1
• Statins provide 10-30% dose-dependent triglyceride reduction 1
• Prescription omega-3 fatty acids (2-4g daily) can be added if triglycerides remain elevated despite statin therapy and lifestyle changes 2, 1

Monitoring Strategy

• Recheck fasting lipid panel in 6-12 weeks after implementing lifestyle modifications 1
• Target non-HDL cholesterol (total cholesterol minus HDL cholesterol) of less than 130 mg/dL 2
• Continue annual lipid monitoring once goals are achieved 1

Critical Pitfalls to Avoid

• Do not ignore secondary causes like uncontrolled diabetes or hypothyroidism, as treating these can dramatically reduce triglycerides independent of other interventions 1
• Do not substitute over-the-counter fish oil supplements for prescription omega-3 fatty acids if medication becomes necessary 1
• Do not delay lifestyle modifications while waiting for medication effects 1