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American Journal of Clinical Nutrition, Vol 19, 84-98, Copyright © 1966 by The American Society for Clinical Nutrition, Inc.

Treatment of Hypertriglyceridemia

I. Total Caloric Restriction Followed by Refeeding a Low Carbohydrate, High Fat Diet in the Carbohydrate-Induced Type (Eight Cases) II. Low Fat Diet Plus Medium-Chain Triglycerides in the Fat-Induced Type (Two Cases)

P. K. REISSELL M.D.1, P. A. MANDELLA B.S.1, T. M. W. POON-KING M.D.1, F. T. HATCH M.D., PH.D.1, and L. M. HAGOPIAN B.S.1

1 From the Department of Medicine, Harvard Medical School, the Arteriosclerosis Unit, Medical Services, and the Dietary Department, Massachusetts General Hospital, Boston, Massachusetts

Clinical and laboratory characteristics are presented for eight patients presumed to have carbohydrate-induced hyperlipidemia and two brothers presumed to have an atypical form of fat-induced hyperlipidemia. The former patients presented a heterogeneous picture in which overweight, history of abdominal pain, hyperuricemia, low normal postheparin lipolytic activity and abnormal glucose tolerance were present in a majority of subjects. Elevation of serum triglyceride levels predominated over that of cholesterol and there was a marked increase of very low density lipoproteins and depression of agr1-lipoprotein. The latter patients exhibited marked hypertriglyceridemia with minimal symptoms and without positive physical signs. Although the postheparin lipolytic activity was low initially, the atypical feature of the disorder was the appearance of substantial postheparin lipolytic activity after the serum lipids had been reduced by treatment.

The patients with carbohydrate-induced hyperlipidemia were treated with a brief period of total caloric restriction, which went smoothly, followed by refeeding with a low carbohydrate, high fat diet at a caloric level slightly below the energy requirement. The combined regimen was rapidly and uniformly effective under research ward conditions in lowering the serum lipid and lipoprotein levels to slightly above normal. In two patients, the good response was maintained for more than a year at home, but extraordinary compliance with the regimen was required to prevent recurrence of hyperlipidemia. This difficult therapeutic procedure may be a way-station along the route to successful management of carbohydrate-induced hyperlipidemia.

The patients with atypical fat-induced hyperlipidemia were treated with a low fat diet supplemented by medium-chain triglyceride (MCT) oil. The treatment is not original to this study, but was highly successful in these patients.






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Copyright © 1966 by The American Society for Nutrition