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Lifestyle disorders

The fat of the matter

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You might already know that the lifestyle of most urban Indians - characterised by lack of physical activity, long hours spent sitting at desks and predominantly high fat diets - is fuelling the country's diabetes and heart disease epidemics. But what do you know of hypertriglyceridemia? Of increased triglyceride levels in the blood being a silent killer too? Because, as experts point out, triglycerides affects both your heart and the pancreas, while high cholesterol primarily affects only the heart.

Triglycerides are fatty substances produced by the liver. As the food you eat is either used or stored, extra calories get rapidly converted into such triglycerides. Large amounts can mean trouble in many cases. Which is why America's Endocrine Society recently recommended screening adults for hypertriglyceridemia (hTG) every five years.

The society states that hTG is a common disorder in the US caused or exacerbated by uncontrolled diabetes, obesity and sedentary habits. A paper, 'Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline', in the September 2012 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM) further lays bare the how and why. It says that the most common reasons for high triglycerides include metabolic syndrome, type 2 diabetes, being overweight, not exercising and 'familial combined hyperlipidemia' (where elevated cholesterol levels are deduced to have also been inherited).

All of this results in high triglyceride levels, high LDL (low-density lipoprotein, or 'bad cholesterol) and low HDL (high-density lipoprotein, or 'good cholesterol' ). "There is increasing evidence that high triglyceride levels represent a cardiovascular risk and in addition, are a risk factor for pancreatitis, " said Lars Berglund of the University of California and chair of the task force that authored these guidelines. The recommendations also say, "Diagnosis of hypertriglyceridemia should be based on fasting triglyceride levels and not on non-fasting triglyceride levels. Individuals found to have any elevation of fasting triglycerides should be evaluated for secondary causes of hyperlipidemia. Treatment should be focused on such secondary causes. "

The guidelines also add: "Patients with primary hypertriglyceridemia should be assessed for other cardiovascular risk factors, such as central obesity, hypertension, abnormalities of glucose metabolism and liver dysfunction. Clinicians should evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk. "

Indians probably need to be more careful. As Dr Anoop Misra of Delhi's Fortis hospital points out, "Liver is the primary factory for triglyceride production and Indians are known to suffer from fatty liver due to their high fat diet. Hence triglyceride levels are particularly high in the Indian race. We are also seeing people as young as 20 suffering from hypertriglyceridemia. My recommendation is therefore to start checking for hypertriglyceridemia at 20 years of age and every three years. Indians with high triglyceride levels and low HDL (or good cholesterol ) face an increased risk of heart disease and pancreatitis. "

Earlier studies have also shown that high levels of triglycerides and not low-density lipoprotein (LDL, or the 'bad cholesterol' ), could be the reason why so many Indians suffer from strokes.

A 33-year long study by Danish researchers showed, for the first time, that increased levels of non-fasting triglycerides are associated with an increased risk of ischemic stroke in both men and women. But higher cholesterol levels were associated with greater stroke risk in men only, and that too if their LDL was double what it should be.

Guidelines may have to be changed, as current ones on stroke prevention have recommendations on desirable cholesterol levels, but not on non-fasting triglycerides. The Danish study - published in Annals of Neurology - is very important for India, as the country is expected to report 1. 6 million cases of stroke annually by 2015. The Indian Council of Medical Research estimates that there were 9. 3 lakh cases of stroke and 6. 4 lakh deaths in 2004;and most of those victims were less than 45 years of age.

Says Dr Kameshwar Prasad, professor of neurology at AIIMS, Delhi, "This is a very important finding. However, the cholesterol and stroke risk data is very strong because we have seen how lowering cholesterol levels reduces cases of stroke. The same has to be demonstrated by lowering non-fasting triglyceride levels and seeing if that reduces stroke numbers for it to become clinching evidence. This data is important for Indians known to have high triglyceride levels. "

Experts also say there are often no symptoms of hypertriglyceridemia, and it is not noticed until the victim develops pancreatitis. All seem to agree on preventive measures, however.

Exercise, avoiding alcohol and fatty foods, and watching the calories are the best ways to combat elevated triglyceride levels. Alcohol especially, say experts, further increases triglyceride levels and may cause unwanted interactions with medications prescribed.

"Follow a low-fat, high fiber diet to lower triglyceride levels and reduce your weight. Carbohydrates can be either simple (such as fruit and sugar) or complex, (such as pasta and cereals). These have a great impact on blood sugar levels, are full of calories, and can turn into fats. Your diet should be about 50 per cent carbohydrates. Avoid unnecessary calories from sugar, " says one expert.

"Your diet should consist of 20 per cent protein. Avoid red meats, fatty or fried foods (like fried fish or fried chicken). Increase fresh vegetables and fiber intake - up to 55 grams of fiber per day is recommended. Fiber and fresh vegetables help to decrease blood cholesterol levels, and help maintain regular bowel habits, which also helps prevent certain cancers, " adds another.

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