Diet therapy is one of the recommended treatments for patients with hypertriglyceridemia. Hypertriglyceridemia usually correlates with a decrease of high-density lipoprotein (HDL) cholesterol and an increase of low-density cholesterol (LDL) levels. Hypertriglyceridemia is a risk factor for various diseases, such as pancreatitis and cardiovascular diseases. As one component of the management of hypertriglyceridemia and as part of lifestyle changes, Diet therapies need to be understood by doctors. Education about the number of calories and food selection is important to do in patients with hypertriglyceridemia. It can prevent disease progression.

Diet effects on hypertriglyceridemia

The wrong diet can raise triglyceride levels. Excessive consumption of fat and carbohydrates plays an essential role in increasing the body's triglyceride levels. Diets high in unsaturated fats (monounsaturated fat) have more effect on decreasing triglyceride levels compared to diets high in saturated fats because the influence of monounsaturated fat in insulin action decreases triglyceride production by the liver.

Fat and glucose metabolisms are closely related to each other. A high carbohydrate diet causes Impaired carbohydrate metabolism and can be followed by an increase in triglyceride levels. Increased triglyceride levels tend to be more common in diets high in carbohydrates with high glycemic index and low in fiber compared with food consumption with high fiber and low glycemic index. However, a high-fiber diet does not guarantee a decrease in triglyceride levels if the food consumed contains high levels of fructose because of fructose consumption associated with an increase in triglycerides, with an effect that only arises when fructose consumption reaches> 10% of daily calorie requirements.

In addition to fat and carbohydrate consumption, alcohol consumption also affects increasing triglycerides. In people with high triglyceride levels, small consumption of alcohol can raise triglyceride levels. In contrast, in healthy people, an increase in triglycerides usually occurs after alcohol consumption of 10 - 30 grams per day.

The Roles of Calorie Management in Triglyceride Levels

One of the therapeutic lifestyle changes to reduce triglyceride levels is weight loss. Obesity has been linked to an increased incidence of hypertriglyceridemia. The American Heart Association (AHA), the European Society of Cardiology, and the National Cholesterol Education Program recommend weight loss as one of the important lifestyle changes in reducing triglyceride levels. Calorie regulation is an effort that can be applied in terms of nutrition to lose weight.

As humans get old, individual calorie requirements will decrease. It can be seen from the basal metabolic rate (BMR), which measures the calorie needs of every kilogram of body weight per hour. BMR will decrease by about 5 kcal per day in women and 7 kcal per day in men. A decrease in BMR that is not followed by an adjustment in caloric intake per day will cause an increase in body weight. So that weight does not follow the reduction in BMR, calorie intake through diet must be reduced with or without an increase in energy output through activity. This principle also applies to patients with hypertriglyceridemia, where an increase in body weight affects the increase in body triglyceride levels.

AHA recommends reducing calorie intake, such as 50% of regular calorie intake in order to reduce the body's triglyceride levels. A study conducted by Normandin et al. on research subjects with metabolic syndrome by reducing calorie intake by 600 kcal from the total daily caloric needs of research subjects. The study found that increasing activity and exercise alone was not enough to reduce lipid profile levels. The study found that increased activity accompanied by calorie restriction had a positive effect in decreasing the lipid profile level of study subjects, including triglyceride levels.

Nutrition Compositions for Patients with Hypertriglyceridemia

In general, patients with hypertriglyceridemia are advised to reduce their consumption of carbohydrates and replace the type of fat consumed. The National Cholesterol Educational Program through the Adult Treatment Panel III (ATP-III) recommends patients with abnormal lipid profile levels to reduce saturated fats less than 7% of total calories and cholesterol less than 200 mg per day. The AHA recommends limiting fat consumption to 25 - 35% of total daily calorie needs. Regulation of fat consumption takes precedence in dietary therapy. Substitution of saturated fat into unsaturated fat is done with a composition of polyunsaturated fat with an amount of up to 10% of daily calorie needs and monounsaturated fat with an amount of up to 20% of daily calorie needs.

foods with monounsaturated fat include:
- Avocado
- Salad dressing made from oil and mayonnaise
- Nuts (like almonds, hazelnuts, peanuts)
- Olive
- Grains (pumpkin and sesame seeds)
- Margarine
- Vegetable oils (canola, olive, peanuts, safflower)

foods with polyunsaturated fat include:
- Fish (herring, bloating, salmon, trout, tuna)
- Salad dressing made from oil and mayonnaise
- Nuts (such as pine nuts and walnuts)
- Grains (flax, pumpkin, sesame seeds and sunflower seeds)
- Vegetable oils (corn, cotton seeds, soybeans, sunflowers)

In addition to regulating fat consumption, patients with hypertriglyceridemia need to regulate carbohydrate intake. ATP-III recommends that carbohydrate consumption not exceed 60% of daily calorie requirements. The European Society of Cardiology recommends reducing the consumption of simple carbohydrates or sugars in the form of monosaccharides, such as fructose, galactose, and glucose, and disaccharides, such as sucrose, lactose, and maltose, to lower the body's triglyceride levels.

The regulation of other nutrients is also important to reduce the body's triglyceride levels. ATP-III recommends consumption of 20-30 grams of fiber per day and protein about 15% of the total daily calorie needs. The substitution of daily foods into high-fiber foods can reduce patients' triglyceride levels by around 16.6%, while the substitution of protein sources from animal protein to vegetable protein in a patient's diet can reduce triglyceride levels by around 7.3%. Consumption of foods rich in omega-3, eicosapentaenoic acid, and docosahexaenoic acids, such as sardines, herring, and salmon, can reduce triglyceride levels by about 25% to 30%.

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