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jeudi 1 décembre 2011

TRIGLYCERIDES IN 20 QUESTIONS

Triglycerides in 20 Questions

Triglycerides and cholesterol are two different types of fats and which are not manufactured in the same way.
Triglycerides accumulate in the blood, especially when you eat too much sugar and amounts in general among those who have too much fat in the abdomen.
Excess cholesterol is due to bad eating habits by eating too much "bad fat".

Table des matières






 LES AUTEURS



Salim Djelouat
Professor Medical Analyses and Medical bacteriology / Scientific Author / knolAuteur
Krishan Maggon
Consultant Pharmaceutical Biotechnology R&D & Advisor, Geneva, Switzerland & New York, USA
Knol Publishing Guild (KPG)
Serving the publishing aspirations of Knol writers, Planet Earth









    In addition to the cholesterol blood transports another type of lipid: triglycerides.    
    Triglycerides are formed in the small intestine from fats absorbed from food and in the liver. 
   
    Study of cholesterol and triglycerides are two completely different but complementary studies and their determination is not interchangeable contrary at what is happening today, or the doctor replaces either cholesterol triglyceride or vice versa and or in the clinical laboratories due to a lack of reagents.  
    
    This interchangeability determination, done at the expense of the sick and wrong interpretation of results. We will try by the same set of questions and answers to give you the essential  facts to know about triglycerides.

Structure of Triglycerides

Glycerol  + free fatty Acids  = Monoglycerides   1 fatty acid attached
                                            DiGlycerides        2 fatty acids linked
                                            Triglycerides        3 fatty acids attached

Fatty acids     Stearic acid
                     Oleic acid
                      Palmatic acid



Triglycerides 2010



Role in       Energy depot
                   Cell Wall
                   Regulatory Pathways

                   Obesity
                   CAD-Atheroscelrosis
                   Metabolic Syndrome
                   Pancreatitis
                   Hyperchylomiconemia
                   Dyslipidemia         
 



File:Fat triglyceride shorthand formula.PNG
     Hydrophilic                                  Hydrophobic

Palmitic acid, 
Oleic acid
alpha Linolenic acid                    Triglycerides


http://www.cardioconnection.org/frameWork.aspxcnt=dyslipidemia/triglycerides/triglycerides                                                                                                                                                           Structures of Some common lipids

http://upload.wikimedia.org/wikipedia/commons/thumb/2/20/Common_lipids_lmaps.png/450px-Common_lipids_lmaps.png



Self organization of lipids layers with Hydrophilic layer outside

http://upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Phospholipids_aqueous_solution_structures.svg/250px-Phospholipids_aqueous_solution_structures.svg.png

                                                                                   
 
 
 
American Heart Association

Causes of Hypertriglyceridemia


Genetic/Inherited Familial

Chylomicronemia
Dysbetalipoproteinemia
Hyperlipidemia
Hypertriglyceridemia

Diseases

Diabetes
Renal failure
Hyperthyroidism
HIV
Pregnancy
Obesity

                   CAD-Atheroscelrosis
                   Metabolic Syndrome
                   Pancreatitis
                   Hyperchylomiconemia
                   Dyslipidemia 

Life style

Diet rich in carbohydrates and fats
Sedantary life style 
Alcohol       


Treatment


Weight loss
Regular exercise
Healthy diet low in sugars and fats

Drugs

Fibrates    gemfibrozil
               fenofibrate

Niacin
NIASPAN®, Niacin Extended-Release Tablets
Fish oil Omega 3
Statins

Crestor - rosuvastatin calcium

American Council on Exercise
http://www.acefitness.org
American Diabetes Association
http://www.diabetes.org
American Dietetic Association
http://www.eatright.org
This professional association provides a listing of local dietitians and information on diet and nutrition.
American Heart Association
http://www.americanheart.org
Calorie Control Council
http://www.caloriecontrol.org
National Cholesterol Education Program (National Heart, Lung, and Blood Institute)
http://www.nhlbi.nih.gov/about/ncep/index.htm
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/index.htm
.

US Department of Health and Human Services
http://www.pueblo.gsa.gov
Vascular Disease Foundation
http://www.vdf.org

                            

01 - What is the difference between triglycerides and cholesterol?

    Triglycerides and cholesterol are two different types of fats and which are not manufactured in the same way.
    Triglycerides accumulate in the blood, especially when you eat too much sugar and amounts in general among those who have too much fat in the abdomen and are major contributors to obesity and bigger waistlines.
    Excess cholesterol is due to bad eating habits by eating too much "bad fat".
 

02 - What are triglycerides? 

    Triglycerides constitute the bulk of dietary lipids and body fat stored in adipose tissue.
    Those are the body fat and energy reserves for emergency.

 

03 - What is the role of triglycerides in the body?      

    Triglycerides are the energy source of the body, because as fats, they are rapidly metabolized.    
    So the extra energy we eat is stored as triglycerides.
    Their second main role is to transport fat-soluble vitamins (vitamins A, D, E and K) in the blood.
    Triglycerides are fats essential for the proper functioning of the body and cell membranes .
 

04 - Where do the triglycerides come from?

    Triglycerides are produced by the liver, but also come with fats we eating.  In a meal rich with fats like Swiss fondu or raclette, the fat we eat is first converted to small particles called chylomicrons or very low density lipoproteins (proteins+lipids). These in turn are converted to low density lipoproteins or LDL.
    
    They move in the blood serum or they move together with specific proteins, different according to their origin:
    •  chylomicron triglycerides for foodborne or VLDL (Very Low Density Lipoproteins, lipoprotein very low density), 
    • and their derivatives, triglycerides produced in the liver from glucose. 
 
    These "fats" from degradation by the liver of sugar absorbed in excess. 

    The scheme will thus eliminating their food (or at least limiting them). 

Image from (fair use)



 

05 - What causes the increase of triglyceride levels?

    Their increase, often linked to diabetes unknown or badly treated, or an excess of sugars or alcohol consumption can very often regress after correction of these causes. 
 

YouTube Video

 

06 - What is the risk of an excessive rate of triglycerides?

    An excessive rate of triglyceride is a risk to health. When high triglycerides is accompanied by elevated VLDL, it is called endogenous hypertriglyceridemia.

    This type of hypertriglyceridemia is directly associated with cardiovascular disease, except for women aged 20 to 50 years.

    However, this discrete elevation of triglycerides causes: 
    • overweight (obesity)
    • Diabetes and prediabetes
    • A low HDL 
    • pancreatitis (inflammation of pancreas)
    
    A hypertriglyceridemia may facilitate the occurrence:

    • cardiovascular as myocardial infarction.
    • or the ischaemic stroke in addition,
 
    Furthermore, chronic kidney disease may develop following hypertriglyceridemia.  

 
Atherosclerosis
 


07 - How  are triglycerides dosed or measured?

    Methods for determination of triglycerides methods are all based on the determination of the glycerol released by hydrolysis of triglycerides.   
    It should be noted that the determination of triglycerides expression is most often inappropriate since the vast majority of techniques for determination plasma total glycerol including free glycerol


08 - Determination of triglycerides?

    The determination of triglycerides is called: triglycéridémia 

09 - Why your doctor ask for triglycerides determination?

    This determination is requested in a cardiovascular diseases prevention approach.    
    It allows the screening (often) the dyslipidémia, allows you to specify the diagnosis in order to better assess the cardiovascular risk of an individual, and is useful to follow-up on the hypolipémiants treatments (which aim to standardize rates of lipids in the blood).  
 

10 - Do you know your triglyceride level?

    Triglyceride levels in serum is included:
    • In men:           between:  0.45  and  1.75 g/l  or  between  0.5 and 2   mmol/l. 
    • In Women:      between:  0.40  and  1.60 g/l  or  between  0.4 and 1.6 mmol/l. 

 
             AGE       WOMEN            MEN
       0 -   4 years 0,35 - 1,20 mmol/l 0,3 5 - 1,10 mmol/l
       4 -   9 years 0,40 - 1,25 mmol/l 0,35 - 1,20 mmol/l
      10 - 14 years 0,40 - 1,55 mmol/l 0,35 - 1,50 mmol/l
      14 - 19 years 0,45 - 1,45 mmol/l 0,40 - 1,80 mmol/l
        >  20 years 0,40 - 1,50 mmol/l 0,50 - 2,10 mmol/l
 
  

11 - How high triglycerides, should you worry?

    Rising blood levels of triglycerides in excess of 1,50 g/liter is a risk factor for cardiovascular disease.  
 
 

12 - How to detect the triglycerides excess?

    Only an analysis of blood to detect an abnormal triglyceride value.     
    The determination of triglycerides can be part of the lipid, balance sheet as may be prescribed alone or in combination with the cholesterol.    
    Triglyceride must be dosed within the hour following the meal. 




 

13 - Why it is preferable to the determination of triglycerides after an hour of taking a meal?

    Triglycerides, derived from our body by transforming foods rich in sugars and starches, are the first fats into our bloodstream and disappear within four hours. 
    So far, this rate was generally ignored by clinicians. 
    They were focused on cholesterol, "said Borge Nordestgaard professor of medicine at Herlev University Hospital and author of the study conducted in Denmark (2007). 

The market success of Statins and industry role in emphasis on cholesterol led to ignoring the importance of triglycerides/. There is no approved drug which can reduce the levels of Cholesterol, triglycerides and free fatty acids at the same time.
 

14 - What are the precautions necessary to conduct the assay? 

     It is imperative to conduct the sampling period of habitual diet and distance: 
    • pregnancy 
    • an acute illness (including an infection or heart attack) 
    • without any medication recently and in particular: 
                - By antihypertensive drugs (diuretics, beta blockers)
                - Taking estrogen-progestin (high-dose estrogen)
                - Certain anti-inflammatory (corticosteroids)

 

15 - How to interpret the result?

    The triglycerides in the blood vary with age and sex (it increases with age and is higher in men after age 20 years).
    However, rates vary depending on factors which are:
 
  • the sex: In humans, triglycerides rises steadily until age 40 years then stabilizes, while among women it remained stable until age 45 years, and increases after menopause.
  • vary according to age (increasing with age) 
  • body weight: increase in obesity "android" (obesity of "upper body" with increased waist circumference  >40 inches or >100 cms)
  • the feeding (increase in diets rich in sugars and consumption of alcoholic beverages)
  • consumption of tobacco and especially alcohol facts raise triglycerides 
  • Pregnancy is marked by a progressive elevation of triglycerides, net beyond the 28th week of amenorrhea, which averaged 2.75 mmol / l at term.
                In post-partum return to the basal value requires 4 to 8 weeks.

                    - Taking some oral contraceptive
containing of estrogen.
                    - In certain diseases
: diabetes, hyperuricemia and kidney diseases.
  
 

16 - For what type of diet food "anti" triglycerides?

    For an excess weight, it would be desirable to maintain a healthy to normal weight.    
    Often, the mere fact of losing weight can reduce triglycerides at a normal rate.

    a - lower consumption of edible fats:
    a weight control diet regime is the best way to reduce your rate of triglycerides.
    The consumption of edible fats may not exceed 30 % of the total energy intake of the day.
    Consume more of olives, oil of sunflower, soybean oil or oil nut oil (if find you it on the market).
    Fish (especially salmon oil) oils are recommended.
    Eat whole grain (full bread, complete rice) green vegetables and fresh fruit
 

    b - Avoid consume sugar-rich products:
    The simple carbohydrates (sweets, sugar and other sweets), are largely responsible for High triglyceride levels. 

    c - The following products are to be consumed in very small quantities: white sugar, jam, syrup, frozen, honey, chocolate, chewing sweet, ordinary soft drinks, fruit, condensed milk, pastries, puddings, biscuits drinks sweet, Sweet cereals.    
    A total abstention from alcohol shall return the triglycerides at a normal rate.
 

    d - Slim silhouette:
    Losing weight is very important.
    The amount of weight you should lose depends on your ideal weight, but it is not necessary to lose excess weight to see a decrease in triglycerides.  

    e - Burn calories:
    Exercise, 1 pm and 3 times a week, is reducing the rate of triglycerides. 

    f - consumed fish:
    A person who regularly eat fish shouldn't have a problem.     
    Include fish (especially fatty fish *) to the menu at least 2 or 3 times a week.     
    Rich in omega-3 polyunsaturated, fish have a beneficial effect to lower the rate of triglycerides in the blood.     
    Fatty so-called fish are, inter alia, salmon, trout, swordfish, sardines, mackerel... 

    g - Foods not recommended are:
  • Dairy products: milk gelled yogurt with fruit, sweetened condensed milk, puddings.
  • Breads: croissant, brioche bread, brioche,
  • Dessert: white sugar, brown sugar, honey, cakes, pastries, biscuits, chocolate products, marzipan, fruit jellies, ice creams, sorbets. Fruit in syrup or applesauce, dried fruits: figs, prunes, dates ... candied or dried fruit jams.
  • Seasonings: Vinegar (contains alcohol), mayonnaise Trade, sweet sauces (ketchup, ..).
  • Drinks: Soda (Coke, Schweppes ....), Lemonade, fruit juice trade, syrups, chocolate breakfast, drink milk, vanilla, caramel, chocolate, all alcohol.
  • Consume sugar in moderation to slow absorption: potatoes, rice, pasta, dried vegetables. 




YouTube Video


 

17 - Everyone talks about 3 omegas, what is just?

    3 Omegas’ are like 6 polyunsaturated fatty acids, omegas.     
    They are part of the "" good fats", i.e. that they protect the heart of the myocardial partly."    
    It is the low level of cardiovascular disease in the old (big fish poppers) Eskimo discovery that permits to causal relationship to effect.       

    3 Omegas’ include 3 different molecules:
 

    • The ALA (alpha-linolenic acid),
    • ( ecosapantenoic acid) EPA
    • DHA (Docosahexaenoic or cervonic acid) 

    These 3 omégas are exclusively made by power, because they are not summarized by the body.     
In addition to their cardiovascular impact 3 omegas are one of the important constituents of the brain (20 % of fats) and the nervous system (40 %).    
    Human breast milk is rich in omega 3 of all species.  This wealth varies however depending on the power of the mother.    
    3 Omegas’ are vital to brain development of the child and make an argument in favor of breastfeeding because the current maternise milk if they are rich in ALA, are poor in DHA due to technical problems.    
    This involvement in nerve structures could also have a bearing on the retina, structure rich in omega-3 and therefore on the AMD (degeneration macula ire related to age, blindness provided), on senile dementia (reduced risk of 34 % for consumers of fish once a week), and possibly on depression.
3 Omégas are used in cardiovascular prevention after a myocardial and hypertriglycéridémies because of one gram per day in the form of gélule.     
    They do however provide not other treatments.    
    The nutritional intake ALA 2 g/day in humans is a good idea either 2 tablespoons oil rape or nuts (1.60 g/day in women).    
    For DHA 100 - 120 mg /jour (250 mg per day if pregnant or breast-feeding) for a good nutritional balance must also be a diet rich in fruit and vegetables.

18 - Or find the oméga3? 

    A - for ALA (acid Alph-linolenic) omégas: 
    • vegetable oils: rape (the richest and the cheapest), nuts, soy (more of Omega 6)
    • the Cretan pourpier (kind of difficult to find watercress)
    • the regrowing (240 mg / 100 g),
    • salad spinach
    • the rabbit, goose, the horse, wild game or snails!

    B - For EPA and DHA omega:
    • Fish and seafood, especially sardines, herring and mackerel
    • The cold sea fish

    The content varies depending on the origin, species and season.
 
    For farmed fish (eg: salmon), same problem for the chickens, depending on diet and omega 3 can vary from 1 to 40!
    C - For the three types of omega (ALA, EPA and DHA):
    • Eggs: yellow and it only depends on feeding the chickens: wild herbs, flaxseed.
    • Cow's milk and butter but it still depends on feeding the cow 
The mass harvesting of thee omega 3 and 6 from Sea Weeds, algae, krill and plankton strips the sea and oceans of nutrients for the sea life and fishes on top of overfishing.

 

19 - What is the body mass index (BMI) or Body Mass Index (BMI)?

    It is a Belgian scientist among the founders of modern statistics, Lambert Adolphe Jacques Quetelet, who invented the body mass index to determine their weight status. 
    Thus, according to the index if we know we need to lose weight and how much.
    The calculation of body mass index does not take into account information such as:

    • the frame (if it is light or heavy)
    • muscle
    • fat distribution
   
    And it is for these reasons that the calculation of this index is considered incomplete.
    The BMI calculation must be done between 18 and 65 years and it is not indicated for:

    • pregnant women
    • the nursing
    • In most sports
    • among amputees
    • in patients with severe disease.


20 - What is the body mass index?

    The body mass index is a measure commonly used to determine overweight.
    The definition by the WHO of a healthy weight is a BMI between 18.5 and 24.5.
    A BMI over 25 kg/m2 is defined as overweight and a BMI of over 30 as obese while a BMI of 16 defines severe thinness.
    Both conditions, severe thinness and severe obesity are live threatening conditions.
    BMI     Weight in Kg/ Height in meters2
    With a Weight 100 Kg and Height  2 meters  ie 100/4=25
    BMI= 25


Lipid storage Disease
Lipid accumulation in AIDS patients after HIV protease inhibitor or tritherapy treatment

Coenzyme Q10
Omega 3, 6
DHA
Satiety role
bile, bile acids
glycolipids
liposaccharides

There is another good knol on the same subject



Metabolic syndrome and lipid abnormalities Images from

































































 
 
 
 
 
 
 

Causes of Hypertriglyceridemia


Genetic/Inherited Familial

Chylomicronemia
Dysbetalipoproteinemia
Hyperlipidemia
Hypertriglyceridemia

Diseases

Diabetes
Renal failure
Hyperthyroidism
HIV
Pregnancy
Obesity

 CAD-Atheroscelrosis
Metabolic Syndrome
Pancreatitis
Hyperchylomiconemia
Dyslipidemia 

Life style

Diet rich in carbohydrates and fats
Sedantary life style 
Alcohol       


Treatment


Weight loss
Regular exercise
Healthy diet low in sugars and fats

Drugs

Fibrates    gemfibrozil
               fenofibrate

Niacin



NIASPAN®, Niacin Extended-Release Tablets
Fish oil Omega 3
Statins

Crestor - rosuvastatin calcium
 

Web Links



American Council on Exercise
http://www.acefitness.org
American Diabetes Association
http://www.diabetes.org
American Dietetic Association
http://www.eatright.org
This professional association provides a listing of local dietitians and information on diet and nutrition.
American Heart Association
http://www.americanheart.org
Calorie Control Council
http://www.caloriecontrol.org
National Cholesterol Education Program (National Heart, Lung, and Blood Institute)
http://www.nhlbi.nih.gov/about/ncep/index.htm
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/index.htm
.

US Department of Health and Human Services
http://www.pueblo.gsa.gov
Vascular Disease Foundation
http://www.vdf.org



 

 



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