- This is done ideally on fasting serum of the patient. Venous blood is taken.
- Fasting for 12 to 14 hours is required.
- Plasma with EDTA can be used.
- The sample is stable at 4 °C for 7 days and at -20 °C for 3 months.
- If plasma is used then multiply the result by 1.03.
- Patients must have at least fasting for 12 hours.
- If TG in male > 160 mg/dL and female > 135 mg/dL then two more samples should be done in next 6 to 8 weeks.
- Intake of the fatty meal may increase the TG.
- Alcohol intake increases the TG.
- In pregnancy, the TG level is raised.
- Take H/O drubs like oral contraceptive and estrogen increase the TG level.
- Take H/O ascorbic acid, clofibrate and colestipol decrease the TG level.
- This is done to evaluate the cases of atherosclerosis (Coronary artery disease).
- This is done to evaluate the turbid serum (milky).
- Triglyceride is part of lipid profile.
- Triglyceride advised in a patient with suspected fat metabolism disorder.
- TG consists of three fatty acid + one molecule of glycerol by ester bond, so called as Triglycerides.
- Glycerol and fatty acids building block for TG.
- Three fatty acids + one molecule of glycerol (ester bond) = Triglyceride
- TG is present in the blood and transported by the VLDL and LDL.
- Glucose must be present in the cells for the formation of TG.
- There is Triglyceride formation by the glycolytic pathway in the glucose catabolism.
- This triglyceride formation may be absent in case of:
- Uncontrolled diabetes mellitus.
- TG when catabolized, it forms a small fraction of free fatty acid which appears in plasma bound to albumin.
- These nonesterified fatty acids after oxidation enter the Acetyl CoA cycle.
- The end result is water, CO2, and ATP which is the source of energy.
- TG is the fat in the bloodstream.
- TG accounts for more than 90 % of the food intake and is 95% of the fat stored.
- TG is insoluble in water and these are the main glycerol ester.
- TG is stored in adipose tissue as :
- Fatty acids.
- The liver is the factory to converts all above into triglycerides.
Metabolism of Triglyceride in hepatocyte
- One of the sources gives the following ratio of triglycerides in various fats.
- TG are Transported and present in :
- 80 % are in VLDL.
- 15 % are in LDL.
- TG is the source of energy.
- When TG is high then starts depositing in fatty tissue.
- Source of Triglyceride:
- Plants contain polyunsaturated fatty acids.
- Animal source contains mostly saturated fatty acids and solid at room temperature.
- The Fredrickson-levy classification method for hyperlipidemia: Keep the plasma at 4 C refrigerate for 16 hours and then made an observation of the creamy layer at the top of turbidity.
- This can be completed by doing a lipid profile.
|| Male mg/dL
|| Female mg/dL
| Cord blood
||13 to 95
||11 to 76
| 0 to 9 year
||30 to 100
||35 to 110
| 10 to 14 year
||32 to 125
||37 to 131
| 15 to 19 year
||37 to 148
||39 to 124
| 20 to 24 year
||44 to 201
||36 to 131
| 25 to 29 year
|| 46 to 249
||37 to 144
|30 to 34 year
||50 to 266
||39 to 150
|35 to 39 year
||54 to 321
||40 to 176
|40 to 44 year
||55 to 320
||45 to 191
|45 to 49 year
||58 to 327
||46 to 214
|50 to 54 year
||58 to 320
||52 to 233
|55 to 59 year
||58 to 286
||55 to 262
|60 to 64 year
||58 to 291
||56 to 239
||55 to 260
||60 to 240
- To convert into SI unit x 0.0113 = mmol/L
- Recommended cutoff point for evaluating triglyceridemia status:
- Normal = <250 mg/dL
- Borderline high = 250 to 500 mg/dL
- Hypertriglyceridemic = >500 mg/dL
- High risk for pancreatitis = >1000 mg/dL
- Male Adult = 40 to 160 mg /dL.
- Female Adult = 35 to 135 mg /dL.
|| Male mg/dL
|| Female mg/dL
|0 to 5 years
||30 to 86
||32 to 99
|6 to 11 years
||33 to 108
||35 to 114
|12 to 15 years
||36 to 138
||41 to 138
|16 to 19 years
||40 to 163
||40 to 128 mg
Critical values are:
- Desirable = < 150 mg /dL.
- Borderline high = 150 to 199 mg /dL.
- High = 200 to 499 mg /dL.
- Very high = > 500 mg /dL.
- Critical value >400 mg/dL
Triglycerides concentration according to the National cholesterol education program adult treatment panel (NECP-ATP II).
||Serum Triglyceride mg/dL
||200 to 400
||400 to 1000
Increased Triglycerides values are seen in:
- Nephrotic syndrome.
- Liver diseases.
- Alcoholism (alcoholic cirrhosis).
- Diabetes Mellitus, uncontrolled.
- Glycogen storage disease (Von Gierke disease).
- Familial hypertriglyceridemia.
- Anorexia nervosa.
- Down’s syndrome.
- Myocardial infarction.
Decreased Triglycerides level is seen in:
- Congenital α-β- lipoproteinemia.
Management of Hypertriglyceridemia:
- If Triglycerides is < 200 mg/dL then the person needs diet control and he should be advised to repeat triglyceride once a year.
- If Triglycerides is 200 to 500 mg/dL then evaluate the patient with risk factors like:
- Diabetes mellitus
- Medication like beta blockers, Estrogen, corticosteroids, oral contraceptives.
- Diseases like kidney, pancreatitis.
- No above risk factors in a person need only diet control
- Positive above risk factors and family history in a person needs diet and medication
- Critical value If triglyceride is >500 mg/dL in a person then these patients needs diet control and medication.
Table showing the summary of characteristics of the lipoproteins
|Size (diameter nm)
||4 to 10
||19.6 to 22.7
||25 to 70
||α - region
||β - region
||Pre - β region
||0.4 to 30 x 109
||3.6 x 109
||2.75 x 109
||5 to 10 x 109
||Intestine and liver
||Liver and intestine
|Composition by weight in %
| Cholesterol esterified
||11 to 14
| Cholesterol unesterified
||5 to 8
||44 to 60
||20 to 23
||4 to 11
Possible References Used
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