Dietary Fat Restriction Research Articles

Protective effects of dietary PUFA against chronic disease: evidence from epidemiological studies and intervention trials

This review considers evidence for a protective effect of PUFA on chronic disease. Estimates of PUFA intakes in prospective cohort studies are usually based on FFQ or biomarkers of intake. Cohort studies suggest that both linoleic and linolenic acid intake are associated with a lower risk of CHD. The intake of fish, the major source of long-chain n-3 PUFA is associated with a lower risk of both stroke and CHD, particularly sudden cardiac death. No relationship with common sites of cancer (breast and colon) and PUFA has been found. However, some recent studies suggest an association of high intakes of n-3 PUFA with risk of prostate cancer. An updated Cochrane review of dietary fat modification (replacing SFA with PUFA) randomised controlled trials to prevent CHD found a 14% lower incidence and a non-significant 7% lower mortality from CHD. The effects of an increased intake of n-3 PUFA on CHD incidence mortality have been tested in patients with pre-existing CHD in randomised controlled trials. Meta-analysis of these trials showed no overall benefit on total mortality or CVD incidence but a trend for lower risk of cardiac death was 0·91 (95% CI 0·85, 0·98). At present, there is little evidence from other trials demonstrating the clear benefits or harm from increased intakes of PUFA. In conclusion, present evidence intakes benefit from partial replacement of SFA with a balanced mixture of n-6 and n-3 PUFA which may contribute to CVD prevention.

Maldigestion from pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency (PEI) is one of the long-term consequences of chronic pancreatitis (CP). Majority of patients with PEI were undiagnosed or undertreated. Inadequately treated or subclinical severe PEI causes malnutrition and may pose the patients at risk of premature atherosclerosis and cardiovascular events. Indication of pancreatic enzyme replacement therapy (PERT) is patients with severe PEI, as indicated by the presence of steatorrhea, diarrhea, weight loss, fecal fat > 7 g/day, (13) C-mixed triglyceride breath test < 29%, fecal elastase < 100 ug/g stool, imaging or endoscopic findings of pancreatic ductal dilatation or calculi, and eight endosonographic criteria of CP. The mainstay treatment of PEI is PERT. Dietary fat restriction is unnecessary. PERT with lipase > 40,000 U per meal is recommended. Enteric-coating may be preferred to conventional enzymes because of the availability of high-dose preparations and no need of acid suppression co-therapy. Administration of enzymes with meals is proven to be the most effective regimen. Response to PERT should be measured by the improvement of patients' symptoms, nutritional status, and, in selected cases, by fecal fat or (13) C-mixed triglyceride breath test. Patients unresponsive to PERT should be checked for compliance, increase the dose of lipase to 90,000 units/meal or co-therapy with proton pump inhibitor. In patient with previous gastrointestinal surgery that may interfere enzyme-food mixing, opening the capsules and administering the enzyme granules with meals. Finally, search for small intestinal bacterial overgrowth syndrome and other causes of small bowel malabsorption.

Development of a transgenic mouse for hepatitis C virus core protein-induced liver disease

Development of a transgenic mouse for hepatitis C virus core protein-induced liver disease

Seven-Day Caloric and Saturated Fat Restriction Increases Myocardial Dietary Fatty Acid Partitioning in Subjects with Impaired Glucose Tolerance

We recently found increased myocardial partitioning of dietary fatty acids associated with subclinical ventricular dysfunction in subjects with impaired glucose tolerance (IGT+). These metabolic and functional myocardial abnormalities were significantly improved following an individually tailored 1-year lifestyle intervention leading to weight loss. The aim of the present study was to determine the effect of a 7-day dietary caloric (–500 kcal/day) and saturated fat (<7% of caloric intake) restriction (LowCal) vs. a 7-day isocaloric diet (Control), in random order with a washout period of at least 10 days in between, on myocardial dietary fatty acid partitioning in IGT+ subjects determined using our positron emission tomography coupled with computed tomography (PET/CT) method with the fatty acid analog 18-Fluoro-6-thia-heptadecanoic acid (18FTHA) during a standard liquid meal. Eight IGT+ subjects (3M/5W) have completed the study thus far. Postprandial 18FTHA activity in circulation was not significantly different between the 2 interventions. Myocardial 18FTHA mean standard uptake value (SUV) after 6 hours was increased in LowCal vs. Control (2.4±0.2 vs. 1.9±0.2, p=0.05). Organ-specific partitioning of dietary fatty acids was not significantly changed in the liver, subcutaneous adipose tissue or skeletal muscles in the LowCal vs. Control diet, but tended to be increased in visceral adipose tissue (0.9±0.7 vs. 0.7±0.4, p=0.07). Our preliminary results suggest that a low-calorie, low-fat diet does not explain by itself the normalization of organ-specific dietary fatty acid partitioning associated with a lifestyle-based weight loss intervention in IGT+ subjects.

Weight Loss Is More Important Than the Diet Type in Improving Adiponectin Levels Among Overweight/Obese Adults

Objective: The study objective was to compare the effect of a standard calorie- and fat-restricted diet (STD-D) and a calorie- and fat-restricted lacto-ovo-vegetarian diet (LOV-D) on total and high-molecular-weight (HMW) adiponectin levels after 6 months of behavioral intervention. Design: This study is an ancillary study to a randomized clinical trial. Subjects: Subjects included 143 overweight/obese adults (STD-D = 79; LOV-D = 64). Intervention: Both groups received the same standard behavioral intervention; the only difference was that LOV-D participants were instructed to eliminate meat, poultry, and fish from their diet. Measures: Weight, dietary intake with the 3-day food diary, and total and HMW adiponectin levels were measured. Results: Both groups significantly increased total (STD-D +7.2 ± 17.8%; LOV-D +9.4 ± 21.8%) and HMW adiponectin levels (STD-D +18.5 ± 32.9%; LOV-D +15.8 ± 34.5%; ps < 0.05) with no significant differences between the groups. We found significant associations between weight loss and increases in total (β (SE) = −.071(.27); p = 0.003) and HMW adiponectin (β (SE) = −1.37(.47); p = 0.001) levels independent of the diet type. Weight loss at the higher quartile was associated with improvements of adiponectin levels (p < 0.05). Conclusion: Weight loss was associated with increased total and HMW adiponectin levels regardless of the diet type. Enhancing weight loss may be a means to improve adiponectin levels.

Review of the evidence for the potential impact and feasibility of substituting saturated fat in the New Zealand diet

To estimate the potential impact on cardiovascular health of modifying dietary intake of saturated fat across the New Zealand population, and whether this would be appropriate and feasible. First, a literature review of meta-analyses was conducted to estimate the magnitude of reduction in risk for cardiovascular events in response to a reduction in dietary saturated fat intake (with or without substitution with other macronutrients). Second, data from the New Zealand Adult Nutrition Survey 2008/09 were used to determine whether a change to the population's dietary fat intake would be warranted and feasible. Five relevant meta-analyses were identified. No significant association between saturated fat intake alone and cardiovascular disease was found. However, the incidence of cardiovascular disease events was less when dietary saturated fats were replaced with polyunsaturated fats, reducing the risk of cardiovascular events by about 10%. Compared with nutritional guidelines, New Zealanders' current saturated fat intake is excessive while polyunsaturated fat intake is inadequate; both would be corrected by a substitution of 5% of daily energy intake. Replacing 5% of daily energy consumed as saturated fat with polyunsaturated fats would be expected to reduce cardiovascular events by about 10%. In order to achieve the population-wide dietary fat modifications needed to improve cardiovascular health for New Zealanders, a public health strategy (e.g. fiscal, regulatory and/or educational interventions) must be implemented. Further work is needed to establish the cost-effectiveness of the various strategies.

Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection

Steatosis and steatohepatitis have been associated with increased morbidity and mortality after liver resection. Our objective was to determine the effect of a preoperative calorie-restricted diet on steatosis and steatohepatitis in patients undergoing liver resection. We studied 111 consecutive patients who had major elective hepatic resections. More than 90% of the patients had cancer resections. The mean body mass index was 27.2; 32% had a body mass index ≥30. A week-long calorie- and fat-restricted diet was instituted in the most recent patient group (n= 51). We retrospectively evaluated steatosis and steatohepatitis in the diet and no-diet control groups. Clinical outcomes of the 2 groups, including complications and blood loss, were compared. The preoperative diet patients had less steatosis (15.7% vs 25.5% of hepatocytes containing fat, P = .05) than the nondiet controls. A lower percentage of patients in the diet group had steatohepatitis than in the nondiet group (15% vs 27%, P =.02). Preoperative diet patients had less mean intraoperative blood loss than nondiet patients (600mL vs 906mL, P=.002). There was no difference in overall or infectious complications between the groups. We have shown for the first time that short-term calorie restriction before liver resection significantly reduces both hepatic steatosis and steatohepatitis. Dietary modification also was associated with decreased intraoperative blood loss. This intervention is easily instituted; therefore, it is clinically feasible.

Prevalence and clinical features of lymphedema in patients with lymphangioleiomyomatosis

Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease predominantly affecting young women. Some of these patients develop lymphedema of the lower extremities and buttocks; however, neither the exact frequency of LAM-associated lymphedema nor the clinical features of such patients is well delineated. To document the frequency, features, and treatment of LAM-associated lymphedema. We reviewed all medical records of patients listed in the Juntendo University LAM registry for the 30 years preceding August 2010. Of 228 patients registered with a diagnosis of LAM, eight (3.5%) had LAM-associated lymphedema of the lower extremities. All were females with sporadic LAM, and their mean age when diagnosed was 32.5 years (range 23-44). Lymphedema of the lower extremities was the chief or a prominent presenting feature in five of these LAM patients. CT scans showed that all eight patients had enlarged lymph nodes (lymphangioleiomyomas) in the retroperitoneum and/or pelvic cavity. Yet, cystic destruction of the lungs was mild in four patients, moderate in two and severe only in two. Seven of these patients were treated by administering a fat-restricted diet and complex decongestive physiotherapy, and four received a gonadotropin-releasing hormone analog. With this combined protocol, all eight patients benefitted from complete relief or good control of the lymphedema. Lymphedema is a rare complication of LAM and may be associated with axial lymphatic involvement or dysfunction rather than severe cystic lung destruction. The combined multimodal treatments used here effectively resolved or controlled LAM-associated lymphedema.

Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy

Radiotherapy-induced damage to noncancerous gastrointestinal mucosa has effects on secretory and absorptive functions and can interfere with normal gastrointestinal physiology. Nutrient absorption and digestion may be compromised. Dietary manipulation is an attractive option for the prevention and management of symptoms. To synthesise the evidence for the use of elemental formula low- or modified-fat diets, fibre, lactose restriction and probiotics, prebiotics and synbiotics to protect the gastrointestinal tract during pelvic radiotherapy. Four electronic databases were searched. Randomised controlled trials (RCT), controlled trials (CT) and case series in adult patients receiving radiotherapy for pelvic cancers employing nutritional interventions to reduce gastrointestinal toxicity were included. Methodological quality was assessed using a bespoke tool. Twenty-two original studies (2446 patients) were identified. Study quality was highly variable with only 37% scoring ≥10 points (maximum 17: bespoke scale). Few studies assessed compliance with the intervention. End-points varied and included symptom scales (IBDQ, CTC, Bristol Stool and RTOG). Evidence from RCTs was weak for elemental, low- or modified-fat, fibre and low-lactose interventions with 1/4, 3/4, 1/2, 0/1 trials respectively reporting favourable outcomes. Evidence for probiotics as prophylactic interventions was more promising (4/5 favourable), but dose, strains and methodologies varied. There is insufficient high-grade evidence to recommend nutritional intervention during pelvic radiotherapy. Total replacement of diet with elemental formula may be appropriate in severe toxicity. Probiotics offer promise, but cannot be introduced into clinical practice without rigorous safety analysis, not least in immunocompromised patients. The methodological quality of nutritional intervention studies needs to be improved.

Abstract 314: Effect of dietary carbohydrates and exercise on prostate cancer progression in LNCaP xenograft model.

Abstract Introduction: Prostate cancer (PCa) is the second leading cause of death among North American men. There are many risk factors for PCa, dietary as well as physical activity play a role in the development and progression of the disease. Our lab has previously reported that increased intake of dietary carbohydrates was associated with increased tumor growth and activation of signaling pathways distal to the insulin receptor in a murine model of prostate cancer. In humans, one of the most potent stimulants for insulin production is glucose consumption and carbohydrate restriction reduces serum insulin and IGF-I levels to a greater extent than dietary fat restriction. Numerous studies have also found an inverse relationship between exercise and PCa progression. For example, a study by Barnard et al (2003) demonstrated that regular physical activity in PCa patients decreased serum insulin and IGF-I levels, and also elevated IGF binding protein I. However, the exact relationships between diet, exercise and PCa, as well as their underlying mechanisms, are unclear. Herein we aim to investigate the effect of sustained aerobic exercise on PCa tumour growth in animals placed on a high carbohydrate diet. Methods: Athymic (6 -8 week old) nude mice (n=40) were inoculated subcutaneously with 1 million LNCaP cells. Mice were fed ad libitum with a high-carbohydrate (HC) diet or a low-carbohydrate (LC) diet. Animals were randomized into four groups: HC with and without exercise, LC with and without exercise. Exercise was implemented for 5 days/week (3 x 15 mins; 2-min breaks between cycles; 2.0-10.0 m/min) using a forced exercise wheel. Exercise was performed for a period of 10 weeks. Body weights, tumour volumes, and food consumption were recorded tri-weekly. Blood samples were obtained by sephenous vein bleeding at various times during the study period. Comparisons between groups over time were performed using RANOVA Type 3 Tests of Fixed Effects. Results: There were no significant differences in animal weight and food consumption between groups. Tumour growth, wet tumour weights were not significantly different between groups. However it was very interesting to note that animals from the exercise group had a slower tumour growth rate compared to animals from the no exercise group. Citation Format: Xiangfeng Ge, Natalie Venier, Neil Fleshner, Laurence Klotz, Vasundara Venkateswaran. Effect of dietary carbohydrates and exercise on prostate cancer progression in LNCaP xenograft model. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 314. doi:10.1158/1538-7445.AM2013-314

The effect of one Hass avocado per day on cardiovascular disease (CVD) risk factors

Avocados are a good source of MUFA and also are rich in vitamins, minerals and phytosterols which could beneficially affect CVD risk. Well controlled studies are lacking about the specific effects of avocados on CVD risk. We conducted a randomized 3‐ period cross‐over, controlled feeding study to evaluate the effects of avocados on risk factors for CVD. Healthy, overweight/obese adults (BMI: 25–35 kg/m2) with moderately elevated LDL‐C (25– 90th percentile) consumed 3 isocaloric treatment diets (5 weeks each) with a 2 week run‐in Average American diet. Treatment diets were matched for SFA (&lt;7% energy) and included a low‐fat diet (LF: 24% fat, 59% CHO, 16% PRO), a moderate fat diet (MF: 34% fat, 49% CHO, 16% PRO), and an avocado diet, which provided 1 avocado/day and an equivalent fatty acid profile as the MF diet (AV: 34% fat, 49% CHO, 16% PRO). Blood samples were collected at baseline and the end of each treatment diet. The AV diet significantly decreased TC, LDL‐C, apoB, LDL/HDL ratio and apoB/apoAI ratio (P&lt;0.001). All treatment diets elicited a reduction in LDL‐C, however the LDL‐C reduction during the AV diet was the greatest (P&lt;0.05). The AV diet and the MF diet did not significantly affect TG and HDL‐C, whereas the LF diet increased TG (P&lt;0.001) and decreased HDL‐C (P&lt;0.05). In summary, inclusion of one avocado a day as part of a healthy moderate fat diet beneficially affects CVD risk factors.Grant Funding Source: Hass Avocado Board

Amelioration of circulating lipoprotein profile and proteinuria in a patient with LCAT deficiency due to a novel mutation (Cys74Tyr) in the lid region of LCAT under a fat-restricted diet and ARB treatment

Familial lecithin-cholesterol acyltransferase (LCAT) deficiency is a hereditary disease characterized by an abnormal lipid profile, corneal opacity, anemia and progressive renal disease. We report a patient with complete loss of LCAT activity due to a novel lcat gene mutation of Cys74Tyr in the lid region of LCAT protein. Esterification of cholesterol in this patient was disturbed by disruption of a substrate binding loop of Cys50-Cys74 in LCAT protein. She had progressive renal dysfunction, proteinuria, corneal opacity, anemia and an abnormal lipid profile. Her serum lipids showed a significant increase in abnormal lipoproteins at the original position in agarose gel electrophoresis and VLDL-cholesterol, and a severe decrease in serum HDL-cholesterol. Lipoprotein analyzes also revealed the presence of an abnormal midband lipoprotein, and a maturation disturbance of HDL particles. Renal function and proteinuria improved following the adoption of a fat-restricted diet and administration of an angiotensin II receptor blocker. The abnormal lipoproteins also decreased after this treatment.

Long-term dietary effects on substrate selection and muscle fiber type in very-long-chain acyl-CoA dehydrogenase deficient (VLCAD−/−) mice

Dietary fat restriction and increased carbohydrate intake are part of treatment in very-long-chain acyl-CoA dehydrogenase (VLCAD)-deficiency, the most common defect of long-chain fatty acid oxidation. The long-term impact of these interventions is unknown. We characterized here the effects of a fat-reduced, carbohydrate-enriched diet and an increased fat intake on energy metabolism in a mouse model of VLCAD-deficiency.Wild-type and VLCAD−/− mice were fed one year either with a normal (5.1%), a high fat (10.6%) or a low-fat, carbohydrate-enriched (2.6%) diet. Dietary effects on genes involved in lipogenesis, energy homeostasis and substrate selection were quantified by real-time-PCR. Acylcarnitines as sign of impaired energy production were determined in dried blood spots and tissues. White skeletal muscle was analyzed for muscle fiber type as well as for glycogen and triglyceride content.Both dietary modifications induced enhanced triacylglyceride accumulation in skeletal muscle and inhibition of glucose oxidation. This was accompanied by an up-regulation of genes coding for oxidative muscle fiber type I and a marked accumulation of acylcarnitines, especially prominent in the heart (164±2.8 in VLCAD−/− vs. 82.3±2.1 in WT μmol/mg) under a low-fat, carbohydrate-enriched diet.We demonstrate here that both dietary interventions with respect to the fat content of the diet reverse endogenous compensatory mechanisms in muscle that have evolved in VLCAD−/− mice resulting in pronounced energy deficiency. In particular, the low-fat carbohydrate-enriched diet was not effective in the long term. Further experiments are necessary to define the optimal energy provision for fatty acid oxidation defects.

Dietary fat modification in patients with chronic kidney disease: n-3 fatty acids and beyond

Replacement of dietary saturated fat with unsaturated fat has been recommended for prevention of cardiovascular disease (CVD) in the general population. Less is known of the health risks in individuals with chronic kidney disease (CKD), of a diet with an unhealthy fat profile, in general characterized by insufficient polyunsaturated fatty acids (PUFA) and excess satu-rated fatty acids (SFA). The dietary intake of PUFA, both the n-3 and n-6 subfamilies, is increasingly gaining attention in CKD, owing to its broad cardioprotective effects. Conversely, dietary SFA may promote CVD in this vulnerable population. This review discusses the potential benefits of dietary fat modification in CKD patients, including plausible effects on renal function, albuminuria, lipoproteins, nutritional status, inflammation, thrombosis and clinical outcomes. Increasing evidence supports the concept that n-3 PUFA might have therapeutic potential in reducing proteinuria in CKD and reducing triglycerides and inflammation in dialysis patients. In addition, emerging evidence suggests that linoleic acid, a major n-6 PUFA derived from vegetable oils, may be beneficial for a number of CVD risk factors. Increased consumption of oily fish as part of plant-based diets with low content of SFA is likely to benefit patients who have CKD, or are at risk of developing CKD. Such recommendations are in line with the concept of a healthy "Mediterranean diet" and are in line with current dietary recommendations for CVD prevention in the community.

Behavioral lifestyle intervention in the treatment of obesity.

This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP) and the Look AHEAD (Action for Health in Diabetes) trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density) on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed.

Hepatobiliary Quiz-3 (2012)

Hepatobiliary Quiz-3 (2012)

Hepatobiliary Quiz-3 (2012)

Hepatobiliary Quiz-3 (2012)

Effect of Ala54Thr polymorphism of FABP2 on anthropometric and biochemical variables in response to a moderate-fat diet

ObjectiveTo analyze the effect of the fatty acid–binding protein (FABP2) gene Ala54Thr polymorphism on anthropometric and biochemical variables in response to a moderate-fat diet in overweight or obese subjects. MethodsOne hundred nine subjects with a body mass index ≥25 kg/m2 were studied. Participants underwent a dietary intervention that consisted of 30% fat (saturated fat <7% of total calories), 15% protein, and 55% carbohydrates. The FABP2 genotypes were analyzed by polymerase chain reaction–restriction fragment length polymorphism. Anthropometric and biochemical data were measured at baseline, 1 mo, and 2 mo of nutritional intervention. ResultsThe mean age was 38.6 ± 11.3 y and the mean body mass index 32.7 ± 6.1 kg/m2, with 20 men (18%) and 89 women (82%). Fifty-three patients (48.6%) had genotype Ala54Ala (wild-type group) and 56 patients had genotype Ala54Thr/Thr54Thr (51.4%, mutant group). At baseline, no significant difference was found between the FABP2 genotypes groups, except for the carbohydrate intake and resting metabolic rate, which were higher in the Ala54Thr/Thr54Thr group (P < 0.05). At 2 mo, participants had lost 6.8% of their initial weight. The Ala54Thr/Thr54Thr group compared with the Ala54Ala group showed significant decreases in the parameters of weight (−7.5 versus −4.2 kg), body mass index (−2.1 versus −1.2 kg/m2), waist circumference (−7.6 versus −5.2 cm), waist-to-hip ratio (−0.04 versus −0.02), and C-reactive protein (−1.4 versus −0.76 mg/L), respectively (P < 0.05). After the resting metabolic rate was adjusted, the decreases in waist circumference, waist-to-hip ratio, and C-reactive protein remained significant between the two groups. ConclusionsThis study showed that the Thr54 allele carriers responded better to a moderate-fat diet.

The Daily Practice of Pancreatic Enzyme Replacement Therapy After Pancreatic Surgery: a Northern European Survey

IntroductionAfter pancreatic surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after surgery are lacking, and therefore, we conducted this analysis. MethodsAn anonymous survey was distributed to members of the Dutch and German patient associations for pancreatic disorders. The target population consisted of patients with chronic pancreatitis or pancreatic cancer who had undergone pancreatic surgery and were using enzymes to treat exocrine insufficiency. Results were compared to a similar group of non-operated patients. ResultsNinety-one cases were analyzed (84 % underwent a resection procedure). The median daily enzyme dose was 6, and 25 % took three or less capsules. Despite treatment, 68 % of patients reported steatorrhea-related symptoms, 48 % adhered to a non-indicated dietary fat restriction, and only 33 % had visited a dietician. The outcome was equally poor for the 91 non-operated patients. ConclusionMost patients suffering from exocrine insufficiency after pancreatic surgery are undertreated. To improve efficacy, physicians should be more focused on treating exocrine insufficiency and educate patients to adjust the dose according to symptoms and their diet.

Severe Hypertriglyceridemia in Pregnancy

Pregnancy-related hypertriglyceridemia is rare, but it can be life threatening in some patients with genetic susceptibility. Complications can include acute pancreatitis, hyperviscosity syndrome, and possibly preeclampsia. We present a case of successful management of recurrent gestational chylomicronemia due to compound heterozygous mutations in the LPL gene. To outline advances in clinical management of this condition, we searched English language publications in PubMed, EMBASE, and ISI Web of Science (search terms: pregnancy, pregnancy complications, pregnan*, hyperlipoproteinemia, hypertriglyceridemia, chylomicrons, chylomicronemia) and reference lists of relevant published articles from 2002 to 2011. We identified eight case reports. Interventions reported in those cases are reviewed including: 1) low-fat diet; 2) nutritional supplements; 3) oral prescription medications; 4) parenteral heparin; 5) insulin infusion in the context of hyperglycemia; and 6) therapeutic plasma exchange. Overall, our recommendations are to monitor for pregnancy-related hypertriglyceridemia in those with prepregnancy fasting triglyceride level greater than 4 mmol/liter and to institute therapy when triglyceride level increases to more than 10 mmol/liter. Therapy should include a multidisciplinary team to address dietary fat restriction, appropriate supplements, and possible medications when needed. Admission to hospital is recommended in severe cases. We conclude that complications are preventable with appropriate and timely intervention.