Hyperlipoproteinemia type IV

FISH OILS IN HYPERTRIGLYCERIDEMIA Earlier studies have documented dramatic decreases in triglyceride levels in hypertriglyceridemic subjects receiving fish oils containing n-3 fatty acids. In a study conducted at the Lipid Disorders Clinic at the Oregon Health Sciences University, researchers studied the effects of three different supplemental doses of n-3 fatty acids given to 11 subjects (five with type IV, five with type IIb, and one with type III hyperlipoproteinemia) for three six-week periods. The study was preceded by a three-week baseline period, and supplemented periods were separated by four-week washout periods. The doses of fish oils used were 15, 25, or 40 ml daily, equivalent to 4.5,7.5, and 12g of n-3 fatty acids. A single 24-hour dietary recall showed that total dietary intake of cholesterol (including that from the fish oil) ranged from 188 to 259 mg/day. The ratio of polyunsaturated to saturated fatty acids (P:S) of the fish-oil supplement was 1.1. Plasma very-low-density lipoprotein (VLDL) cholesterol and total triglycerides decreased progressively as the amount of fish oil increased in the patients with Type IV and Type IIb hyperlipidemia. Low-density lipoprotein (LDL) increased concurrently, but the increase was greater in patients with Type IV hyperlipidemia. The combined results for all 10 patients showed a 14% decrease in total cholesterol concentrations, produced by a 54% decline in VLDL, a 9% increase in LDL concentrations, and a 6% decrease in HDL concentrations. Triglyceride concentrations decreased by 53%. Bleeding times increased only at the highest dose. Patients gained weight appropriate for the increased calories from added n-3 fatty acids. The one patient with Type III hyperlipoproteinemia "responded dramatically" to the n-3 supplements: his VLDL cholesterol concentrations decreased from 6.55 mmo1/L at baseline to 2.45, 1.30, and 0.70 mmo1/L with increasing doses, and were associated with a normalization of his ratio of VLDL cholesterol to total plasma triglyceride. Based on the results of this study, the authors conclude that the lowest dose (15 ml) is potentially the most effective in terms of lipid changes per gram of n-3 fatty acids, and that the effects of the fish-oil supplement result entirely from a decrease in VLDL concentrations. As they observe, "it is somewhat paradoxical that an agent that reduces the synthesis of a precursor (VLDL) can simultaneously increase the concentrations of the product (LDL)." William S Harris et al, Fish Oils in Hypertriglyceridemia: A Dose-Response Study, American J Clinical Nutrition 51(3):399406 (Mar 1990) [Reprints: William S Harris, Lipid and Arteriosclerosis Prevention Clinic, 3800 Cambridge Street, University of Kansas Medical Center, Kansas City KS 66103]*

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