TRIGLYCERIDES
ABSTRACT
REVIEW ARTICLE
DANIELLA M. ANTONIO1
ANNA MARIELLE C. RAFANAN1
KAREN GRACE D.V. SACRAMENTO1
1Chinese General Hospital Colleges
Chinese General Hospital Colleges
286 Blumentritt St., Sta. Cruz, Manila
1014, Philippines
College of Nursing and Liberal Arts
Bachelor of Science in Medical
Laboratory Science
Analytical Chemistry (CHEM 111)
Mr. Dino F. De Guzman
Triglycerides are the main type of dietary fat and
the most common type of lipid in the body. Like
cholesterol, triglycerides can be made in the liver and
obtained from the diet - fats which are found in foods
such as meats, dairy produce and cooking oils.
Triglycerides are absorbed in the intestines and
transported by the bloodstream to the tissues where they
are either stored as fat or used to provide energy. Most
of the fat in the body exists in the form of triglycerides,
and most of the saturated fat in food also is in triglyceride
form. The amount of triglycerides (or blood fats) in blood
are one important barometer of metabolic health; high
levels are associated with coronary heart disease,
diabetes and fatty liver disease. The treatment of
elevated triglycerides emphasizes targeted therapeutic
lifestyle changes; however, secondary causes of
hypertriglyceridemia need to be either ruled out or
diagnosed and treated. Obesity in the United States is a
major health issue, resulting in numerous diseases,
specifically increased risk of certain types
of cancer, coronary artery disease, type 2
diabetes, stroke, as well as significant increase in early
mortality and economic costs. The United States have
the most obese people in the world. The
pathophysiology in relation to elevated triglyceride level
has a multiple effect to the health particularly with obese
people, the abnormalities of triglyceride levels pertains
to susceptibility to diseases associated with coronary
heart diseases, fatty liver diseases, diabetes, and other
major health risks. Changes in habits to a better lifestyle
is the primary key in response to treatment.
1
INTRODUCTION Triglycerides are the
main type of dietary fat and the most common type
of lipid in the body. Like cholesterol, triglycerides can
be made in the liver and obtained from the diet - fats
which are found in foods such as meats, dairy
produce and cooking oils.
A triglyceride, or triacylglycerol, is comprised of
a glycerol molecule with three fatty acids attached.
The structure of a triglyceride can vary based on the
length of the fatty acid chains.1 The attached fatty
acids may be saturated – a type of fatty acid with no
double bonds. Saturated fatty acids have a very
straight shape and pack tightly together; trans – a
type of fatty acid with one double bond but no kink,
therefore creating a very straight, rigid shape and
tight packing; monounsaturated – a type of fatty acid
with one double bond, which introduces a structural
kink that prevents tight packing; polyunsaturated – a
type of fatty acid with two or more double bonds,
which create several structural kinks that create
complex shapes and prevent tight packing, or a
combination of these.2
Triglycerides are absorbed in the intestines and
transported by the bloodstream to the tissues where
they are either stored as fat or used to provide energy.
Most of the fat in the body exists in the form of
triglycerides, and most of the saturated fat in food
also is in triglyceride form.3
Excess calories are converted to triglycerides,
transported to fat cells, and stored as a source of
energy that the body can later use between meals or
snacks. Bile salts emulsify the triglycerides. The
pancreatic enzyme lipase then hydrolyzes the ester
bonds in each triglyceride, allowing the fatty acids to
separate from the glycerol molecule. The free fatty
acids and the glycerol molecule are transported
across the intestinal membrane of the duodenum
and recombined to form triglycerides.
Triglycerides
Once inside the intestinal cells,
triglycerides are packed inside chylomicrons
(small lipoprotein particles consisting of
triglycerides, cholesterol, and protein). These
chylomicrons carry the water-insoluble lipids
from the intestine through the lymphatic and
circulatory systems. Once in the bloodstream,
the lipids go to the liver to be used for energy
immediately or to adipose tissue to be stored
for future energy use.4
When more energy than the body's
glycogen stores can provide is needed, the
release of these triglycerides into the
bloodstream is determined by the body's
hormones: epinephrine, norepinephrine,
glucagon, growth hormone,
adrenocorticotropic hormone, and thyroid-
stimulating hormone. Each of these hormones
stimulates lipolysis at different rates.5
INFLUENCE The amount of
triglycerides (or blood fats) in blood are one
important barometer of metabolic health; high
levels are associated with coronary heart
disease, diabetes and fatty liver disease.
Metabolism refers to the chemical process that
converts the food we eat into the energy our
cells need.
ANTONIO, RAFANAN, SACRAMENTO. 2
 The amount of triglycerides (or blood
fats) in blood are one important barometer of
metabolic health.6 High levels of triglycerides
(known to doctors as hypertriglyceridemia) are
associated with an increased risk of heart
disease, stroke, diabetes, fatty liver disease and
metabolic syndrome (a condition that
increases your risk of cardiovascular disease
and is associated with high blood pressure and
abnormal fasting blood sugar levels).
Triglycerides are associated with
atherosclerosis – the build-up of fatty material
(plaque) in the lining of your arteries, which can
lead to coronary heart disease (which causes
angina and heart attack) and stroke.7
Unfortunately, high triglyceride
measurements often go hand in hand with
other measures of metabolic health that
increase the risk of coronary heart disease
include too much LDL cholesterol – the “bad”
cholesterol and too little HDL cholesterol – the
“good” cholesterol. Other important risk factors
include total and LDL cholesterol. 6
Very high levels of triglycerides (above 10
mmol/L) are associated with a risk of an attack
of acute pancreatitis – sudden onset of
inflammation of the pancreas that is very
painful and sometimes fatal.
TESTS AND DIAGNOSES
Triglyceride levels are usually tested as
part of a full fat or lipid profile to help assess
someone's risk of developing cardiovascular
disease. A triglyceride test is a blood test that
measures blood levels of triglycerides. Blood
can be tested either in a fasting or non-fasting
state.
Triglycerides
Because triglycerides are a type of fat or lipid,
their levels are checked as part of a blood test called
a lipid profile.
Triglyceride levels in the blood increase after a
person eats, therefore, many practitioners believe
that a person should fast before taking a triglyceride
test.
However, recent research has shown that non-
fasting triglyceride tests may be as accurate as fasting
tests in certain situations. Experts state that non-fasting
triglycerides levels of more than 200 milligrams per
deciliter (mg/dL) should be considered high.8
With a fasting triglyceride test, a person is asked
to fast for between 9 and 12 hours before having
blood taken and tested. Non-fasting tests do not
require a person to fast beforehand.
Also, certain drugs such as corticosteroids,
protease inhibitors for HIV, beta blockers, and
estrogens can increase blood triglyceride levels.9
The American College of Cardiology (ACC) has
divided their guidelines for when to use a fasting or a
non-fasting test based on the individual. As of 201610,
their recommendations are as follows:
• Evaluating the risk of heart disease in a person not
treated for high cholesterol: Non - fasting
acceptable.
• Screening for metabolic syndrome: Non - fasting
acceptable.
• Screening individuals with a family history of
inherited cholesterol problems or early onset heart
disease: Fasting required.
• Confirming hypertriglyceridemia or high
triglycerides: Fasting preferred.
• Evaluating pancreatitis: Fasting preferred.
• Evaluating the risk of heart disease in a person
treated for high cholesterol: Fasting preferred.
ANTONIO, RAFANAN, SACRAMENTO. 3
 A non-fasting test can be more comfortable
and convenient for the individual and may be safer
for people with diabetes, who can
experience hypoglycemia or low blood sugar when
they have been fasting.

It is recommended that people whose

triglyceride or TG levels are found to be abnormally
high during a non-fasting test have a fasting test to
confirm the result.

A lipid profile, which includes triglycerides, is

recommended every 4 to 6 years to evaluate risk of
heart disease in healthy adults. Children should have
a lipid profile screening at least once between the
ages of 9 and 11 and once again between the ages
of 17 and 21. Earlier and more frequent screening with
a lipid profile is recommended for children and youths • Family history of premature heart disease
who are at an increased risk of developing heart (heart disease in an immediate family
disease as adults. High-risk children should have their member—male relative under age 55 or
first cholesterol test between 2 and 8 years old, female relative under age 65)
according to the American Academy of Pediatrics.
• Pre-existing heart disease or already having
Children younger than 2 years old are too young to
had a heart attack
be tested.
For diabetics, it is especially important to
Testing may be ordered more frequently when
have triglycerides measured as part of any lipid
people have identified risk factors for heart
testing since triglycerides increase significantly
disease. Some risk factors for heart disease include:
when blood glucose levels are not well-
• Cigarette smoking controlled.

• Being overweight or obese As part of a lipid profile, triglycerides tests

may be ordered at regular intervals to evaluate
• Unhealthy diet
the success of lipid-lowering lifestyle changes,
• Being physically inactive—not getting enough such as diet and exercise, or to determine the
exercise effectiveness of drug therapy such as statins.
Guidelines from the American College of
• Age (men 45 years or older or women 55 years or
Cardiology and the American Heart
older)
Association recommend that adults taking
• High blood pressure (hypertension—blood statins have a fasting lipid profile done 4 to 12
pressure of 140/90 or higher or taking high blood weeks after starting therapy and then every 3
pressure medication) to 12 months thereafter to assure that the drug
is working.
• Diabetes or prediabetes

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 4

 According to the American College of • For children, teens and young adults:
Cardiology (ACC) and the American Heart - From newborn to age 9
Association (AHA) the most up-to-date ➢ Acceptable: Less than 75 mg/dL (0.85
guidelines for interpreting triglyceride levels for mmol/L)
adults are as follows10: ➢ Borderline high: 75-99 mg/dL (0.85-1.12
mmol/L)
Table 1. Categorization of Hypertriglyceridemia
➢ High: Greater than 100 mg/dL (1.13 mmol/L)
Triglyceride
range
NCEP ATP 111 AHA Statement - For ages 10-19 years
(2004) (2011)
(mg/dL) ➢ Acceptable: Less than 90 mg/dL (1.02
< 100 Desirable Optimal mmol/L)
< 150 Normal
➢ Borderline high: 90-129 mg/dL (1.02-1.46
mmol/L)
150 – 199 Borderline high Borderline ➢ High: Greater than 130 mg/dL (1.47 mmol/L)
200 – 499 High High
- For young adults older than 19
➢ Acceptable: Less than 115 mg/dL (1.30
>500 Very high Very high mmol/L)
➢ Borderline high: 115-149 mg/dL (1.30-1.68
mmol/L)
For those undergoing a non-fasting test,
➢ High: Greater than 150 mg/dL (1.7 mmol/L)
a result of 200 mg/dL or more is categorized as
high. The individual would usually then be When triglycerides are very high (greater than
asked to have a fasting triglyceride test for a 1000 mg/dL (11.30 mmol/L)), there is a risk of
follow-up. developing pancreatitis in children and
adults. Treatment to lower triglycerides should be
However, use of the updated guidelines
started as soon as possible.11
remains controversial. Many still use the older
guidelines from the NCEP ATP III to evaluate
lipid levels and cardiovascular disease risk:
Note: These values are based on fasting
triglyceride levels.
OBESITY Abnormalities in lipid metabolism
are very commonly observed in patients who are
• For adults, triglyceride test results are obese. Approximately 60-70% of patients with obesity
categorized as follows: are dyslipidemic.12 Dyslipidemia occurs when
- Desirable: Less than 150 mg/dL (1.7 someone has abnormal levels of lipids in their blood,
mmol/L) while the term describes a wide range of conditions,
- Borderline high: 150 to 199 mg/dL (1.7-2.2 the most common forms of dyslipidemia involve13:
mmol/L)
a) high levels of low-density lipoproteins (LDL), or
- High: 200 to 499 mg/dL (2.3-5.6 mmol/L)
bad cholesterol;
- Very high: Greater than 500 mg/dL (5.6
mmol/L) b) low levels of high-density lipoproteins (HDL), or
good cholesterol;

c) high levels of triglycerides; and d) high cholesterol,

which refers to high LDL and triglyceride levels.

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 5

 The lipid abnormalities in patients who are
obese include elevated serum triglyceride, VLDL,
apolipoprotein B, and non-HDL cholesterol levels. The
increase in serum triglycerides is due to increased
hepatic production of VLDL particles and a decrease
in the clearance of triglyceride rich lipoproteins. HDL
cholesterol levels are typically low and are
associated with the increase in serum triglycerides.
LDL cholesterol levels are frequently in the normal
range but there is an increase in small dense LDL.
Patients who are obese are at an increased risk of
developing cardiovascular disease and therefore
treatment of their dyslipidemia is often indicated.
These small dense LDL particles are considered
to be more pro-atherogenic than large LDL particles
for a number of reasons. Small dense LDL particles
have a decreased affinity for the LDL receptor
resulting in a prolonged period of time in the
circulation. Additionally, these small particles enter
the arterial wall more easily than large particles and
then they bind more avidly to intra-arterial
proteoglycans, which traps them in the arterial wall.
Finally, small dense LDL particles are more susceptible
to oxidation, which could result in an enhanced
uptake by macrophages.
The greater the increase in BMI the greater the
abnormalities in lipid levels. The increased risk for
cardiovascular disease in patients with obesity is
partially accounted for by this dyslipidemia.12
Triglycerides
HYPERTRIGLYCERIDEMIA
Hypertriglyceridemia is a condition that
pertains to elevated triglyceride levels. There
are many causes of high triglycerides, which
could range from following a poor diet to
inheriting the condition from a parent. 14
Elevations in triglycerides can be caused
by an inherited disorder, another health
condition, adverse effects of medications, or a
combination of these factors. The most
common acquired causes of high triglycerides
are obesity and physical inactivity. Because
hypertriglyceridemia is a component of the
metabolic syndrome, the presence of high
triglycerides should trigger a search for
concomitant risk factors such as hypertension,
abnormal glucose metabolism, abdominal
obesity, and low high-density lipoprotein
cholesterol levels.15
People with diabetes can often struggle
to manage triglycerides and because diabetes
is such a complicated and intricate disease,
there are many ways diabetes can contribute
to high triglycerides. Triglycerides are obtained
from food you eat or are released from your
liver and are used to meet short-term energy
needs. When too much food is consumed or
significant high-fat foods or foods that contain
high levels of simple carbohydrates, the excess
is converted to triglycerides and is stored as
body fat.16
Triglyceride levels can also rise due to
medical conditions such as diabetes, obesity
and liver disease. Certain types of medications
also can raise triglyceride levels over the normal
limit of 150 milligrams per deciliter (mg/dL).
ANTONIO, RAFANAN, SACRAMENTO. 6
Antipsychotics
Antipsychotic medications are given to
treat disorders such as bipolar disease and
schizophrenia. Some antipsychotic
medications can raise triglyceride levels,
particularly medications classed as atypical,
which includes clozapine (Clozaril) and
olanzapine (Zyprexa), Deborah Antai-Otong.
Blood Pressure Medications
Several types of blood pressure
medications can affect triglyceride levels.
Diuretics — which decrease the blood volume
to lower the amount of blood being forced
through the blood vessels — in doses greater
than 50 milligrams per day can increase
triglyceride levels, the Mayo Clinic reports. This
effect may resolve within a year. Beta blockers
can also raise triglycerides levels slightly,
although the effect may be temporary. Older
classes of beta blockers such as atenolol
(Tenormin), metoprolol (Lopressor) and
propanolol (Inderal) are more likely to raise
triglyceride levels than newer beta blockers
such as carvedilol (Coreg) and nebivolol
(Bystolic).
Estrogen
Estrogen in synthetic form is found in birth
control pills and hormone replacement
therapy. Estrogen can raise triglyceride levels,
but this may be offset by the synthetic
progesterone, or progestin, in the birth control
pill, which lowers triglyceride levels.
Retinoids
Retinoids are medications used to treat
acne. One well-known retinoid is isotretinoin
(Accutane).
Triglycerides
Since retinoids raise triglyceride levels, most
doctors check triglyceride levels before starting the
medication and every four to six weeks thereafter, as
long as a person is taking the medication.
Steroids
Steroid medications are often prescribed to
reduce inflammation. Many people also take
anabolic steroids to build body mass. Both types of
steroids can raise triglyceride levels. Steroids also
increase appetite, which can increase the intake of
foods with high levels of fat that raise levels further.17
There are many causes of high triglycerides,
which could range from following a poor diet to
inheriting the condition from a parent. The other
following factors below could place you at risk for
having triglycerides:
• Certain conditions, such as hypothyroidism,
diabetes, and metabolic syndrome
• Consuming a diet high in refined carbohydrates
and saturated fats
• Smoking cigarettes
• Taking certain medications, including
estrogen, protease inhibitors, and corticosteroids
• Drinking too much alcohol 14
• Sugar, saturated and transfat, and refined grains
or starchy food16
MEDICATIONS The treatment of
elevated triglycerides emphasizes targeted
therapeutic lifestyle changes; however, secondary
causes of hypertriglyceridemia need to be either
ruled out or diagnosed and treated.15 For example,
reducing serum glucose in individuals with diabetes
helps decrease triglyceride levels.19 Furthermore,
medications that have the potential to cause
elevated triglycerides need to be evaluated; drug
substitution within the same class of drugs may be
helpful.
ANTONIO, RAFANAN, SACRAMENTO. 7

For example, oral contraceptives that contain
a high concentration of estrogen can greatly
influence triglyceride levels; therefore, in patients with
hypertriglyceridemia preparations that contain less
estrogen or other forms of contraception should be
considered.20
Clinicians should counsel patients with
hypertriglyceridemia that lifestyle modification is the
cornerstone of treatment. An interdisciplinary
approach that includes consultation with a
registered dietician may be beneficial .21
For patients who are overweight, the aim is to
lose weight by consuming fewer calories and
increasing daily exercise; reducing carbohydrate
consumption can also help to reduce weight and
lower triglycerides.22 In patients with triglyceride levels
greater than or equal to 150 mg/dL, physical activity
has been shown to decrease triglycerides by up to
20%.23
To promote increased physical activity, it's
important that clinicians negotiate measurable,
achievable goals with the patient; therefore, they
should encourage patients to choose an activity they
enjoy, such as brisk walking, bike riding, hiking,
dancing, or golf.24
Triglycerides
The American College of Sports
Medicine (ACSM) recommends a minimum of
150 minutes per week of moderate-intensity
endurance exercise (the equivalent of an
expenditure of 1,000 kilocalories per week).
The ACSM recommends that clinicians
encourage patients to set goals for steps per
minute as well as duration of exercise-for
example, 100 steps per minute for 30 minutes
per session.25 Recent data demonstrate that
individuals who reported exercising strenuously
three days per week accumulated a mean
5,486 (SD, 231) steps per day; those who
exercised four to five days per week
accumulated a mean 6,200 (SD, 220) steps per
day. Overweight participants reported taking
fewer steps, and the number of steps taken per
day also decreased with age.26
Dietary recommendations aimed at
lowering triglyceride levels include reducing
caloric intake as well as consumption of refined
carbohydrates, fructose, and saturated fat and
increasing the intake of dietary fiber to more
than 30 g per day.27
Although the literature suggests that low-
to-moderate alcohol consumption may lower
triglyceride levels, excess alcohol consumption
is known to increase the secretion of VLDLs and
lead to hypertriglyceridemia. The type of
alcohol and other factors, such as a high-fat
diet, can intensify hypertriglyceridemia;
therefore, clinicians should encourage patients
with high triglyceride levels to limit or cease
consumption of alcoholic beverages.28
ANTONIO, RAFANAN, SACRAMENTO. 8
 Clinicians should also encourage
patients to consume fresh fruits and
vegetables; whole grains; fish containing
omega-3 fatty acids, such as salmon, trout, and
halibut; and plants and plant-based foods
containing omega-3 fatty acids, such as
flaxseed, walnuts, soybeans, and canola oil.
In addition to intensive lifestyle
modification that includes abstinence from
alcohol, some pharmacologic treatments
might be prescribed. Medications commonly
used to treat hypertriglyceridemia include
fibrates, niacin, omega-3 fatty acids, statins,
and ezetimibe.
Fibrates
Fibrates available in the United States
include fenofibrate (Tricor and others) and
gemfibrozil (Lopid and others), can lower your
triglyceride levels. Although fibrates typically
decrease triglyceride levels by approximately
36%, the cardiovascular outcomes have been
inconsistent.15 Fibrates aren't used if you have
severe kidney or liver disease.
Niacin
Niacin, sometimes called nicotinic acid
or vitamin B3, a water-soluble vitamin,
decreases triglyceride levels by approximately
25% to 40% when used in pharmacologic
doses29 and reduces the incidence of major
coronary heart disease (CHD) events, but not
stroke. There are primarily three different
formulations of niacin: immediate release,
extended release, and sustained release. Many
of these niacin preparations are available as
over-the-counter (OTC) dietary supplements,
but they aren't subject to oversight by the U.S.
Food and Drug Administration (FDA); therefore,
OTC formulations are not recommended as a
substitute for prescription niacin.30
Triglycerides
Fish oil
Also known as omega-3 fatty acids, Long-
chain omega-3 fatty acids are known to decrease
triglyceride levels by 20% to 50%.However,
cardiovascular outcomes have been inconsistent in
clinical trials.31 Some studies found an important
reduction in major cardiovascular events, but others
have not; differences in outcomes may be related to
variations in dosage, medication, or the populations
studied.32 Three forms of omega-3 fatty acids are
approved as prescription formulations: icosapent
(Vascepa), which is pure EPA; omega-3 acid ethyl
esters (Lovaza), which is a combination of EPA, DHA,
and ethyl esters of omega-3 fatty acids; and Omtryg
(omega-3 acid ethyl esters A), which is also a
combination of EPA and DHA.
Statins
These cholesterol-lowering medications may
be recommended if you also have poor cholesterol
numbers or a history of blocked arteries or diabetes
However, statins are not considered a first-line
monotherapy in patients with triglyceride levels over
500 mg/dL.33 Statins can be used in combination with
niacin, fenofibrate, omega-3 fatty acids, and
ezetimibe. Examples of statins include atorvastatin
calcium (Lipitor) and rosuvastatin calcium (Crestor).
Ezetimibe (Zetia)
A selective cholesterol absorption inhibitor
usually given with a statin that can enhance the lipid-
lowering effect of the statin. In a meta-analysis of
5,039 patients, ezetimibe 10 mg per day in
combination with statin treatment demonstrated an
additional 10.7% reduction in triglyceride levels.31
When ezetimibe was used in combination with
atorvastatin in patients with combined
hyperlipidemia whose triglyceride levels were
between 150 and 499 mg/dL and who were given an
oral fat load,
ANTONIO, RAFANAN, SACRAMENTO. 9
postprandial triglyceride levels were significantly lower than those of patients who received atorvastatin
alone.34 Ezetimibe is fairly well tolerated and is associated with a low incidence of reversible impaired
hepatic function, rare myositis, and occasional gastrointestinal upset.35

TRIGLYCERIDES IN RELATION TO
OBESITY IN THE U.S.

Obesity in the United States is a major health issue, resulting in numerous diseases, specifically
increased risk of certain types of cancer, coronary artery disease, type 2 diabetes, stroke, as well as
significant increase in early mortality and economic costs. While many industrialized countries have
experienced similar increases, obesity rates in the United States are the highest in the world.36

An obese person in America incurs an average of $1,429 more in medical expenses annually.
Approximately $147 billion is spent in added medical expenses per year within the United States. This
number is suspected to increase approximately $1.24 billion per year until the year 2030. 37

The United States had the highest rate of obesity within the OECD grouping of large trading
economies.38 From 23% obesity in 1962, estimates have steadily increased. The following statistics
comprise adults age 20 and over. The overweight percentages for the overall US population are higher
reaching 39.4% in 1997, 44.5% in 2004,39 56.6% in 2007,40 and 63.8% (adults) and 17% (children) in
200841,42 In 2010, the Centers for Disease Control and Prevention (CDC) reported higher numbers once
more, counting 65.7% of American adults as overweight, and 17% of American children, and according
to the CDC, 63% of teenage girls become overweight by age 11.43 In 2013 the Organization for
Economic Co-operation and Development (OECD) found that 57.6% of American citizens were
overweight or obese. The organization estimates that 3/4 of the American population will likely be
overweight or obese by 2020.44 2014 figures from the CDC found that more than one-third (36.5%) of
U.S. adults age 20 and older45 and 17% of children and adolescents aged 2–19 years were obese.46 A
second study from the National Center for Health Statistics at the CDC showed that 39.6% of US adults
age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women).47

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 10

 Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the
United States per year48 and has increased health care use and expenditures,49,50,51,52 costing society
an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight)
and indirect (absenteeism, loss of future earnings due to premature death) costs.53 This exceeds health
care costs associated with smoking52 and accounts for 6% to 12% of national health care expenditures
in the United States.54

PREVALENCE The National Center for Health Statistics estimates that, for 2015-2016 in the
U.S., 39.8% of adults aged 20 and over were obese (including 7.6% with severe obesity) and that another
31.8% were overweight.55

Obesity rates have increased for all population groups in the United States over the last several
decades.48 Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled
from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased
by a factor of five, from one in two thousand to one in four hundred.56

There have been similar increases seen in children and adolescents, with the prevalence of
overweight in pediatric age groups nearly tripling over the same period. Approximately nine million
children over six years of age are considered obese. Several recent studies have shown that the rise in
obesity in the US is slowing, possibly explained by saturation of health-oriented media or a biological
limit on obesity.56

Race

Obesity is distributed unevenly across racial groups in the United States.57

Caucasian

The obesity rate for Caucasian adults 18 years and older (over 30 BMI) in the US in 2015 was
29.7%.58For adult Caucasian men, the rate of obesity was 31.1% in 2015.59 For adult Caucasian women,
the rate of obesity was 27.5% in 2015.59 The most recent statistics from the NHANES of age adjusted
obesity rates for Caucasian adults 20 years and older in the U.S. in 2016 was 37.9%.60 The obesity rates
of Caucasian males and Caucasian females from the NHANES 2016 data were relatively equivalent,
obesity rates were 37.9% and 38.0%, respectively.61 This large jump in obesity rate could possibly be
attributed to the fact when teenagers of 18 and 19 years old are classified as adults instead of
adolescents, their much lower rates of obesity skew and bring down the adult average.

African-American

The obesity rate for Black adults 18 years and older (over 30 BMI) in the US in 2015 was 39.8%.58 For
adult Black men, the rate of obesity was 34.4% in 2015.59 For adult Black women, the rate of obesity was
44.7% in 2015.59 The most recent statistics from the NHANES of age adjusted obesity rates for Black adults
20 years and older in the U.S. in 2016 was 46.8%.60

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 11

 According to the obesity rates of from the NHANES 2016 data, Black males had significantly lower
than Black females, their rates were 36.9% and 54.8%, respectively.61 BMI is not a good indicator in
determining all-cause and coronary heart disease mortality in black women compared to white
women.62 This is perhaps caused by the fact that black females tend to have less body fat, especially
visceral fat, for a given BMI or waist measurement than both White and Latina women. 63

American-Indian (Alaska Native)

The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2015 was
42.9%.58 No breakdown by sex was given for American Indian or Alaska Native adults in the CDC
figures.58

Asian

The obesity rate for Asian adults 18 years and older (over 30 BMI) in the US in 2015 was 10.7%.58 No
breakdown by sex was given for Asian adults in the CDC figures.58 In more recent statistics from the
NHANES in 2016 of a breakdown by sex was provided. Asian adults 20 years and older had a total
obesity rate of 12.7%. The rate among Asian males was 10.1% and among Asian females it was 14.8%.
Asian Americans have substantially lower rates of obesity than any other racial or ethnic group. Notably,
however, there is discussion that Asians should have a lower BMI cut-off for obesity than other
races/ethnicities since they have higher health risks at a lower BMI.60,61

Hispanic or Latino

The obesity rate for the Hispanic or Latino adults 18 years and older category (over 30 BMI) in the
US in 2015 was 31.8%.58 For the overall Hispanic or Latino men category, the rate of obesity was 31.6%
in 2015.59 For the overall Hispanic or Latino women category, the rate of obesity was 31.9% in
2015.59 According to the most recent statistics from the NHANES in 2016 Latino adults had the highest
overall obesity rates. Latino Adults age 20 and older had reached an obesity rate of 47.0%.60 Adult
Latino men’s rate was 43.1%, the highest of all males. For adult Latina women the rate was 50.6%,
making them second to African-American women.61

Mexican Americans

Within the Hispanic or Latino category, obesity statistics for Mexican or Mexican Americans were
provided, with no breakdown by sex.58 The obesity rate for Mexican or Mexican Americans adults (over
30 BMI) in the US in 2015 was 35.2%.58

Native Hawaiian or Other Pacific Islander

The obesity rate for Native Hawaiian or Other Pacific Islander adults (over 30 BMI) in the US in 2015
was 33.4%.58 No breakdown by sex was given for Native Hawaiian or Other Pacific Islander adults in the
CDC figures.58

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 12

Newborns

Mothers who are obese and become pregnant have a higher risk of complications during
pregnancy and during birth, and their newborns are at greater risk for preterm birth, birth defects, and
perinatal death. There are more possible risks to children born to obese mothers than pregnant women
who are not obese. Newborns are also at risk for neurodevelopmental issues. Obese women are in the
position to possibly put their child at risk for compromised neurodevelopmental outcomes. It is not
known the whole effect that obesity can have on the neurodevelopmental of the child. Reports
concluded that "children born to mothers with gestational diabetes, which is linked with maternal
obesity, are at a higher risk for lower cognitive test scores and behavioral problems.”69 Obese women
are less likely to breastfeed their newborns, and those who start doing so are likely to stop
sooner.70 Children who were breastfed every extra week by age 2 had a lower chance of being obese.
If the hospitals were informative about breastfeeding with mothers or if mothers chose to breastfeed
that played a role in the child's weight.71

Children and Teens

From 1980 to 2008, the prevalence of obesity in children aged 6 to 11 years tripled from 6.5% to
19.6%. The prevalence of obesity in teenagers more than tripled from 5% to 18.1% in the same time
frame.72 In less than one generation, the average weight of a child has risen by 5 kg in the United
States.37 In 2014 it was reported 17.2% of youth aged 2–19 were considered obese and another 16.2%
were overweight.73 Meaning, over one-third of children and teens in the US were overweight or obese.
Statistics from a 2016-2017 page on the CDC’s official website that 13.9% of toddlers and children age
2-5, 18.4% of children 6-11, and 20.6% of adolescents 12-19 are obese.66 The prevalence of child obesity
in today's society concerns health professionals because a number of these children develop health
issues that weren't usually seen until adulthood.74

Some of the consequences in childhood and adolescent obesity are psychosocial. Overweight
children and overweight adolescents are targeted for social discrimination, and thus, they begin to
stress-eat.75 The psychological stress that a child or adolescent can endure from social stigma can
cause low self-esteem which can hinder a child's after school social and athletic capability, especially
in plump teenage girls, and could continue into adulthood.76 Teenage females are often overweight
or obese by age 12, as, after puberty, teenage girls gain about 15 pounds, specifically in the arms, legs,
and chest/midsection.76

Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has
increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11
years, prevalence increased from 6.5% to 19.6%; and for those aged 12–19 years, prevalence increased
from 5.0% to 17.6%.77

Analyses of the trends in high BMI for age showed no statistically significant trend over the four
time periods (1999–2000, 2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall, in 2003–
2006, 11.3% of children and adolescents aged 2 through 19 years were at or above the 97th percentile
of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at
or above the 85th percentile.79

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 13

 Trend analyses indicate no significant trend between 1999–2000 and 2007–2008 except at the
highest BMI cut point (BMI for age 97th percentile) among all 6- through 19-year-old boys. In 2007–2008,
9.5% of infants and toddlers were at or above the 95th percentile of the weight-for-recumbent-length
growth charts. Among children and adolescents aged 2 through 19 years, 11.9% were at or above the
97th percentile of the BMI-for-age growth charts; 16.9% were at or above the 95th percentile; and 31.7%
were at or above the 85th percentile of BMI for age.80

In summary, between 2003 and 2006, 11.3% of children and adolescents were obese and 16.3%
were overweight. A slight increase was observed in 2007 and 2008 when the recorded data shows that
11.9% of the children between 6 and 19 years old were obese and 16.9% were overweight. The data
recorded in the first survey was obtained by measuring 8,165 children over four years and the second
was obtained by measuring 3,281 children.

"More than 80 percent of affected children become overweight adults, often with lifelong health
problems.”81 Children are not only highly at risk of diabetes, high cholesterol and high blood pressure
but obesity also takes a toll on the child's psychological development. Social problems can arise and
have a snowball effect, causing low self-esteem which can later develop into eating disorders.

Adults

There are more obese US adults than those who are just overweight.82 According to a study in The
Journal of the American Medical Association (JAMA), in 2008, the obesity rate among adult Americans
was estimated at 32.2% for men and 35.5% for women; these rates were roughly confirmed by the CDC
again for 2009–2010. Using different criteria, a Gallup survey found the rate was 26.1% for U.S. adults in
2011, up from 25.5% in 2008. Though the rate for women has held steady over the previous decade, the
obesity rate for men continued to increase between 1999 and 2008, according to the JAMA study
notes.82 Moreover, "The prevalence of obesity for adults aged 20 to 74 years increased by 7.9
percentage points for men and by 8.9 percentage points for women between 1976–1980 and 1988–
1994, and subsequently by 7.1 percentage points for men and by 8.1 percentage points for women
between 1988–1994 and 1999–2000.”83,84 According to the CDC, "obesity is higher among middle age
adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above
(35.4%) adults.”45

Elderly

Although obesity is reported in the elderly, the numbers are still significantly lower than the levels
seen in the young adult population. It is speculated that socioeconomic factors may play a role in this
age group when it comes to developing obesity.85 Obesity in the elderly increases healthcare
costs.85 Nursing homes are not equipped with the proper equipment needed to maintain a safe
environment for the obese residents. If a heavy bedridden patient is not turned, the chances of a bed
sore increases. If the sore is untreated, the patient will need to be hospitalized and have a wound
vac placed.86

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 14

In the Military

An estimated 16% percent of active duty U.S. military personnel were obese in 2004, with the cost
of remedial bariatric surgery for the military reaching US$15 million in 2002. Obesity is currently the largest
single cause for the discharge of uniformed personnel.87 A financial analysis published in 2007 further
showed that the treatment of diseases and disorders associated with obesity costs the military $1.1
billion annually. Moreover, the analysis found that the increased absenteeism of obese or overweight
personnel amounted to a further 658,000 work days lost per year. This lost productivity is higher than the
productivity loss in the military due to high alcohol consumption which was found to be 548,000 work
days. Problems associated with obesity further manifested itself in early discharge due to inability to
meet weight standards. Approximately 1200 military enlistees were discharged due to this reason in
2006.88

The rise in obesity has led to less citizens able to join the military and therefore more difficulty in
recruitment for the armed forces. In 2005, 9 million adults aged 17 to 24, or 27%, were too overweight
to be considered for service in the military.89 For comparison, just 6% of military aged men in 1960 would
have exceed the current weight standards of the U.S. military. Excess weight is the most common reason
for medical disqualification and accounts for the rejection of 23.3% of all recruits to the military. Of those
who failed to meet weight qualifications but still entered the military, 80% left the military before
completing their first term of enlistment.90 In light of these developments, organizations such as Mission:
Readiness, made up of retired generals and admirals, have advocated for focusing on childhood
health education to combat obesity's effect on the military.91

Prevalence by State and Territory

The following figures were averaged from 2005–2007 adult data compiled by the
CDC BRFSS program 92 and 2003–2004 child data from the National Survey of Children's Health.93,94 There
is also data from a more recent 2016 CDC study of the 50 states plus the District of Columbia, Puerto
Rico, the U.S. Virgin Islands and Guam.95

Care should be taken in interpreting these numbers, because they are based on self-report
surveys which asked individuals (or, in case of children and adolescents, their parents) to report their
height and weight. Height is commonly overreported and weight underreported, sometimes resulting
in significantly lower estimates. One study estimated the difference between actual and self-reported
obesity as 7% among males and 13% among females as of 2002, with the tendency to increase.96

The long-running REGARDS study, published in the journal of Obesity in 2014, brought in individuals
from the nine census regions and measured their height and weight. The data collected disagreed with
the data in the CDC's phone survey used to create the following chart. REGARDS found that the West
North Central region (North Dakota, South Dakota, Minnesota, Missouri, Nebraska, and Iowa), and East
North Central region (Illinois, Ohio, Wisconsin, Michigan, and Indiana) were the worst in obesity numbers,
not the East South Central region (Tennessee, Mississippi, Alabama, Kentucky) as had been previously
thought.97

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 15

 Dr. P.H., professor in the Department of
Biostatistics in the UAB School of Public Health George
Howard explains that "Asking someone how much
they weigh is probably the second worst question
behind how much money they make," "From past
research, we know that women tend to under-report
their weight, and men tend to over-report their height."
Howard said as far as equivalency between the self-
reportedTriglycerides
and measured data sets, the East South- 15
Central region showed the least misreporting. "This
suggests that people from the South come closer to
telling the truth than people from other regions,
perhaps because there's not the social stigma of
being obese in the South as there is in other regions.”98

The area of the United States with the highest

obesity rate is American Samoa (75% obese and 95%
overweight).99

States, District, Obese Obese adults Overweight Obese children Obesity

& Territories adults (2016) 95,100 (incl. obese) and adolescents rank
(mid- adults (mid-2000s)101
2000s) (mid-2000s)

Alabama 30.1% 35.7% 65.4% 16.7% 3

Alaska 27.3% 31.4% 64.5% 11.1% 14

American — 75%99 95%92 35%99,103 —

Samoa

Arizona 23.3% 29.0% 59.5% 12.2% 40

Arkansas 28.1% 35.7% 64.7% 16.4% 9

California 23.1% 25.0% 59.4% 13.2% 41

Colorado 21.0% 22.3% 55.0% 9.9% 51

Connecticut 20.8% 26.0% 58.7% 12.3% 49

Delaware 25.9% 30.7% 63.9% 22.8% 22

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 16

 District of 22.1% 22.6% 55.0% 14.8% 43
Columbia

Florida 23.3% 27.4% 60.8% 14.4% 39

Georgia 27.5% 31.4% 63.3% 16.4% 12

Guam — 28.3% — 22%104 —

Hawaii 20.7% 23.8% 55.3% 13.3% 50

Idaho 24.6% 27.4% 61.4% 10.1% 31

Illinois 25.3% 31.6% 61.8% 15.8% 26

Indiana 27.5% 32.5% 62.8% 15.6% 11

Iowa 26.3% 32.0% 63.4% 12.5% 19

Kansas 25.8% 31.2% 62.3% 14.0% 23

Kentucky 28.4% 34.2% 66.8% 20.6% 7

Louisiana 29.5% 35.5% 64.2% 17.2% 4

Maine 23.7% 29.9% 60.8% 12.7% 34

Maryland 25.2% 29.9% 61.5% 13.3% 28

Massachusetts 20.9% 23.6% 56.8% 13.6% 48

Michigan 27.7% 32.5% 63.9% 14.5% 10

Minnesota 24.8% 27.8% 61.9% 10.1% 30

Mississippi 34.4% 37.3% 67.4% 17.8% 1

Missouri 27.4% 31.7% 63.3% 15.6% 13

Montana 21.7% 25.5% 59.6% 11.1% 45

Nebraska 26.50% 32.00% 63.90% 11.90% 18

Nevada 23.6% 25.8% 61.8% 12.4% 36

New Hampshire 23.6% 26.6% 60.8% 12.9% 35

New Jersey 22.9% 27.4% 60.5% 13.7% 42

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 17

 New Mexico 23.3% 28.3% 60.3% 16.8% 38

New York 23.5% 25.5% 60.0% 15.3% 37

North Carolina 27.1% 31.8% 63.4% 19.3% 16

North Dakota 25.9% 31.9% 64.5% 12.1% 21

Northern — — — 16%105 —
Mariana Islands

Ohio 26.9% 31.5% 63.3% 14.2% 17

Oklahoma 28.1% 32.8% 64.2% 15.4% 8

Oregon 25.0% 28.7% 60.8% 14.1% 29

Pennsylvania 25.7% 30.3% 61.9% 13.3% 24

Puerto Rico — 30.7% — 26%106,107 —

Rhode Island 21.4% 26.6% 60.4% 11.9% 46

South Carolina 29.2% 32.3% 65.1% 18.9% 5

South Dakota 26.1% 29.6% 64.2% 12.1% 20

Tennessee 29.0% 34.8% 65.0% 20.0% 6

Texas 27.2% 33.7% 64.1% 19.1% 15

Virgin Islands — 32.5% — — —

(U.S.)

Utah 21.8% 25.4% 56.4% 8.5% 44

Vermont 21.1% 27.1% 56.9% 11.3% 47

Virginia 25.2% 29.0% 61.6% 13.8% 27

Washington 24.5% 28.6% 60.7% 10.8% 32

West Virginia 30.6% 37.7% 66.8% 20.9% 2

Wisconsin 25.5% 30.7% 62.4% 13.5% 25

Wyoming 24.0% 27.7% 61.7% 8.7% 33

Triglycerides ANTONIO, RAFANAN, SACRAMENTO. 18


EPIDEMIOLOGY Obesity is
a chronic health problem. It is one of the biggest
factors for a type II diabetes, and cardiovascular
disease. It is also associated with cancer
(e.g. colorectal cancer), osteoarthritis, liver
disease, sleep apnea, depression and other medical
conditions that affect mortality and morbidity.108
According to the NHANES data, African
American and Mexican American adolescents
between 12 and 19 years old are more likely to be
overweight than non-Hispanic White adolescents.
The prevalence is 21%, 23% and 14% respectively.
Also, in a national survey of American Indian children
5–18 years old, 39 percent were found to be
overweight or at risk for being overweight.109 As per
national survey data, these trends indicate that by
2030, 86.3% of adults will be overweight or obese and
51.1% obese.110
A 2007 study found that receiving Food Stamps
long term (24 months) was associated with a 50%
increased obesity rate among female adults.111
Looking at the long-term consequences,
overweight adolescents have a 70 percent chance
of becoming overweight or obese adults, which
increases to 80 percent if one or more parent is
overweight or obese. In 2000, the total cost of obesity
for children and adults in the United States was
estimated to be US$117 billion (US$61 billion in direct
medical costs). Given existing trends, this amount is
projected to range from US$860.7-956.9 billion in
healthcare costs by 2030.110
Food consumption has increased with time. For
example, annual per capita consumption of cheese
was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in
2000; the average person consumed 389 grams
(13.7 oz) of carbohydrates daily in 1970; 490 grams
(17 oz) in 2000; 41 pounds (19 kg) of fats and oils in
1909; 79 pounds (36 kg) in 2000.
Triglycerides
In 1977, 18% of an average person's food
was consumed outside the home; in 1996, this
had risen to 32%.112
Contributing Factors
Numerous studies have attempted to
identify contributing factors for obesity in the
United States. These studies have resulted in
numerous hypotheses as to what those key
factors are. A common theme is that of too
much food and too little exercise, however.
Dieting can be useful in lowering someone's
body weight, though which foods should be
avoided is very confusing to the public. The
public has trouble determining what to eat and
what not to eat as well as how much or how
little they should. For example, while dieting,
people tend to consume more low-fat or fat-
free products, even though those items can be
just as damaging to the body as the items with
fat are. As far as the theoretical contributing
factor of too little exercise, one contributing
factor is that only a small amount, 20%, of jobs
require physical activity. Therefore, most of our
time working is spent sitting.113
Other factors not directly related to
caloric intake and activity levels that are
believed to contribute to obesity include air
conditioning,114 the ability to delay
gratification, and the thickness of the prefrontal
cortex of the brain.115,116 Genetics are also
believed to be a factor, with a 2018 study
stating that the presence of the human gene
APOA2 could result in a higher BMI in
individuals.117 Also, the probability of obesity
can even start before birth due to things that
the mother does such as smoking and gaining
a lot of weight.113
ANTONIO, RAFANAN, SACRAMENTO. 19
Total Costs
There has been an increase in obesity-
related medical problems, including type II
diabetes, hypertension, cardiovascular
disease, and disability.118,49 In particular,
diabetes has become the seventh leading
cause of death in the United States,119 with
the U.S. Department of Health and Human
Services estimating in 2008 that fifty-seven
million adults aged twenty and older were pre-
diabetic, 23.6 million diabetic, with 90–95% of
the latter being type 2-diabetic.120
Obesity has also been shown to increase
the prevalence of complications during
pregnancy and childbirth. Babies born to
obese women are almost three times as likely to
die within one month of birth and almost twice
as likely to be stillborn than babies born to
women of normal weight.121
Obesity has been cited as a contributing
factor to approximately 100,000–400,000
deaths in the United States per year48 (including
increased morbidity in car accidents)122 and
has increased health care use and
expenditures,49,50,51,52 costing society an
estimated $117 billion in direct (preventive,
diagnostic, and treatment services related to
weight) and indirect (absenteeism, loss of
future earnings due to premature death)
costs.53 This exceeds health-care costs
associated with smoking or drinking and, by
52
one estimate, accounts for 6% to 12% of
national health care expenditures in the United
States.54 (although another estimate states the
figure is between 5% and 10%).123
Triglycerides
The Medicare and Medicaid programs bear
about half of this cost.52 Annual hospital costs for
treating obesity-related diseases in children rose
threefold, from US$35 million to US$127 million, in the
period from 1979 to 1999,124 and the inpatient and
ambulatory healthcare costs increased drastically by
US$395 per person per year.51
These trends in healthcare costs associated
with pediatric obesity and its comorbidities are
staggering, urging the Surgeon General to predict
that preventable morbidity and mortality associated
with obesity may surpass those associated with
cigarette smoking.50,125 Furthermore, the probability
of childhood obesity persisting into adulthood is
estimated to increase from approximately twenty
percent at four years of age to approximately eighty
percent by adolescence,126 and it is likely that these
obesity comorbidities will persist into adulthood.127
Effects on Life Expectancy
The United States' high obesity rate is a major
contributor to its relatively low life expectancy
relative to other high-income countries.128 It has been
suggested that obesity may lead to a halt in the rise
in life expectancy observed in the United States
during the 19th and 20th centuries.129,130 In the event
that obesity continues to grow in newer generations,
a decrease in well being and life span in the future
generations may continue to degenerate.
According to Olshansky, obesity diminishes "the
length of life of people who are severely obese by an
estimated 5 to 20 years.”129 History shows that the
number of years lost will continue to grow because
the likelihood of obesity in new generations is higher.
Children and teens are now experiencing obesity at
younger ages. They are eating less healthy and are
becoming less active, possibly resulting in less time
lived compared to their parents'.129
ANTONIO, RAFANAN, SACRAMENTO. 20
 The life expectancy for newer generations can expect to be lower due to obesity and the health
risks they can experience at a later age.

CONCLUSION To conclude, the pathophysiology in relation to elevated triglyceride level

has a multiple effect to the health particularly with obese people, the abnormalities of triglyceride levels
pertains to susceptibility to diseases associated with coronary heart diseases, fatty liver diseases,
diabetes, and other major health risks. Changes in habits to a better lifestyle is the primary key in response
to treatment.

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