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Triglycerides

SI UNITS (recommended)

CONVENTIONAL UNITS

(Major Circulating Lipid - Critical Marker for Cardiovascular Risk, Metabolic Syndrome & Pancreatitis)

Synonyms

  • Triglycerides
  • Triacylglycerol (TAG)
  • Serum triglyceride
  • Neutral fats
  • TG level
  • Blood fats

Units of Measurement

  • mmol/L
  • µmol/L
  • mg/dL
  • mg/100 mL
  • mg%
  • mg/L
  • µg/mL

Unit Conversions

Molecular Weight (average TG molecule) ≈ 885 g/mol

(Used for standard TG conversions.)

mmol/L ↔ mg/dL

1 mmol/L=88.5 mg/dL1\ \text{mmol/L} = 88.5\ \text{mg/dL}1 mmol/L=88.5 mg/dL 1 mg/dL=0.0113 mmol/L1\ \text{mg/dL} = 0.0113\ \text{mmol/L}1 mg/dL=0.0113 mmol/L

µmol/L ↔ mg/L

1 µmol/L=0.885 mg/L1\ \text{µmol/L} = 0.885\ \text{mg/L}1 µmol/L=0.885 mg/L 1 mg/L=1.13 µmol/L1\ \text{mg/L} = 1.13\ \text{µmol/L}1 mg/L=1.13 µmol/L

mg/100 mL = mg% = mg/dL

µg/mL ↔ mg/L

1 µg/mL=1 mg/L1\ \text{µg/mL} = 1\ \text{mg/L}1 µg/mL=1 mg/L

Description

Triglycerides (TGs) are esters of glycerol + 3 fatty acids, representing:

  • The main storage form of fat in humans
  • A key circulating lipid transported by:
    • Chylomicrons (post-meal)
    • VLDL (endogenous production by liver)

They serve as a major energy source and a central component of metabolic dysfunction.

Elevated triglycerides are strongly linked with:

  • Atherosclerotic cardiovascular disease (ASCVD)
  • Insulin resistance
  • Pancreatitis
  • Fatty liver (MASLD/NAFLD)

Physiological Role

  • Energy storage & release (lipolysis → free fatty acids)
  • Transport of dietary fat (via chylomicrons)
  • Substrate for gluconeogenesis
  • Component of metabolic pathways (VLDL → LDL cascade)

Clinical Significance

HIGH TRIGLYCERIDES (Hypertriglyceridemia)

1. Metabolic Syndrome / Insulin Resistance (most common)

  • Obesity
  • Type 2 diabetes
  • PCOS
  • Sedentary lifestyle

2. Dietary Causes

  • High carbohydrates
  • Sugars / fructose
  • Excess alcohol

3. Secondary Causes

  • Hypothyroidism
  • CKD
  • Nephrotic syndrome
  • Pregnancy
  • Liver disease (steatosis)
  • Medications (steroids, OCPs, isotretinoin, antipsychotics, beta blockers)

4. Genetic Disorders

  • Familial hypertriglyceridemia
  • Familial combined hyperlipidemia
  • Lipoprotein lipase deficiency
  • ApoC-II deficiency

5. Pancreatitis Risk

TG >1000 mg/dL (11.3 mmol/L)⇒high risk\text{TG } > 1000\ \text{mg/dL (11.3 mmol/L)} \Rightarrow \text{high risk}TG >1000 mg/dL (11.3 mmol/L)⇒high risk TG >2000 mg/dL⇒very high risk\text{TG } > 2000\ \text{mg/dL} \Rightarrow \text{very high risk}TG >2000 mg/dL⇒very high risk

LOW TRIGLYCERIDES

Less common. Seen in:

  • Malnutrition
  • Hyperthyroidism
  • Malabsorption
  • Chronic illness
  • Abetalipoproteinemia (extremely low TG)

Reference Intervals

(NCEP ATP III + ACC/AHA + ESC/EAS)

Normal Fasting TG

  • <150 mg/dL
     (= <1.7 mmol/L)

Borderline High

  • 150–199 mg/dL
     (= 1.7–2.2 mmol/L)

High

  • 200–499 mg/dL
     (= 2.3–5.6 mmol/L)

Very High

  • ≥500 mg/dL
     (= ≥5.7 mmol/L)
    Risk of pancreatitis rises sharply.

Critical Levels

  • >1000 mg/dL (11.3 mmol/L) → acute pancreatitis risk
  • >2000 mg/dL (22.6 mmol/L) → lipemic serum, very high risk

Diagnostic Uses

1. Cardiovascular Risk Assessment

TG contributes to:

  • ASCVD
  • Atherogenic dyslipidemia
  • Remnant cholesterol elevation

2. Metabolic Syndrome Diagnosis

TG ≥150 mg/dL is one of the criteria.

3. Pancreatitis Risk Stratification

TG >1000 mg/dL is a medical emergency.

4. Monitoring Therapy

  • Lifestyle interventions
  • Statins
  • Fibrates
  • Omega-3 fatty acids
  • Insulin therapy in severe cases

5. Evaluation in fatty liver (MASLD/NAFLD)

High TG common.

Analytical Notes

  • Fasting sample preferred (8–12 hours).
    Non-fasting acceptable for ASCVD screening (<200 mg/dL stable).
  • Hemolysis & lipemia may interfere.
  • Enzymatic colorimetric assays used in automated analyzers.
  • Avoid alcohol 48 hours before test for accurate interpretation.

Clinical Pearls

  • TG rise post-meal due to chylomicron surge - use fasting test for accuracy.
  • High TG + low HDL = classic insulin-resistance pattern.
  • Very high TG (>1000 mg/dL) requires urgent reduction with insulin, heparin, fluids.
  • Statins lower TG modestly; fibrates and omega-3 fatty acids lower it more strongly.
  • TG lowering reduces pancreatitis risk; LDL lowering reduces ASCVD risk.

Interesting Fact

Triglycerides are transported through blood as oil droplets inside lipoproteins - the body’s way of moving hydrophobic fat in a water-based environment.

References

  1. Tietz Clinical Chemistry & Molecular Diagnostics, 8th Edition - Lipids & Lipoproteins
  2. ACC/AHA 2018 & 2022 Cholesterol Guidelines
  3. NCEP ATP III Lipid Guidelines
  4. ESC/EAS 2019 Dyslipidemia Guidelines
  5. Mayo Clinic Laboratories - Triglycerides
  6. ARUP Consult - Lipid Disorders
  7. NIH / MedlinePlus - Triglycerides

Last updated: January 27, 2026

Reviewed by : Medical Review Board

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