Carbohydrate-induced Hypertriglyceridaemia in a Child

Carbohydrate-induced hypertriglyceridaemia is described in a 12-year-old boy, whose father died of premature coronary heart disease. Serum triglyceride and pre-fl-lipoprotein concentrations were high on a self-selected diet and were reduced to normal by a low carbohydrate diet. It proved difficult to maintain triglyceride levels by diet at home, but the addition of clofibrate improved the control. Clearing of lipid from the serum after an oral fat load was delayed when the fasting serum triglyceride was high, but became normal after the serum triglyceride had been reduced by diet. An oral glucose load showed impairment of glucose tolerance. Insulin resistance was suggested by a small decrease in plasma glucose, with a normal increase in serum insulin, after intravenous tolbutamide. Serum triglyceride and pre-f-lipoprotein concentrations increased after oral glucose. Observations in two other children with diabetic glucose tolerance curves suggested that the increase in serum triglyceride after oral glucose was related to the insulin response rather than to the degree of hyperglycaemia.