Top Things to Know: Screening, Diagnosis, & Management of Pediatric Hypertriglyceridemia
Published: February 18, 2026
Prepared by Jonathan P. Wong, MD, Ambika P. Ashraf MD
- Pediatric hypertriglyceridemia is increasingly prevalent, affecting up to 10–20% of U.S. youth, often in the context of obesity, insulin resistance, or secondary causes such as diabetes, hypothyroidism, nephrotic syndrome, or medication use.
- Elevated triglycerides (TG) are clinically important, as they are associated with long-term risk of atherosclerotic cardiovascular disease (ASCVD) at mild to moderate elevations and, at very high levels, with acute pancreatitis.
- Triglyceride-rich lipoproteins (TGRLPs), including very low-density lipoproteins (VLDL), chylomicrons, intermediate-density lipoproteins (IDL), and chylomicron remnants, underpin the pathophysiology of hypertriglyceridemia and guide management decisions.
- TG levels help stratify risk and inform management, with categories defined as mild (<400 mg/dL), moderate (401–885 mg/dL), severe (886–2000 mg/dL), and very severe (>2000 mg/dL); all levels require evaluation of secondary causes and lifestyle modification.
- TG levels <885 mg/dL are usually driven by increased hepatic VLDL production, and lifestyle strategies such as limiting added sugars and refined carbohydrates, increasing physical activity, promoting weight loss, and avoiding alcohol are central to management.
- Non-high-density lipoprotein cholesterol (non-HDL-C) should be calculated when TG levels are <885 mg/dL; persistent levels ≥145 mg/dL may indicate elevated ASCVD risk, reflecting elevated atherogenic apoB-containing particles and could warrant statin use.
- TG levels of 886–2000 mg/dL reflect impaired clearance and chylomicronemia, often due to partial lipoprotein lipase (LPL) dysfunction; management includes total fat restriction (<10–15% of total daily calories) and, in some cases, off-label use of omega-3 fatty acids or fibrates.
- TG levels >2000 mg/dL carry markedly elevated pancreatitis risk, requiring more restrictive dietary approaches such as very low-fat, no-fat, or temporary fasting strategies, especially in acute care settings.
- Multifactorial chylomicronemia syndrome (MCS) typically presents in adolescence or adulthood with fluctuating TG levels influenced by genetic predisposition and metabolic stressors, and may respond to pharmacotherapy; familial chylomicronemia syndrome (FCS), in contrast, is an early-onset autosomal recessive disorder with persistently severe hypertriglyceridemia and limited treatment options.
- Emerging therapies targeting the LPL regulatory complex, including agents that inhibit apolipoprotein C-III, angiopoietin-like protein 3 (ANGPTL3), or microsomal triglyceride transfer protein (MTP), show promise in treating chylomicronemia, and further pediatric studies are needed to establish safety and efficacy.
Citation
Peterson AL, Ashraf AP, Bachman J, Hegele RA, Rashad M, South AM, Tran AH, Zachariah J, Wong JP; on behalf of the American Heart Association Cardiovascular Disease Prevention Committee of the Council on Lifelong Con¬genital Heart Disease and Heart Health in the Young; Council on Clinical Car¬diology; Council on Genomic and Precision Medicine; Council on Lifestyle and Cardiometabolic Health; Council on Basic Cardiovascular Sciences; and Coun¬cil on Cardiovascular and Stroke Nursing. Screening, diagnosis, and manage¬ment of pediatric hypertriglyceridemia: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. Published online February 18, 2026. doi: 10.1161/ ATV.0000000000000195