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Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale

SUMMARY: Drinking fruit juice is an increasingly popular health trend, as it is widely perceived as a source of vitamins and nutrients. However, high fructose load in fruit beverages can have harmful metabolic effects. When consumed in high amounts, fructose is linked with hypertriglyceridemia, fatt...

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Autores principales: Dugic, Ana, Kryk, Michael, Mellenthin, Claudia, Braig, Christoph, Catanese, Lorenzo, Petermann, Sandy, Kothmann, Jürgen, Mühldorfer, Steffen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630754/
https://www.ncbi.nlm.nih.gov/pubmed/34747355
http://dx.doi.org/10.1530/EDM-21-0110
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author Dugic, Ana
Kryk, Michael
Mellenthin, Claudia
Braig, Christoph
Catanese, Lorenzo
Petermann, Sandy
Kothmann, Jürgen
Mühldorfer, Steffen
author_facet Dugic, Ana
Kryk, Michael
Mellenthin, Claudia
Braig, Christoph
Catanese, Lorenzo
Petermann, Sandy
Kothmann, Jürgen
Mühldorfer, Steffen
author_sort Dugic, Ana
collection PubMed
description SUMMARY: Drinking fruit juice is an increasingly popular health trend, as it is widely perceived as a source of vitamins and nutrients. However, high fructose load in fruit beverages can have harmful metabolic effects. When consumed in high amounts, fructose is linked with hypertriglyceridemia, fatty liver and insulin resistance. We present an unusual case of a patient with severe asymptomatic hypertriglyceridemia (triglycerides of 9182 mg/dL) and newly diagnosed type 2 diabetes mellitus, who reported a daily intake of 15 L of fruit juice over several weeks before presentation. The patient was referred to our emergency department with blood glucose of 527 mg/dL and glycated hemoglobin (HbA1c) of 17.3%. Interestingly, features of diabetic ketoacidosis or hyperosmolar hyperglycemic state were absent. The patient was overweight with an otherwise unremarkable physical exam. Lipase levels, liver function tests and inflammatory markers were closely monitored and remained unremarkable. The initial therapeutic approach included i.v. volume resuscitation, insulin and heparin. Additionally, plasmapheresis was performed to prevent potentially fatal complications of hypertriglyceridemia. The patient was counseled on balanced nutrition and detrimental effects of fruit beverages. He was discharged home 6 days after admission. At a 2-week follow-up visit, his triglyceride level was 419 mg/dL, total cholesterol was 221 mg/dL and HbA1c was 12.7%. The present case highlights the role of fructose overconsumption as a contributory factor for severe hypertriglyceridemia in a patient with newly diagnosed diabetes. We discuss metabolic effects of uncontrolled fructose ingestion, as well as the interplay of primary and secondary factors, in the pathogenesis of hypertriglyceridemia accompanied by diabetes. LEARNING POINTS: Excessive dietary fructose intake can exacerbate hypertriglyceridemia in patients with underlying type 2 diabetes mellitus (T2DM) and absence of diabetic ketoacidosis or hyperosmolar hyperglycemic state. When consumed in large amounts, fructose is considered a highly lipogenic nutrient linked with postprandial hypertriglyceridemia and de novo hepatic lipogenesis (DNL). Severe lipemia (triglyceride plasma level > 9000 mg/dL) could be asymptomatic and not necessarily complicated by acute pancreatitis, although lipase levels should be closely monitored. Plasmapheresis is an effective adjunct treatment option for rapid lowering of high serum lipids, which is paramount to prevent acute complications of severe hypertriglyceridemia.
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spelling pubmed-86307542021-12-02 Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale Dugic, Ana Kryk, Michael Mellenthin, Claudia Braig, Christoph Catanese, Lorenzo Petermann, Sandy Kothmann, Jürgen Mühldorfer, Steffen Endocrinol Diabetes Metab Case Rep Insight into Disease Pathogenesis or Mechanism of Therapy SUMMARY: Drinking fruit juice is an increasingly popular health trend, as it is widely perceived as a source of vitamins and nutrients. However, high fructose load in fruit beverages can have harmful metabolic effects. When consumed in high amounts, fructose is linked with hypertriglyceridemia, fatty liver and insulin resistance. We present an unusual case of a patient with severe asymptomatic hypertriglyceridemia (triglycerides of 9182 mg/dL) and newly diagnosed type 2 diabetes mellitus, who reported a daily intake of 15 L of fruit juice over several weeks before presentation. The patient was referred to our emergency department with blood glucose of 527 mg/dL and glycated hemoglobin (HbA1c) of 17.3%. Interestingly, features of diabetic ketoacidosis or hyperosmolar hyperglycemic state were absent. The patient was overweight with an otherwise unremarkable physical exam. Lipase levels, liver function tests and inflammatory markers were closely monitored and remained unremarkable. The initial therapeutic approach included i.v. volume resuscitation, insulin and heparin. Additionally, plasmapheresis was performed to prevent potentially fatal complications of hypertriglyceridemia. The patient was counseled on balanced nutrition and detrimental effects of fruit beverages. He was discharged home 6 days after admission. At a 2-week follow-up visit, his triglyceride level was 419 mg/dL, total cholesterol was 221 mg/dL and HbA1c was 12.7%. The present case highlights the role of fructose overconsumption as a contributory factor for severe hypertriglyceridemia in a patient with newly diagnosed diabetes. We discuss metabolic effects of uncontrolled fructose ingestion, as well as the interplay of primary and secondary factors, in the pathogenesis of hypertriglyceridemia accompanied by diabetes. LEARNING POINTS: Excessive dietary fructose intake can exacerbate hypertriglyceridemia in patients with underlying type 2 diabetes mellitus (T2DM) and absence of diabetic ketoacidosis or hyperosmolar hyperglycemic state. When consumed in large amounts, fructose is considered a highly lipogenic nutrient linked with postprandial hypertriglyceridemia and de novo hepatic lipogenesis (DNL). Severe lipemia (triglyceride plasma level > 9000 mg/dL) could be asymptomatic and not necessarily complicated by acute pancreatitis, although lipase levels should be closely monitored. Plasmapheresis is an effective adjunct treatment option for rapid lowering of high serum lipids, which is paramount to prevent acute complications of severe hypertriglyceridemia. Bioscientifica Ltd 2021-10-18 /pmc/articles/PMC8630754/ /pubmed/34747355 http://dx.doi.org/10.1530/EDM-21-0110 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Insight into Disease Pathogenesis or Mechanism of Therapy
Dugic, Ana
Kryk, Michael
Mellenthin, Claudia
Braig, Christoph
Catanese, Lorenzo
Petermann, Sandy
Kothmann, Jürgen
Mühldorfer, Steffen
Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title_full Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title_fullStr Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title_full_unstemmed Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title_short Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
title_sort fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale
topic Insight into Disease Pathogenesis or Mechanism of Therapy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630754/
https://www.ncbi.nlm.nih.gov/pubmed/34747355
http://dx.doi.org/10.1530/EDM-21-0110
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