Dugic Ana, Kryk Michael, Mellenthin Claudia, Braig Christoph, Catanese Lorenzo, Petermann Sandy, Kothmann Jürgen, Mühldorfer Steffen
Department for Gastroenterology, Endocrinology and Metabolic Diseases, Bayreuth University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, Germany.
Department of Surgery, HFR Fribourg, Fribourg, Switzerland.
Endocrinol Diabetes Metab Case Rep. 2021 Nov 1;2021. doi: 10.1530/EDM-21-0110.
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.
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.
饮用果汁是一种越来越流行的健康趋势，因为它被广泛认为是维生素和营养物质的来源。然而，水果饮料中高果糖含量可能会产生有害的代谢影响。大量摄入果糖会导致高甘油三酯血症、脂肪肝和胰岛素抵抗。我们报告了一例罕见病例，患者患有严重无症状性高甘油三酯血症（甘油三酯水平为9182mg/dL）和新诊断的2型糖尿病，该患者在就诊前几周报告每天饮用15升果汁。患者因血糖527mg/dL和糖化血红蛋白（HbA1c）17.3%被转诊至我院急诊科。有趣的是，患者没有糖尿病酮症酸中毒或高渗高血糖状态的特征。患者超重，体格检查其他方面无异常。密切监测脂肪酶水平、肝功能检查和炎症标志物，结果均无异常。初始治疗方法包括静脉补液、胰岛素和肝素。此外，进行了血浆置换以预防高甘油三酯血症可能导致的致命并发症。我们对患者进行了关于均衡营养和水果饮料有害影响的咨询。患者入院6天后出院。在2周的随访中，他的甘油三酯水平为419mg/dL，总胆固醇为221mg/dL，HbA1c为12.7%。本病例强调了果糖过量摄入在新诊断糖尿病患者严重高甘油三酯血症中的作用。我们讨论了不受控制的果糖摄入的代谢影响，以及在伴有糖尿病的高甘油三酯血症发病机制中主要因素和次要因素的相互作用。
过量的膳食果糖摄入会加重2型糖尿病（T2DM）患者的高甘油三酯血症，且无糖尿病酮症酸中毒或高渗高血糖状态。大量摄入时，果糖被认为是一种高度致脂性营养素，与餐后高甘油三酯血症和肝脏从头脂肪生成（DNL）有关。严重脂血症（甘油三酯血浆水平>9000mg/dL）可能无症状，不一定并发急性胰腺炎，尽管应密切监测脂肪酶水平。血浆置换是快速降低高血清脂质的有效辅助治疗选择，这对于预防严重高甘油三酯血症的急性并发症至关重要。
