Introduction
hypertriglyceridemia, TG
HYPERTRIGLYCERIDEMIA
The use of supplements with high concentrations of omega-3 polyunsaturated fatty acids (N3PUFA) has become increasingly popular, delivering greater than 90% N3PUFA, most commonly as free fatty acids (FFA), ethyl esters (EE), or re-esterified triglycerides (rTG). The re-esterification process involves the transfer of N3PUFA from fish body oil (FBO) TG-bound fatty acid (FA) concentrates to ethanol, yielding EE concentrates which are then subjected to molecular distillation. The resulting distillate is enzymatically re-esterified into a TG form similar to natural FBO. The fidelity of re-esterification into a TG form is variable and may be a misnomer, as the glyceride profile of rTG supplements is approximately 55–60% TG, 38–42% diglycerides, and 1–3% monoglycerides [Several intervention comparator studies of ≥ 12 weeks have indicated a relationship between lipid format and blood lipidomic response. Neubronner et al. randomized 150 statin therapy subjects with moderate hypertriglyceridemia into three groups: fish oil concentrate given as rTGs or EEs, delivering equal amounts of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or a corn oil placebo [Given the potential for incomplete re-esterification of acylglycerides into rTG forms of N3PUFA [