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Familial lipoprotein lipase deficiency

Type I hyperlipoproteinemia; Familial chylomicronemia; Familial LPL deficiency

 

Familial lipoprotein lipase deficiency is a group of rare genetic disorders in which a person lacks a protein needed to break down fat molecules. The disorder causes a large amount of fat to build up in the blood.

Causes

 

Familial lipoprotein lipase deficiency is caused by a defective gene that is passed down through families.

People with this condition lack an enzyme called lipoprotein lipase. Without this enzyme, the body cannot break down fat from digested food. Fat particles called chylomicrons build up in the blood.

Risk factors include a family history of lipoprotein lipase deficiency.

The condition is usually first seen during infancy or childhood.

 

Symptoms

 

Symptoms may include any of the following: 

  • Abdominal pain (may appear as colic in infancy)
  • Loss of appetite
  • Nausea
  • Pain in the muscles and bones (musculoskeletal pain)
  • Vomiting

 

Exams and Tests

 

Signs of this condition include:

  • Enlarged liver and spleen
  • Failure to thrive in infancy
  • Fatty deposits in the skin (xanthomas)
  • High triglyceride levels in the blood
  • Pale retinas and white-colored blood vessels in the retinas
  • Pancreatitis that keeps returning
  • Yellowing of the eyes and skin (jaundice)

Blood tests will be done to check cholesterol and triglyceride levels. Sometimes, a special blood test is done after you are given blood thinners through a vein. This test looks for lipoprotein lipase activity in your blood.

Genetic tests may be done.

 

Treatment

 

Treatment aims to control the symptoms and blood triglyceride levels with a very low-fat diet. You should eat no more than 20 grams of fat per day to prevent the symptoms from coming back.

Twenty grams of fat is equal to one of the following:

  • 2 8-ounce glasses of whole milk
  • 4 teaspoons of margarine
  • 4-ounce serving of meat

The average American diet has a fat content of up to 45% of total calories. Fat-soluble vitamins A, D, E, and K and mineral supplements are recommended for people who eat a very low-fat diet. You may want to discuss your diet needs with a registered dietitian.

Pancreatitis that is related to lipoprotein lipase deficiency responds to treatments for that disorder.

 

Outlook (Prognosis)

 

People with this condition who follow a very low-fat diet can live into adulthood.

 

Possible Complications

 

Pancreatitis and recurrent episodes of abdominal pain may develop.

Xanthomas are not usually painful unless they are rubbed a lot.

 

When to Contact a Medical Professional

 

Call your health care provider for screening if someone in your family has lipoprotein lipase deficiency. Genetic counseling is recommended for anyone with a family history of this disease.

 

Prevention

 

There is no known prevention for this rare, inherited disorder. Awareness of risks may allow early detection. Following a very low-fat diet can improve the symptoms of this disease.

 

 

References

Ferri FF. Primary hyperlipoproteinemia. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. Philadelphia: PA Elsevier Mosby; 2015:611-612.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 213.

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      Review Date: 4/30/2015

      Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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