Patients with very high levels of serum triglycerides (greater than 1000 mg/dL) are at risk for pancreatitis. Most patients with congenital abnormalities in triglyceride metabolism present in childhood. By way of contrast, hypertriglyceridemia-induced pancreatitis in adults is often due to an acquired lipid metabolism problem. Although, there are no clear triglyceride levels that predict pancreatitis, most clinicians treat fasting levels above 500 mg/dL. The risk of pancreatitis here may be more related to the triglyceride level following consumption of a fatty meal. Thus, because postprandial increases in triglyceride are inevitable if fat-containing foods are eaten, fasting triglyceride levels in persons prone to pancreatitis should be kept below that level. The primary treatment for high triglyceride levels is dietary and calls for reduced consumption of alcohol, simple sugars, and refined starches as well as saturated and trans fatty acids. In patients with fasting triglycerides greater than or equal to 500 mg/dL despite adequate dietary compliance, a triglyceride lowering drug such as niacin, a fibric acid derivative, an omega-3-acid ethyl ester, or an HMG-CoA reductase inhibitor may be helpful.