A 51-year-old man with diabetes and TG levels exceeding 1050 mg/dL has been adhering to a very-low-fat diet. What might be contributing to his high triglycerides?

The presence of very high triglyceride levels, such as those exceeding 1050 mg/dL, can be significantly influenced by dietary and lifestyle factors, particularly excessive alcohol consumption. Alcohol is metabolized primarily in the liver, where it can lead to increased production of triglycerides. When alcohol is consumed in large amounts, it promotes de novo lipogenesis, a process where the liver converts excess calories into fat, exacerbating hypertriglyceridemia, especially in individuals already predisposed to it, such as those with diabetes.

In this scenario, the patient is adhering to a very-low-fat diet, which typically should help lower triglyceride levels, but if there is excessive alcohol intake simultaneously, it can counteract the advantages of a low-fat diet and lead to elevated triglyceride levels. Therefore, the connection between excessive alcohol consumption and elevated triglycerides stands out as a critical factor in understanding the patient's condition.

While other factors can contribute to high triglyceride levels, in this particular case, alcohol consumption provides a clear link considering the dietary habits mentioned.