1. Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease
- Author
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Kathryn E. Harlow, Jonathan A. Africa, Alan Wells, Patricia H. Belt, Cynthia A. Behling, Ajay K. Jain, Jean P. Molleston, Kimberly P. Newton, Philip Rosenthal, Miriam B. Vos, Stavra A. Xanthakos, Joel E. Lavine, Jeffrey B. Schwimmer, Stephanie H. Abrams, Sarah Barlow, Ryan Himes, Rajesh Krisnamurthy, Leanel Maldonado, Rory Mahabir, April Carr, Kimberlee Bernstein, Kristin Bramlage, Kim Cecil, Stephanie DeVore, Rohit Kohli, Kathleen Lake, Daniel Podberesky, Alex Towbin, Gerald Behr, Jay H. Lefkowitch, Ali Mencin, Elena Reynoso, Adina Alazraki, Rebecca Cleeton, Maria Cordero, Albert Hernandez, Saul Karpen, Jessica Cruz Munos, Nicholas Raviele, Molly Bozic, Oscar W. Cummings, Ann Klipsch, Emily Ragozzino, Kumar Sandrasegaran, Girish Subbarao, Laura Walker, Kimberly Kafka, Ann Scheimann, Joy Ito, Mark H. Fishbein, Saeed Mohammad, Cynthia Rigsby, Lisa Sharda, Peter F. Whitington, Theresa Cattoor, Jose Derdoy, Janet Freebersyser, Debra King, Jinping Lai, Pat Osmack, Joan Siegner, Susan Stewart, Susan Torretta, Kristina Wriston, Susan S. Baker, Diana Lopez-Graham, Sonja Williams, Lixin Zhu, Hannah Awai, Craig Bross, Jennifer Collins, Janis Durelle, Michael Middleton, Melissa Paiz, Claude Sirlin, Patricia Ugalde-Nicalo, Mariana Dominguez Villarreal, Bradley Aouizerat, Jesse Courtier, Linda D. Ferrell, Natasha Feier, Ryan Gill, Camille Langlois, Emily Rothbaum Perito, Patrika Tsai, Kara Cooper, Simon Horslen, Evelyn Hsu, Karen Murray, Randolph Otto, Matthew Yeh, Melissa Young, Elizabeth M. Brunt, Kathryn Fowler, David E. Kleiner, Sherry Brown, Edward C. Doo, Jay H. Hoofnagle, Patricia R. Robuck, Averell Sherker, Rebecca Torrance, Jeanne M. Clark, Michele Donithan, Erin Hallinan, Milana Isaacson, Kevin P. May, Laura Miriel, Alice Sternberg, James Tonascia, Mark Van Natta, Laura Wilson, and Katherine Yates
- Subjects
Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Hypercholesterolemia ,Article ,03 medical and health sciences ,0302 clinical medicine ,Non-alcoholic Fatty Liver Disease ,030225 pediatrics ,Internal medicine ,Intervention (counseling) ,Diabetes mellitus ,Nonalcoholic fatty liver disease ,Humans ,Medicine ,Longitudinal Studies ,Child ,Life Style ,Triglycerides ,Hypertriglyceridemia ,business.industry ,Cholesterol, LDL ,medicine.disease ,Diet ,Clinical research ,Pediatrics, Perinatology and Child Health ,Female ,030211 gastroenterology & hepatology ,business ,Dietary modifications ,Dyslipidemia - Abstract
OBJECTIVE:To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines. STUDY DESIGN:This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention. RESULTS:There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications. CONCLUSIONS:More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management.
- Published
- 2018