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Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease

2018; Elsevier BV; Volume: 198; Linguagem: Inglês

10.1016/j.jpeds.2018.02.038

1097-6833

Kathryn E. Harlow, Jonathan A. Africa, Alan Wells, Patricia Belt, Cynthia 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 E. Barlow, Ryan Himes, Rajesh Krisnamurthy, Leanel Maldonado, Rory Mahabir, April Carr, Kimberlee Bernstein, Kristin Bramlage, Kim M. Cecil, Stephanie DeVore, Rohit Kohli, Kathleen D. Lake, Daniel J. Podberesky, Alexander J. Towbin, Gerald Behr, Jay H. Lefkowitch, Ali Mencin, Elena Reynoso, Adina Alazraki, Rebecca Cleeton, María Cordero, Albert Altés, Saul J. Karpen, Jessica Cruz Muños, Nicholas Raviele, Molly Bozic, Oscar W. Cummings, Ann Klipsch, Emily Ragozzino, Kumar Sandrasegaran, Girish Subbarao, Laura Walker, Kimberly Kafka, Ann O. Scheimann, Joy Ito, Mark Fishbein, Saeed Mohammad, Cynthia K. Rigsby, Lisa Sharda, Peter F. Whitington, Sarah E. Barlow, Theresa Cattoor, Jose Derdoy, Janet Freebersyser, Debra King, Jinping Lai, Pat Osmack, Joan Siegner, Susan D. Stewart, Susan Torretta, Kristina Wriston, Susan S. Baker, Diana Lopez–Graham, Sonja D. Williams, Lixin Zhu, Hannah I. Awai, Craig Bross, Jennifer Collins, Janis Durelle, Michael S. Middleton, Melissa Paiz, Claude B. Sirlin, Patricia Ugalde‐Nicalo, Mariana Dominguez Villarreal, Bradley E. Aouizerat, Jesse Courtier, Linda D. Ferrell, Natasha A. Feier, Ryan M. Gill, Camille Langlois, Emily R. Perito, Patrika Tsai, Kara Cooper, Simon Horslen, Evelyn Hsu, Karen F. Murray, Randolph K. Otto, Matthew M. Yeh, Melissa Young, Elizabeth M. Brunt, Kathryn J. Fowler, David E. Kleiner, Sherry Brown, Edward Doo, Jay H. Hoofnagle, Patricia R. Robuck, Averell H. Sherker, Rebecca Torrance, Jeanne M. Clark, Michele Donithan, Erin Hallinan, Milana Isaacson, Kevin P. May, Laura Miriel, Jürgen Floege, James Tonascia, Mark L. Van Natta, Laura Wilson, Katherine P. Yates,

Diet, Metabolism, and Disease

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. 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. 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. 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. 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.