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J Pediatr. 2018 Jul;198:76-83.e2. doi: 10.1016/j.jpeds.2018.02.038. Epub 2018 Apr 13.

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

Author information

1
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatrics, Division of Gastroenterology, Rady Children's Hospital, San Diego, CA.
2
Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, CA.
3
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
4
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, CA; Department of Pathology, Sharp Medical Center, San Diego, CA.
5
Department of Pediatrics, St. Louis University, St. Louis, MO.
6
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN.
7
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA.
8
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
9
Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
10
Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University, New York, NY.
11
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatrics, Division of Gastroenterology, Rady Children's Hospital, San Diego, CA. Electronic address: jschwimmer@ucsd.edu.
12
Baylor College of Medicine, Houston, TX.
13
Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
14
Columbia University, New York, NY.
15
Emory University, Atlanta, GA.
16
Indiana University School of Medicine, Indianapolis, IN.
17
Johns Hopkins Hospital, Baltimore, MD.
18
Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago.
19
Saint Louis University, St Louis, MO.
20
University at Buffalo, Buffalo, NY.
21
University of California San Diego, San Diego, CA.
22
University of California San Francisco, San Francisco, CA.
23
University of Washington Medical Center and Seattle Children's Hospital, Seattle, WA.
24
Washington University, St. Louis, MO.
25
National Cancer Institute, Bethesda, MD.
26
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
27
Johns Hopkins University, Bloomberg School of Public Health (Data Coordinating Center), Baltimore, MD.

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.

KEYWORDS:

NAFLD; cardiovascular; diet; dyslipidemia; pediatric; statin

PMID:
29661561
PMCID:
PMC6019181
DOI:
10.1016/j.jpeds.2018.02.038
[Indexed for MEDLINE]
Free PMC Article

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