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

Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

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Hypertriglyceridemia
Hypercholesterolemia
Lipids
Dyslipidemias
LDL Cholesterol
National Heart, Lung, and Blood Institute (U.S.)
Diet Therapy
Life Style
Triglycerides
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
Guidelines
Hypolipidemic Agents
Risk Reduction Behavior
Longitudinal Studies
Non-alcoholic Fatty Liver Disease
Fasting
Cohort Studies
Diet
Health
Research

Keywords

  • cardiovascular
  • diet
  • dyslipidemia
  • NAFLD
  • pediatric
  • statin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease. / Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN).

In: Journal of Pediatrics, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease",
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 = "cardiovascular, diet, dyslipidemia, NAFLD, pediatric, statin",
author = "{Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)} and Harlow, {Kathryn E.} and Africa, {Jonathan A.} and Alan Wells and Belt, {Patricia H.} and Behling, {Cynthia A.} and Jain, {Ajay K.} and Molleston, {Jean P.} and Newton, {Kimberly P.} and Philip Rosenthal and Vos, {Miriam B.} and Xanthakos, {Stavra A.} and Lavine, {Joel E.} and Schwimmer, {Jeffrey B.} and Abrams, {Stephanie H.} and Sarah Barlow and Ryan Himes and Rajesh Krisnamurthy and Leanel Maldonado and Rory Mahabir and April Carr and Kimberlee Bernstein and Kristin Bramlage and Kim Cecil and Stephanie DeVore and Rohit Kohli and Kathleen Lake and Daniel Podberesky and Alex Towbin and Gerald Behr and Lefkowitch, {Jay H.} and Ali Mencin and Elena Reynoso and Adina Alazraki and Rebecca Cleeton and Maria Cordero and Albert Hernandez and Saul Karpen and Munos, {Jessica Cruz} and Nicholas Raviele and Molly Bozic and Cummings, {Oscar W.} and Ann Klipsch and Emily Ragozzino and Kumar Sandrasegaran and Girish Subbarao and Laura Walker and Kimberly Kafka and Ann Scheimann and Joy Ito and Bradley Aouizerat",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpeds.2018.02.038",
language = "English (US)",
journal = "Journal of Pediatrics",
issn = "0022-3476",
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T1 - Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease

AU - Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)

AU - Harlow, Kathryn E.

AU - Africa, Jonathan A.

AU - Wells, Alan

AU - Belt, Patricia H.

AU - Behling, Cynthia A.

AU - Jain, Ajay K.

AU - Molleston, Jean P.

AU - Newton, Kimberly P.

AU - Rosenthal, Philip

AU - Vos, Miriam B.

AU - Xanthakos, Stavra A.

AU - Lavine, Joel E.

AU - Schwimmer, Jeffrey B.

AU - Abrams, Stephanie H.

AU - Barlow, Sarah

AU - Himes, Ryan

AU - Krisnamurthy, Rajesh

AU - Maldonado, Leanel

AU - Mahabir, Rory

AU - Carr, April

AU - Bernstein, Kimberlee

AU - Bramlage, Kristin

AU - Cecil, Kim

AU - DeVore, Stephanie

AU - Kohli, Rohit

AU - Lake, Kathleen

AU - Podberesky, Daniel

AU - Towbin, Alex

AU - Behr, Gerald

AU - Lefkowitch, Jay H.

AU - Mencin, Ali

AU - Reynoso, Elena

AU - Alazraki, Adina

AU - Cleeton, Rebecca

AU - Cordero, Maria

AU - Hernandez, Albert

AU - Karpen, Saul

AU - Munos, Jessica Cruz

AU - Raviele, Nicholas

AU - Bozic, Molly

AU - Cummings, Oscar W.

AU - Klipsch, Ann

AU - Ragozzino, Emily

AU - Sandrasegaran, Kumar

AU - Subbarao, Girish

AU - Walker, Laura

AU - Kafka, Kimberly

AU - Scheimann, Ann

AU - Ito, Joy

AU - Aouizerat, Bradley

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - cardiovascular

KW - diet

KW - dyslipidemia

KW - NAFLD

KW - pediatric

KW - statin

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JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -