Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease - 22/06/18

Doi : 10.1016/j.jpeds.2018.02.038

Kathryn E. Harlow, MD ^1,², Jonathan A. Africa, MD ^1,², Alan Wells, MS ³, Patricia H. Belt, BS ⁴, Cynthia A. Behling, MD ^1,⁵, Ajay K. Jain, MD ⁶, Jean P. Molleston, MD ⁷, Kimberly P. Newton, MD ^1,², Philip Rosenthal, MD ⁸, Miriam B. Vos, MD ⁹, Stavra A. Xanthakos, MD ¹⁰, Joel E. Lavine, MD ¹¹, Jeffrey B. Schwimmer, MD ^1,^2,^*
for the
Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)^*
List of additional members of the Nonalcoholic Steatohepatitis Clinical Research Network is available at www.jpeds.com (Appendix).
Stephanie H. Abrams, MD, MS ¹², Sarah Barlow, MD ¹², Ryan Himes, MD ¹², Rajesh Krisnamurthy, MD ¹², Leanel Maldonado, RN ¹², Rory Mahabir, BS ¹², April Carr, BS, CCRP ¹³, Kimberlee Bernstein, BS, CCRP ¹³, Kristin Bramlage, MD ¹³, Kim Cecil, PhD ¹³, Stephanie DeVore, MSPH ¹³, Rohit Kohli, MD ¹³, Kathleen Lake, MSW ¹³, Daniel Podberesky, MD ¹³, Alex Towbin, MD ¹³, Gerald Behr, MD ¹⁴, Jay H. Lefkowitch, MD ¹⁴, Ali Mencin, MD ¹⁴, Elena Reynoso, MD ¹⁴, Adina Alazraki, MD ¹⁵, Rebecca Cleeton, MPH, CCRP ¹⁵, Maria Cordero ¹⁵, Albert Hernandez ¹⁵, Saul Karpen, MD, PhD ¹⁵, Jessica Cruz Munos ¹⁵, Nicholas Raviele ¹⁵, Molly Bozic, MD ¹⁶, Oscar W. Cummings, MD ¹⁶, Ann Klipsch, RN ¹⁶, Emily Ragozzino ¹⁶, Kumar Sandrasegaran, MD ¹⁶, Girish Subbarao, MD ¹⁶, Laura Walker, RN ¹⁶, Kimberly Kafka, RN ¹⁷, Ann Scheimann, MD ¹⁷, Joy Ito, RN ¹⁸, Mark H. Fishbein, MD ¹⁸, Saeed Mohammad, MD ¹⁸, Cynthia Rigsby, MD ¹⁸, Lisa Sharda, RD ¹⁸, Peter F. Whitington, MD ¹⁸, Sarah Barlow, MD ¹⁹, Theresa Cattoor, RN ¹⁹, Jose Derdoy, MD ¹⁹, Janet Freebersyser, RN ¹⁹, Debra King, RN ¹⁹, Jinping Lai, MD ¹⁹, Pat Osmack ¹⁹, Joan Siegner, RN ¹⁹, Susan Stewart, RN ¹⁹, Susan Torretta ¹⁹, Kristina Wriston, RN ¹⁹, Susan S. Baker, MD, PhD ²⁰, Diana Lopez-Graham ²⁰, Sonja Williams ²⁰, Lixin Zhu, PhD ²⁰, Hannah Awai, MD ²¹, Craig Bross ²¹, Jennifer Collins ²¹, Janis Durelle ²¹, Michael Middleton, MD, PhD ²¹, Melissa Paiz ²¹, Claude Sirlin, MD ²¹, Patricia Ugalde-Nicalo, MD ²¹, Mariana Dominguez Villarreal ²¹, Bradley Aouizerat, PhD ²², Jesse Courtier, MD ²², Linda D. Ferrell, MD ²², Natasha Feier, MS ²², Ryan Gill, MD, PhD ²², Camille Langlois, MS ²², Emily Rothbaum Perito, MD ²², Patrika Tsai, MD ²², Kara Cooper ²³, Simon Horslen, MB, ChB ²³, Evelyn Hsu, MD ²³, Karen Murray, MD ²³, Randolph Otto, MD ²³, Matthew Yeh, MD, PhD ²³, Melissa Young ²³, Elizabeth M. Brunt, MD ²⁴, Kathryn Fowler, MD ²⁴, David E. Kleiner, MD, PhD ²⁵, Sherry Brown, MS ²⁶, Edward C. Doo, MD ²⁶, Jay H. Hoofnagle, MD ²⁶, Patricia R. Robuck, PhD, MPH ²⁶, Averell Sherker, MD ²⁶, Rebecca Torrance, RN, MS ²⁶, Jeanne M. Clark, MD, MPH ²⁷, Michele Donithan, MHS ²⁷, Erin Hallinan, MHS ²⁷, Milana Isaacson, BS ²⁷, Kevin P. May, MS ²⁷, Laura Miriel, BS ²⁷, Alice Sternberg, ScM ²⁷, James Tonascia, PhD ²⁷, Mark Van Natta, MHS ²⁷, Laura Wilson, ScM ²⁷, Katherine Yates, ScM ²⁷
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

¹ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, CA
² Department of Pediatrics, Division of Gastroenterology, Rady Children's Hospital, San Diego, CA
³ Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, CA
⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
⁵ Department of Pathology, Sharp Medical Center, San Diego, CA
⁶ Department of Pediatrics, St. Louis University, St. Louis, MO
⁷ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN
⁸ Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
⁹ Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
¹⁰ Steatohepatitis Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
¹¹ Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University, New York, NY

^*Reprint requests: Jeffrey B. Schwimmer, MD, Fatty Liver Clinic, Department of Pediatrics, UC San Diego, 3020 Children's Way, MC 5030, San Diego, CA 92123.Fatty Liver ClinicDepartment of PediatricsUC San Diego3020 Children's Way, MC 5030San DiegoCA92123

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.

Le texte complet de cet article est disponible en PDF.

Keywords : pediatric, NAFLD, dyslipidemia, cardiovascular, diet, statin

Abbreviations : BMI, CHILD-1, LDL-C, NAFLD, NASH CRN, NHLBI, TG

Plan

Methods

NHLBI Guidelines

NASH CRN Standard of Care

Lipid Values and Histology

Sensitivity Analysis

Discussion

The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (U01DK061718, U01DK061728, U01DK061731, U01DK061732, U01DK061734, U01DK061737, U01DK061738, U01DK061730, U01DK061713). Additional support was received from the National Center for Advancing Translational Sciences (NCATS) (UL1TR000439, UL1TR000077, UL1TR000436, UL1TR000150, UL1TR000424, UL1TR000006, UL1TR000448, UL1TR000040, UL1TR000100, UL1TR000004, UL1TR000423, UL1TR000058, UL1TR000454). The authors declare no conflicts of interest.

Portions of this study were presented as an abstract at the World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, Montreal, Quebec, October 5-8 2016.

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P. 76 - juillet 2018 Retour au numéro

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Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease - 22/06/18

Abstract

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Study design

Results

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