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Multicenter Study
. 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

Kathryn E Harlow  1 , Jonathan A Africa  1 , Alan Wells  2 , Patricia H Belt  3 , Cynthia A Behling  4 , Ajay K Jain  5 , Jean P Molleston  6 , Kimberly P Newton  1 , Philip Rosenthal  7 , Miriam B Vos  8 , Stavra A Xanthakos  9 , Joel E Lavine  10 , Jeffrey B Schwimmer  11 ; Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
Collaborators, Affiliations
Multicenter Study

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

Kathryn E Harlow et al. J Pediatr. 2018 Jul.

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The NHLBI guideline for elevated LDL-C. This algorithm and the superimposed numbers show the participants that met criteria for actionable LDL-C and after dietary interventions, those at follow up who met criteria for statin therapy, dietary intensification, or those that met goals.
Figure 2
Figure 2
The NHLBI guideline for elevated TG. This algorithm and the superimposed numbers show the participants that met criteria for actionable TG and after dietary interventions, those at follow up who met criteria for consideration of medications, dietary intensification, or those that met goals.
See this image and copyright information in PMC

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