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. 2019 Feb;68(2):182-189.
doi: 10.1097/MPG.0000000000002194.

Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States

Warren L Shapiro  1   2   3 , Elizabeth L Yu  1   3 , Jennifer C Arin  1 , Karen F Murray  4 , Sabina Ali  5 , Nirav K Desai  6 , Stavra A Xanthakos  7   8 , Henry C Lin  9 , Naim Alkhouri  10   11 , Reham Abdou  12 , Stephanie H Abrams  13   14   15   16 , Megan W Butler  17 , Sarah A Faasse  18   19 , Lynette A Gillis  20 , Timothy A Hadley  18 , Ajay K Jain  21 , Marianne Kavan  22 , Kattayoun Kordy  23 , Peter Lee  24 , Jennifer Panganiban  25 , John F Pohl  22 , Carol Potter  26 , Bryan Rudolph  27 , Shikha S Sundaram  28   29 , Shivali Joshi  1   30 , James A Proudfoot  31 , Nidhi P Goyal  1   3 , Kathryn E Harlow  1   3 , Kimberly P Newton  1   3 , Jeffrey B Schwimmer  1   3
Affiliations

Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States

Warren L Shapiro et al. J Pediatr Gastroenterol Nutr. 2019 Feb.

Abstract

Objectives: Nonalcoholic fatty liver disease (NAFLD) is common; however, no information is available on how pediatric gastroenterologists in the United States manage NAFLD. Therefore, study objectives were to understand how pediatric gastroenterologists in the US approach the management of NAFLD, and to identify barriers to care for children with NAFLD.

Methods: We performed structured one-on-one interviews to ascertain each individual pediatric gastroenterologist's approach to the management of NAFLD in children. Responses were recorded from open-ended questions regarding screening for comorbidities, recommendations regarding nutrition, physical activity, medications, and perceived barriers to care.

Results: Response rate was 72.0% (486/675). Mean number of patients examined per week was 3 (standard deviation [SD] 3.5). Dietary intervention was recommended by 98.4% of pediatric gastroenterologists. Notably, 18 different dietary recommendations were reported. A majority of physicians provided targets for exercise frequency (72.6%, mean 5.6 days/wk, SD 1.6) and duration (69.9%, mean 40.2 minutes/session, SD 16.4). Medications were prescribed by 50.6%. Almost one-half of physicians (47.5%) screened for type 2 diabetes, dyslipidemia, and hypertension. Providers who spent more than 25 minutes at the initial visit were more likely to screen for comorbidities (P = 0.003). Barriers to care were reported by 92.8% with 29.0% reporting ≥3 barriers.

Conclusions: The majority of US pediatric gastroenterologists regularly encounter children with NAFLD. Varied recommendations regarding diet and exercise highlight the need for prospective clinical trials. NAFLD requires a multidimensional approach with adequate resources in the home, community, and clinical setting.

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Figures

FIGURE 1.
FIGURE 1.. Participants by State
Pictorial histogram depicting number of participants by state.
FIGURE 2.
FIGURE 2.. Frequency and Duration of Recommended Exercise
2a. Histogram depicting days per week that pediatric gastroenterologists recommend exercise for patients with NAFLD. 2b.Boxplot showing median and range for days per week that pediatric gastroenterologists recommend exercise for patients with NAFLD. 2c.Boxplot showing median and range for duration of exercise session in minutes that pediatric gastroenterologists recommend for patients with NAFLD.
FIGURE 3.
FIGURE 3.. Socioeconomic Barriers
Barriers to the care of patients with NAFLD reported by pediatric gastroenterologists are presented in the context of the Social-Ecological Model. The percentage of pediatric gastroenterologists that reported one or more barriers within each of the model’s four categories is shown.
See this image and copyright information in PMC

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