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

Warren L. Shapiro, Elizabeth L. Yu, Jennifer C. Arin, Karen F. Murray, Sabina Ali, Nirav K. Desai, Stavra A. Xanthakos, Henry Lin, Naim Alkhouri, Reham Abdou, Stephanie H. Abrams, Megan W. Butler, Sarah A. Faasse, Lynette A. Gillis, Timothy A. Hadley, Ajay K. Jain, Marianne Kavan, Kattayoun Kordy, Peter Lee, Jennifer PanganibanJohn F. Pohl, Carol Potter, Bryan Rudolph, Shikha S. Sundaram, Shivali Joshi, James A. Proudfoot, Nidhi P. Goyal, Kathryn E. Harlow, Kimberly P. Newton, Jeffrey B. Schwimmer

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)182-189
Number of pages8
JournalJournal of pediatric gastroenterology and nutrition
Volume68
Issue number2
DOIs
StatePublished - Feb 1 2019
Externally publishedYes

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Pediatrics
Exercise
Comorbidity
Physicians
Child Care
Dyslipidemias
Gastroenterologists
Non-alcoholic Fatty Liver Disease
Type 2 Diabetes Mellitus
Clinical Trials
Interviews
Diet
Hypertension

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States. / Shapiro, Warren L.; Yu, Elizabeth L.; Arin, Jennifer C.; Murray, Karen F.; Ali, Sabina; Desai, Nirav K.; Xanthakos, Stavra A.; Lin, Henry; Alkhouri, Naim; Abdou, Reham; Abrams, Stephanie H.; Butler, Megan W.; Faasse, Sarah A.; Gillis, Lynette A.; Hadley, Timothy A.; Jain, Ajay K.; Kavan, Marianne; Kordy, Kattayoun; Lee, Peter; Panganiban, Jennifer; Pohl, John F.; Potter, Carol; Rudolph, Bryan; Sundaram, Shikha S.; Joshi, Shivali; Proudfoot, James A.; Goyal, Nidhi P.; Harlow, Kathryn E.; Newton, Kimberly P.; Schwimmer, Jeffrey B.

In: Journal of pediatric gastroenterology and nutrition, Vol. 68, No. 2, 01.02.2019, p. 182-189.

Research output: Contribution to journalArticle

Shapiro, WL, Yu, EL, Arin, JC, Murray, KF, Ali, S, Desai, NK, Xanthakos, SA, Lin, H, Alkhouri, N, Abdou, R, Abrams, SH, Butler, MW, Faasse, SA, Gillis, LA, Hadley, TA, Jain, AK, Kavan, M, Kordy, K, Lee, P, Panganiban, J, Pohl, JF, Potter, C, Rudolph, B, Sundaram, SS, Joshi, S, Proudfoot, JA, Goyal, NP, Harlow, KE, Newton, KP & Schwimmer, JB 2019, 'Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States', Journal of pediatric gastroenterology and nutrition, vol. 68, no. 2, pp. 182-189. https://doi.org/10.1097/MPG.0000000000002194
Shapiro, Warren L. ; Yu, Elizabeth L. ; Arin, Jennifer C. ; Murray, Karen F. ; Ali, Sabina ; Desai, Nirav K. ; Xanthakos, Stavra A. ; Lin, Henry ; Alkhouri, Naim ; Abdou, Reham ; Abrams, Stephanie H. ; Butler, Megan W. ; Faasse, Sarah A. ; Gillis, Lynette A. ; Hadley, Timothy A. ; Jain, Ajay K. ; Kavan, Marianne ; Kordy, Kattayoun ; Lee, Peter ; Panganiban, Jennifer ; Pohl, John F. ; Potter, Carol ; Rudolph, Bryan ; Sundaram, Shikha S. ; Joshi, Shivali ; Proudfoot, James A. ; Goyal, Nidhi P. ; Harlow, Kathryn E. ; Newton, Kimberly P. ; Schwimmer, Jeffrey B. / Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States. In: Journal of pediatric gastroenterology and nutrition. 2019 ; Vol. 68, No. 2. pp. 182-189.
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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.",
author = "Shapiro, {Warren L.} and Yu, {Elizabeth L.} and Arin, {Jennifer C.} and Murray, {Karen F.} and Sabina Ali and Desai, {Nirav K.} and Xanthakos, {Stavra A.} and Henry Lin and Naim Alkhouri and Reham Abdou and Abrams, {Stephanie H.} and Butler, {Megan W.} and Faasse, {Sarah A.} and Gillis, {Lynette A.} and Hadley, {Timothy A.} and Jain, {Ajay K.} and Marianne Kavan and Kattayoun Kordy and Peter Lee and Jennifer Panganiban and Pohl, {John F.} and Carol Potter and Bryan Rudolph and Sundaram, {Shikha S.} and Shivali Joshi and Proudfoot, {James A.} and Goyal, {Nidhi P.} and Harlow, {Kathryn E.} and Newton, {Kimberly P.} and Schwimmer, {Jeffrey B.}",
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TY - JOUR

T1 - Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States

AU - Shapiro, Warren L.

AU - Yu, Elizabeth L.

AU - Arin, Jennifer C.

AU - Murray, Karen F.

AU - Ali, Sabina

AU - Desai, Nirav K.

AU - Xanthakos, Stavra A.

AU - Lin, Henry

AU - Alkhouri, Naim

AU - Abdou, Reham

AU - Abrams, Stephanie H.

AU - Butler, Megan W.

AU - Faasse, Sarah A.

AU - Gillis, Lynette A.

AU - Hadley, Timothy A.

AU - Jain, Ajay K.

AU - Kavan, Marianne

AU - Kordy, Kattayoun

AU - Lee, Peter

AU - Panganiban, Jennifer

AU - Pohl, John F.

AU - Potter, Carol

AU - Rudolph, Bryan

AU - Sundaram, Shikha S.

AU - Joshi, Shivali

AU - Proudfoot, James A.

AU - Goyal, Nidhi P.

AU - Harlow, Kathryn E.

AU - Newton, Kimberly P.

AU - Schwimmer, Jeffrey B.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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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