Open AccessClinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States
Author(s) -
Shapiro Warren L.,
Yu Elizabeth L.,
Arin Jennifer C.,
Murray Karen F.,
Ali Sabina,
Desai Nirav K.,
Xanthakos Stavra A.,
Lin Henry C.,
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.
Publication year - 2019
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002194
Subject(s) - medicine , nonalcoholic fatty liver disease , dyslipidemia , medline , liver disease , pediatric gastroenterology , disease , fatty liver , family medicine , pediatrics , political science , law
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.