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Clinical Practice Approach to Nonalcoholic Fatty Liver Disease by Pediatric Gastroenterologists in the United States
Warren L Shapiro1,2,3, Elizabeth L Yu1,3, Jennifer C Arin1
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla.
Insights
Pediatric gastroenterologists frequently manage nonalcoholic fatty liver disease (NAFLD) in children, often recommending diet and exercise. However, varied approaches and significant barriers to care necessitate standardized guidelines and further research.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Nonalcoholic fatty liver disease (NAFLD) is a growing concern in pediatric populations.
- Current management strategies for pediatric NAFLD by gastroenterologists in the United States are not well-documented.
Purpose of the Study:
- To investigate the current management approaches for pediatric NAFLD among US pediatric gastroenterologists.
- To identify the barriers encountered in providing care for children with NAFLD.
Main Methods:
- Structured one-on-one interviews were conducted with pediatric gastroenterologists.
- Interviews explored screening for comorbidities, lifestyle recommendations (nutrition, exercise), medication use, and perceived barriers to care.
Main Results:
- A high percentage of pediatric gastroenterologists (98.4%) recommend dietary interventions, with significant variability in specific recommendations.
- Most physicians provide exercise targets, but approaches to medication and comorbidity screening (diabetes, dyslipidemia, hypertension) vary.
- Over 90% of providers reported barriers to care, with many citing multiple challenges.
Conclusions:
- US pediatric gastroenterologists commonly treat children with NAFLD, employing diverse dietary and exercise recommendations.
- The heterogeneity in management and reported barriers underscore the need for evidence-based clinical trials and standardized care protocols.
- Effective NAFLD management requires a comprehensive strategy involving clinical, community, and home-based resources.
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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