Warren L Shapiro1,2,3, Elizabeth L Yu1,3, Jennifer C Arin1, Karen F Murray4, Sabina Ali5, Nirav K Desai6, Stavra A Xanthakos7,8, Henry C Lin9, Naim Alkhouri10,11, Reham Abdou12, Stephanie H Abrams13,14,15,16, Megan W Butler17, Sarah A Faasse18,19, Lynette A Gillis20, Timothy A Hadley18, Ajay K Jain21, Marianne Kavan22, Kattayoun Kordy23, Peter Lee24, Jennifer Panganiban25, John F Pohl22, Carol Potter26, Bryan Rudolph27, Shikha S Sundaram28,29, Shivali Joshi1,30, James A Proudfoot31, Nidhi P Goyal1,3, Kathryn E Harlow1,3, Kimberly P Newton1,3, Jeffrey B Schwimmer1,3. 1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla. 2. Department of Pediatric Gastroenterology, Southern California Permanente Medical Group. 3. Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA. 4. Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine, and Seattle Children's Hospital, Seattle WA. 5. Department of Pediatric Gastroenterology, Stanford Children's Health, Stanford, CA. 6. Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA. 7. Cincinnati Children's Hospital Medical Center. 8. Department of Pediatrics, University of Cincinnati, Cincinnati, OH. 9. Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA. 10. The Texas Liver Institute. 11. University of Texas (UT) Health San Antonio, San Antonio, TX. 12. Digestive Diseases and Nutrition Center, Department of Pediatrics, Women and Children's Hospital of Buffalo, The State University of New York, Buffalo, NY. 13. Texas Children's Hospital. 14. Baylor College of Medicine, Houston, TX. 15. Division of Pediatric Gastroenterology, University of California, Irvine School of Medicine. 16. Children's Gastroenterology, Miller Children's Hospital, Long Beach, CA. 17. Pediatric Gastroenterology, Hepatology and Nutrition Duke University, Durham, NC. 18. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Emory University School of Medicine. 19. Children's Healthcare of Atlanta, Atlanta, GA. 20. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. 21. Department of Pediatrics, St. Louis University, St. Louis, MO. 22. University of Utah, Salt Lake City, UT. 23. Department of Gastroenterology, Children's Hospital of Los Angeles, Los Angeles, CA. 24. Pediatric Specialists of Virginia Pediatric Gastroenterology and Hepatology, Ashburn, VA. 25. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, PA. 26. Gastroenterology, Hepatology and Nutrition, Nationwide Children's, Columbus, OH. 27. Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 28. School of Medicine, University of Colorado, Denver. 29. Children's Hospital Colorado, Aurora, CO. 30. Keck Science Department, Claremont McKenna College, Claremont. 31. Altman Clinical and Translational Research Institute, University of California, San Diego School of Medicine, La Jolla, CA.
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.
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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