Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease.

ObjectiveNonalcoholic fatty liver disease (NAFLD) affects 9.6% of children and may put these children at elevated risk of high blood pressure and subsequent cardiovascular morbidity and mortality. Therefore, we sought to determine the prevalence of and risk factors for high blood pressure in children with NAFLD.MethodsCohort study performed by the NIDDK NASH Clinical Research Network. There were 484 children with NAFLD ages 2 to 17 at enrollment; 382 children were assessed both at enrollment and 48 weeks afterwards. The main outcomes were high blood pressure at baseline and persistent high blood pressure at both baseline and 48 weeks.ResultsPrevalence of high blood pressure at baseline was 35.8% and prevalence of persistent high blood pressure was 21.4%. Children with high blood pressure were significantly more likely to have worse steatosis than children without high blood pressure (mild 19.8% vs. 34.2%, moderate 35.0% vs. 30.7%, severe 45.2% vs. 35.1%; P = 0.003). Higher body mass index, low-density lipoprotein, and uric acid were independent risk factors for high blood pressure (Odds Ratios: 1.10 per kg/m2, 1.09 per 10 mg/dL, 1.25 per mg/dL, respectively). Compared to boys, girls with NAFLD were significantly more likely to have persistent high blood pressure (28.4% vs.18.9%; P = 0.05).ConclusionsIn conclusion, NAFLD is a common clinical problem that places children at substantial risk for high blood pressure, which may often go undiagnosed. Thus blood pressure evaluation, control, and monitoring should be an integral component of the clinical management of children with NAFLD

Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease.

OBJECTIVE:Nonalcoholic fatty liver disease (NAFLD) affects 9.6% of children and may put these children at elevated risk of high blood pressure and subsequent cardiovascular morbidity and mortality. Therefore, we sought to determine the prevalence of and risk factors for high blood pressure in children with NAFLD. METHODS:Cohort study performed by the NIDDK NASH Clinical Research Network. There were 484 children with NAFLD ages 2 to 17 at enrollment; 382 children were assessed both at enrollment and 48 weeks afterwards. The main outcomes were high blood pressure at baseline and persistent high blood pressure at both baseline and 48 weeks. RESULTS:Prevalence of high blood pressure at baseline was 35.8% and prevalence of persistent high blood pressure was 21.4%. Children with high blood pressure were significantly more likely to have worse steatosis than children without high blood pressure (mild 19.8% vs. 34.2%, moderate 35.0% vs. 30.7%, severe 45.2% vs. 35.1%; P = 0.003). Higher body mass index, low-density lipoprotein, and uric acid were independent risk factors for high blood pressure (Odds Ratios: 1.10 per kg/m2, 1.09 per 10 mg/dL, 1.25 per mg/dL, respectively). Compared to boys, girls with NAFLD were significantly more likely to have persistent high blood pressure (28.4% vs.18.9%; P = 0.05). CONCLUSIONS:In conclusion, NAFLD is a common clinical problem that places children at substantial risk for high blood pressure, which may often go undiagnosed. Thus blood pressure evaluation, control, and monitoring should be an integral component of the clinical management of children with NAFLD

Longitudinal assessment of high blood pressure in children with nonalcoholic fatty liver disease.

ObjectiveNonalcoholic fatty liver disease (NAFLD) affects 9.6% of children and may put these children at elevated risk of high blood pressure and subsequent cardiovascular morbidity and mortality. Therefore, we sought to determine the prevalence of and risk factors for high blood pressure in children with NAFLD.MethodsCohort study performed by the NIDDK NASH Clinical Research Network. There were 484 children with NAFLD ages 2 to 17 at enrollment; 382 children were assessed both at enrollment and 48 weeks afterwards. The main outcomes were high blood pressure at baseline and persistent high blood pressure at both baseline and 48 weeks.ResultsPrevalence of high blood pressure at baseline was 35.8% and prevalence of persistent high blood pressure was 21.4%. Children with high blood pressure were significantly more likely to have worse steatosis than children without high blood pressure (mild 19.8% vs. 34.2%, moderate 35.0% vs. 30.7%, severe 45.2% vs. 35.1%; P = 0.003). Higher body mass index, low-density lipoprotein, and uric acid were independent risk factors for high blood pressure (Odds Ratios: 1.10 per kg/m2, 1.09 per 10 mg/dL, 1.25 per mg/dL, respectively). Compared to boys, girls with NAFLD were significantly more likely to have persistent high blood pressure (28.4% vs.18.9%; P = 0.05).ConclusionsIn conclusion, NAFLD is a common clinical problem that places children at substantial risk for high blood pressure, which may often go undiagnosed. Thus blood pressure evaluation, control, and monitoring should be an integral component of the clinical management of children with NAFLD

Clinical, Demographic, and Biochemical Risk Factors for Persistently High Blood Pressure.

<p>Abbreviations: OR = odds ratio, CI = confidence interval, BMI = body mass index, GGT = gamma-glutamyl transpeptidase, LDL = low-density lipoprotein.</p>a<p>Persistently high blood pressure was defined as systolic or diastolic blood pressure ≧95th percentile for age, sex and height or the use of antihypertensive medication at both baseline and 48 weeks. Blood pressure percentiles were computed as instructed in The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.</p>b<p><i>P</i> values and 95% CI were obtained from Wald statistics.</p><p>Clinical, Demographic, and Biochemical Risk Factors for Persistently High Blood Pressure.</p

Persistently High Blood Pressure in Children with NAFLD—Baseline Characteristics.

<p>Abbreviations: BMI = body mass index, ALT = alanine aminotransferase, AST =  aspartate aminotransferase, GGT = gamma-glutamyl transpeptidase, HDL = high-density lipoprotein, LDL = low-density lipoprotein, HOMA-IR = homeostasis model of assessment - insulin resistance.</p>a<p>We defined persistently high blood pressure as systolic or diastolic blood pressure ≧95th percentile for age, sex and height or the use of antihypertensive medication at both baseline and 48 week follow-up. Blood pressure percentiles were computed as instructed in The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.</p>b<p>P values determined from chi square tests for categorical variables and from two-sample Wilcoxon rank sum tests for continuous variables due to the presence of non-normality.</p>c<p>Age range from 2–17 years.</p>d<p>HOMA-IR units are (mg/dL × IU/mL/405).</p><p>Persistently High Blood Pressure in Children with NAFLD—Baseline Characteristics.</p

Clinical, Demographic, and Biochemical Risk Factors for High Blood Pressure at Baseline.

<p>Abbreviations: OR = odds ratio, CI = confidence interval, BMI = body mass index, GGT = gamma-glutamyl transpeptidase, LDL = low-density lipoprotein.</p>a<p>High blood pressure was defined as systolic or diastolic blood pressure ≧95th percentile for age, sex and height or the use of antihypertensive medication. Blood pressure percentiles were computed as instructed in The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.</p>b<p><i>P</i> values and 95% CI were obtained from Wald statistics.</p><p>Clinical, Demographic, and Biochemical Risk Factors for High Blood Pressure at Baseline.</p

High Blood Pressure in Children with NAFLD—Baseline Characteristics.

<p>Abbreviations: BMI = body mass index, ALT = alanine aminotransferase, AST =  aspartate aminotransferase, GGT = gamma-glutamyl transpeptidase, HDL = high-density lipoprotein, LDL = low-density lipoprotein, HOMA-IR = homeostasis model of assessment - insulin resistance</p>a<p>We defined high blood pressure as systolic or diastolic blood pressure ≧95th percentile for age, sex and height or the use of antihypertensive medication. Blood pressure percentiles were computed as instructed in The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.</p>b<p>P values determined from chi square tests for categorical variables and from two-sample Wilcoxon rank sum tests for continuous variables due to the presence of non-normality.</p>c<p>Age range from 2–17 years.</p>d<p>HOMA-IR units are (mg/dL×IU/mL/405).</p><p>High Blood Pressure in Children with NAFLD—Baseline Characteristics.</p

Flowchart shows the application of study inclusion and exclusion criteria.

<p>Flowchart shows the application of study inclusion and exclusion criteria.</p

Vibration-controlled Transient Elastography to Assess Fibrosis and Steatosis in Patients With Nonalcoholic Fatty Liver Disease.

BACKGROUND & AIMS: Vibration-controlled transient elastography (VCTE), which measures liver stiffness, has become an important tool for evaluating patients with nonalcoholic fatty liver disease (NAFLD). We aimed to determine the diagnostic accuracy of VCTE in detection of NAFLD in a multicenter cohort of patients. METHODS: We performed a prospective study of 393 adults with NAFLD who underwent VCTE within 1 year of liver histology analysis (median time, 49 days; interquartile range, 25-78 days), from July 1, 2014 through July 31, 2017. Liver stiffness measurement (LSM) cutoffs for pairwise fibrosis stage and controlled attenuation parameter (CAP) cutoffs for pairwise steatosis grade were determined using cross-validated area under the receiver operating characteristics curve (AUROC) analyses. Diagnostic statistics were computed at sensitivity fixed at 90% and specificity fixed at 90%. RESULTS: LSM identified patients with advanced fibrosis with an AUROC of 0.83 (95% CI, 0.79- 0.87) and patients with cirrhosis with an AUROC of 0.93 (95% CI, 0.90-0.97). At fixed sensitivity, a cutoff LSM of 6.5 kPa excluded advanced fibrosis with a negative predictive value of 0.91; a cut-off LSM of 12.1 kPa excluded cirrhosis with a negative predictive value of 0.99. At fixed specificity, LSM identified patients with advanced fibrosis with a positive predictive 0.71 and patients with cirrhosis with a positive predictive value of 0.41. CAP analysis detected steatosis with an AUROC of 0.76 (95% CI, 0.64-0.87). In contrast, the VCTE was less accurate in distinguishing lower fibrosis stages, higher steatosis grades, or presence of NASH. CONCLUSION: In a prospective study of adults with NAFLD, we found VCTE to accurately distinguish advanced vs earlier stages of fibrosis, using liver histology as the reference standard