The Health Care Transition of Youth With Liver Disease Into the Adult Health System

Vajro, Pietro; Fischler, Björn; Burra, Patrizia; Debray, Dominique; Dezsőfi, Antal; Nuzio, Salvatore Guercio; Hadžić, Nedim; Hierro, Loreto; Jahnel, Jörg; Lamireau, T.; McKiernan, Patrick; Mclin, Valérie Anne; Nobili, Valério; Socha, Piotr; Smets, Françoise; Baumann, Ulli; Verkade, Henkjan J.

doi:10.1097/mpg.0000000000001965

Cited by 44 publications

(71 citation statements)

References 171 publications

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Section: Discussionsupporting

confidence: 70%

“…Until now, the practice guidelines of the European and US societies of pediatric gastroenterology and hepatology have not recommended measurement of BMD Z score in children and adolescents with NAFLD. (31)(32)(33) The findings of our meta-analysis support the view that pediatric NAFLD is significantly associated with low whole-body BMD Z scores (irrespective of age, sex, race/ethnicity, and BMI) and may also have clinical implications for the management of children who are overweight or obese. Indeed, these findings suggest that overweight/obese adolescents with NAFLD should be screened for low BMD (given their increased risk of developing osteoporosis and pathologic fractures in adulthood) and that NAFLD should be looked for in all overweight/ obese adolescents with low BMD, given that these subjects are at higher risk of NASH.…”

Section: Discussionsupporting

confidence: 69%

“…It is also noteworthy that sufficient population‐based data correlating BMD measures with fracture risk in healthy children and adolescents are unavailable . Currently, lifestyle modifications to improve diet and increase physical activity are recommended as the first‐line treatment for all children and adolescents with NAFLD . Based on the findings of our meta‐analysis, we believe that another good reason to further reinforce the utility of these nonpharmacological treatments for NAFLD is that increased physical activity in children with NAFLD not only has positive metabolic effects on the liver but may also exert beneficial effects on bone health.…”

Section: Discussionmentioning

confidence: 82%

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Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

et al. 2019

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Recent cross‐sectional studies have examined the association between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) in children or adolescents, but these have produced conflicting results. We performed a systematic review and meta‐analysis of these published studies to quantify the magnitude of the association, if any, between NAFLD and BMD. We searched publication databases from January 2000 to September 2018, using predefined keywords to identify relevant observational studies conducted in children or adolescents in whom NAFLD was diagnosed either by imaging or by histology and BMD Z score was measured by dual‐energy X‐ray absorptiometry. Data from selected studies were extracted, and a meta‐analysis was performed using random‐effects modeling. A total of eight observational cross‐sectional or case–control studies enrolling 632 children and adolescents (mean age 12.8 years), 357 of whom had NAFLD, were included in the final analysis. Meta‐analysis showed significant differences in whole‐body or lumbar BMD Z scores between children/adolescents with and without NAFLD (n = 6 studies; pooled weighted mean difference [WMD], –0.48; 95% confidence interval [CI], –0.74 to –0.21; I2 = 55.5%), as well as between those with biopsy‐confirmed nonalcoholic steatohepatitis (NASH) and those with no‐NASH (n = 4 studies; pooled WMD, –0.27; 95% CI, –0.40 to –0.13; I2 = 0%). The aforementioned WMDs in BMD Z scores were independent of common clinical risk factors, such as age, sex, race/ethnicity, and body mass index. Sensitivity analyses did not modify these findings. Funnel plot and Egger test did not reveal significant publication bias. Conclusion: This meta‐analysis shows that the presence and severity of NAFLD are significantly associated with reduced whole‐body BMD Z scores in children and adolescents; however, the observational design of the studies included does not allow for proving causality.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 82%

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Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

et al. 2019

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“…First, they represent the initial point of contact for patients with CFLD in the crucial transition from pediatric to adult CF care, where the adult hepatologist has an essential role in facilitating the most appropriate and smoothest transition of care. Although the most optimal pediatric‐to‐adult transition pathway for patients with CFLD remains undetermined, there is increasing awareness and calls for research in this particular area . Second, adult hepatologists play an important role in educating patients with CF about the hepatobiliary aspects of the disease.…”

Section: Expanding Role Of the Adult Hepatologistmentioning

confidence: 99%

Multidisciplinary Care for Cystic Fibrosis Liver Disease: Where Does the Adult Hepatologist Fit In?

Ayoub

Blay

et al. 2019

Clinical Liver Disease

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“…This is independent of whether there are separate paediatric and adult allergy clinics or one allergy clinic seeing all age groups. Transition has been de ned as 'active and evolving process that addresses the medical, psychosocial, and educational needs of young people as they prepare to move from child-to adult-centred health care' 8 . So it is not only about transfer of patient information and disease history to an adult healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

Current Transition Management of Adolescents and Young Adults with Allergy and Asthma: A European Survey.

Khaleva

Vazquez‐Ortiz

Comberiati

et al. 2020

Preprint

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Background: Transition from parent-delivered to self-management is a vulnerable time for adolescents and young adults (AYA) with allergy and asthma. There is currently no European guideline available for healthcare professionals (HCPs) on transition of these patients and local/national protocols are also mostly lacking. Methods: European HCPs working with AYA with allergy and asthma were invited to complete an online survey assessing challenges of working with these patients, current transition practices and access to specific healthcare resources. Results: A total of 1179 responses from 41 European countries were collected. Most HCPs (86%) reported a lack of a transition guideline and a lack of a transition process (20% paediatric HCPs, 50% of adult HCPs, 56% HCP seeing all ages). Nearly half (48%) acknowledged a lack of an established feedback system between paediatric and adult medical services. Many respondents never routinely asked about mental health issues such as self-harm or depression and are not confident in asking about self-harm (66.6%), sexuality (64%) and depression (43.6%). The majority of HCPs (76%) had not received specific training in the care of AYA although 87% agreed that transition was important for AYA with allergy and asthma. Conclusion: Although there was agreement that transition is important for AYA with allergy and asthma, there are crucial limitations and variations in the current provision of transition services across Europe. Standardisation of AYA management and specific training are required. This should improve management and continuity of care during adolescence and into adulthood to achieve the best healthcare outcomes.

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The Health Care Transition of Youth With Liver Disease Into the Adult Health System

Abstract: Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers.

Cited by 44 publications

References 171 publications

Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

Multidisciplinary Care for Cystic Fibrosis Liver Disease: Where Does the Adult Hepatologist Fit In?

Current Transition Management of Adolescents and Young Adults with Allergy and Asthma: A European Survey.

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