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In This Issue of JAMA
January 22, 2019


JAMA. 2019;321(3):217-219. doi:10.1001/jama.2018.15157


Treatment guidelines do not recommend a specific diet for children with nonalcoholic fatty liver disease. In a randomized trial that enrolled 40 male adolescents aged 11 to 16 years with histologically diagnosed nonalcoholic fatty liver disease, Schwimmer and colleagues found that a diet low in free sugar content decreased hepatic steatosis.

Visual Abstract

In children with sickle cell disease and high transcranial Doppler (TCD) velocities, transfusion therapy reduces the risk of stroke but is associated with complications such as alloimmunization and iron overload. Bernaudin and colleagues for the DREPAGREFFE Trial Investigators studied 67 children with sickle cell disease who required chronic transfusions for persistently elevated TCD velocities and found that matched-sibling donor hematopoietic stem cell transplantation was associated with lower TCD velocities compared with standard care. In an Editorial, Kwiatkowski suggests that future trials should evaluate the efficacy of transplantation using alternative sources of stem cells for children who lack a matched sibling donor.


Aspirin is indicated for the secondary prevention of stroke and myocardial infarction, but the use of aspirin for primary prevention is controversial. Zheng and Roddick reviewed 13 trials that randomized 164 225 participants with 1 050 511 years of follow-up and found that in participants without cardiovascular disease, aspirin was associated with a lower risk of cardiovascular events and an increased risk of major bleeding. In an Editorial, Gaziano suggests that the value of aspirin for primary prevention depends on the local availability of statin drugs and the need for comprehensive risk factor reduction.



Clinical Review & Education

The choice of therapy for breast cancer is determined primarily by the expression of molecular targets. Waks and Winer review treatment strategies for patients with breast cancer, which may be also influenced by tumor subtype, anatomic cancer stage, and patient preference.

JAMA Patient Page

CME and Audio Interview

In this JAMA Guide to Statistics and Methods, Serghiou and Goodman explain the use of random-effects meta-analysis to estimate treatment effects when the component trials have enrolled different types of patients in different settings.

This JAMA Clinical Challenge by Chatterjee presents a 58-year-old woman with polyarthritis and a malar rash who had recent exposure to children with a febrile illness. What would you do next?