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Walkowiak D, Domaradzki J, Mozrzymas R, Korycińska-Chaaban D, Duś-Żuchowska M, Didycz B, Mikołuć B, Walkowiak J. Professional activity, gender and disease-related emotions: The impact on parents' experiences in caring for children with phenylketonuria. Mol Genet Metab Rep 2023; 36:100992. [DOI: https:/doi.org/10.1016/j.ymgmr.2023.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023] Open
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Walkowiak D, Domaradzki J, Mozrzymas R, Korycińska-Chaaban D, Duś-Żuchowska M, Didycz B, Mikołuć B, Walkowiak J. Professional activity, gender and disease-related emotions: The impact on parents' experiences in caring for children with phenylketonuria. Mol Genet Metab Rep 2023; 36:100992. [PMID: 37502286 PMCID: PMC10368909 DOI: 10.1016/j.ymgmr.2023.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Clinical management of rare diseases often fails to acknowledge the challenges faced by caregivers. Whilst management of phenylketonuria (PKU) may not be considered as dire as other conditions, most studies primarily concentrate on clinical issues, dietary adherence, or the quality of life of the PKU patients, leaving caregivers in the background. The aim of the study was to evaluate the psychosocial effects of PKU on family caregivers. Methods Between October 30th, 2022 and February 28th, 2023, we collected data from caregivers of children with PKU using an anonymous, self-administered, computer-assisted online questionnaire. The survey was distributed among to patients during their regular visits to five Polish PKU treatment centers. Results A total of 159 Polish caregivers of children with PKU completed the survey. This research shows that while women caregivers were more likely to be unemployed due to their responsibilities for childcare (50.3% compared to 0% for men), and men caregivers were more likely to be employed full-time (93.8% compared to 40.6% for women), the former reported higher emotional engagement in caregiving (88.1% vs 56.3% respectively). Significantly, unemployed mothers reported higher levels of loneliness, helplessness, and emotional control problems, and lacked psychological/emotional support more often than employed mothers. This research also shows a statistically significant positive correlation between mothers' education level and financial situation (p < 0.05) and education level and professional activity (p < 0.01). Additionally, a significant positive correlation was found between perceived financial situation and feeling of happiness (p < 0.001), and between financial situation and professional activity (p < 0.001). Finally, a significant positive correlation was observed between feeling of happiness and professional activity (p < 0.05). Conclusions According to our findings, there is a link between subjective happiness, financial situation, and professional activity among female caregivers. The relationship between these factors goes beyond just the income earned from work. The results of our study imply that there could even be a therapeutic advantage for working mothers. It is crucial to recognize the emotional difficulties that employed mothers may experience while taking care of a child with PKU, and to provide them with the necessary assistance and resources to meet their needs. Additionally, our results may provide a foundation for redefining the support system for caregivers in Poland.
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Affiliation(s)
- Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland
| | - Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital, Wrocław, Poland
| | | | - Monika Duś-Żuchowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poland
| | - Bożena Didycz
- Outpatient Metabolic Clinic, University Children's Hospital, Cracow, Poland
| | - Bożena Mikołuć
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poland
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Zuñiga Vinueza AM. Recent Advances in Phenylketonuria: A Review. Cureus 2023; 15:e40459. [PMID: 37456395 PMCID: PMC10349532 DOI: 10.7759/cureus.40459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
This article highlights the significance of inborn errors of metabolism and focuses specifically on phenylketonuria (PKU), a well-known inheritance disorder caused by the deficiency or absence of phenylalanine hydroxylase (PAH). This review discusses associated mutations in the PAH gene and their impact on phenylalanine metabolism. A total of 40 articles were analyzed between 2019 and 2023, covering diagnostic innovations, advancements in treatment and management strategies, and the long-term implications of PKU. This study emphasizes the importance of early diagnosis and highlights the ongoing need for advancements in screening methods and treatment approaches to optimize patient outcomes in PKU patients. This review provides valuable insights for healthcare professionals involved in the care of children with PKU and contributes to the enhancement of clinical practice in this field.
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Rondanelli M, Porta F, Gasparri C, Barrile GC, Cavioni A, Mansueto F, Mazzola G, Patelli Z, Peroni G, Pirola M, Razza C, Tartara A, Perna S. A food pyramid for adult patients with phenylketonuria and a systematic review on the current evidences regarding the optimal dietary treatment of adult patients with PKU. Clin Nutr 2023; 42:732-763. [PMID: 37001196 DOI: 10.1016/j.clnu.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
Early dietary treatment is mind-saving in patients with phenylketonuria. A "diet-for-life" is advocated, aimed to prevent effects of chronic exposure to hyperphenylalaninemia. While adherence to diet is significant during childhood as patients are followed-up at specialized metabolic centers, during adolescence and adulthood percentage of patients discontinuing diet and/or lost at follow-up is still high. The process of passing skills and responsibilities from pediatric team to adult team is defined "transition". The goal of transition clinics is to set up specific multidisciplinary care pathways and guarantee continuity of care and compliance of patients to care. In 2017, "The complete European guidelines on phenylketonuria" were published. These guidelines, however, do not provide an easy way to illustrate to adult patients how to follow correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of adults with phenylketonuria and to provide food pyramid for this population. The pyramid built shows that carbohydrates should be consumed every day (3 portions), together with fruits and vegetables (5 portions), extra virgin olive oil, and calcium water (almost 1 L/day); weekly portions can include 150 g potatoes walnuts and hazelnuts (20 g). At top of pyramid, there are two pennants. The green means that, based on individual metabolic phenotype and daily phenylalanine tolerance, patients need personalized supplementation (specific phenylalanine free amino acid mixtures, vitamins and omega 3 fatty acids); the one red indicates foods that are banned from diet (aspartame and protein foods exceeding individual dietary phenylalanine tolerance).
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino Foundation, 27100 Pavia, Italy; Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
| | - Francesco Porta
- Department of Pediatrics, Città Della Salute e Della Scienza University Hospital, University of Torino, Piazza Polonia 94, 10126, Turin, Italy.
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Gaetan Claude Barrile
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Alessandro Cavioni
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Francesca Mansueto
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Giuseppe Mazzola
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Zaira Patelli
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Martina Pirola
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Claudia Razza
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Alice Tartara
- Endocrinology and Nutrition Unit, Azienda di Servizi Alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100 Pavia, Italy.
| | - Simone Perna
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20122 Milano, Italy.
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Evers RAF, van Wegberg AMJ, MacDonald A, Huijbregts SCJ, Leuzzi V, van Spronsen FJ. Dietary Liberalization in Tetrahydrobiopterin-Treated PKU Patients: Does It Improve Outcomes? Nutrients 2022; 14:nu14183874. [PMID: 36145250 PMCID: PMC9504284 DOI: 10.3390/nu14183874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: this systematic review aimed to assess the effects of dietary liberalization following tetrahydrobiopterin (BH4) treatment on anthropometric measurements, nutritional biomarkers, quality of life, bone density, mental health and psychosocial functioning, and burden of care in PKU patients. Methods: the PubMed, Cochrane, and Embase databases were searched on 7 April 2022. We included studies that reported on the aforementioned domains before and after dietary liberalization as a result of BH4 treatment in PKU patients. Exclusion criteria were: studies written in a language other than English; studies that only included data of a BH4 loading test; insufficient data for the parameters of interest; and wrong publication type. Both within-subject and between-subject analyses were assessed, and meta-analyses were performed if possible. Results: twelve studies containing 14 cohorts and 228 patients were included. Single studies reported few significant differences. Two out of fifteen primary meta-analyses were significant; BMI was higher in BH4-treated patients versus controls (p = 0.02; standardized mean difference (SMD) (95% confidence interval (CI)) = −0.37 (−0.67, −0.06)), and blood cholesterol concentrations increased after starting BH4 treatment (p = 0.01; SMD (CI) = −0.70 (−1.26, −0.15)). Conclusion: there is no clear evidence that dietary liberalization after BH4 treatment has a positive effect on anthropometric measurements, nutritional biomarkers, or quality of life. No studies could be included for bone density, mental health and psychosocial functioning, and burden of care.
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Affiliation(s)
- Roeland A. F. Evers
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Annemiek M. J. van Wegberg
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Anita MacDonald
- Dietetic Department, Birmingham Children’s Hospital, Birmingham B4 6NH, UK
| | - Stephan C. J. Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, 2300 RB Leiden, The Netherlands
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Francjan J. van Spronsen
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: ; Tel.: +31-(0)50-3614147
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Walkowiak D, Mikołuć B, Mozrzymas R, Kałużny Ł, Didycz B, Korycińska-Chaaban D, Patalan M, Jagłowska J, Chrobot A, Staszewski R, Walkowiak J. Phenylketonuria Patients' and Their Caregivers' Perception of the Pandemic Lockdown: The Results of a National Online Survey. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020131. [PMID: 35204852 PMCID: PMC8869859 DOI: 10.3390/children9020131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
The first pandemic lockdown dramatically impacted many aspects of everyday life, including healthcare systems. The purpose of this study was to identify problems of patients with phenylketonuria (PKU) and their parents/caregivers during that time. We aimed to analyse potential differences in the self-reported compliance and characteristics of contacts with a doctor/dietitian before and during the pandemic lockdown and the perception of access to special food and opinions on remote contacts between a particular group of respondents. All participants (n = 614) were asked to complete an online questionnaire that consisted of 31 questions on pandemic-related events and circumstances which may have directly or indirectly impacted health and treatment. The people who completed the survey were divided into three groups: parents of PKU children (n = 403), parents of PKU adults (n = 58) and PKU patients older than 16 years (n = 153). The differences among the three analysed groups were found in the number of contacts, the way of contacting a doctor/dietitian during the pandemic and satisfaction with remote contact. Caregivers of children with PKU reported better therapy compliance, more frequent contacts with specialists and more satisfaction with remote visits than adult patients. We also observed a relationship between satisfaction from remote contact and self-reported frequency of contacts with a doctor/dietitian, as well as a relationship between satisfaction from remote contact and recommended blood Phe levels reported by both patients and caregivers. Travel time exceeding three hours from the respondents’ location to their doctor was associated with higher odds of their recognition of remote contact as a method of PKU treatment only in the group of caregivers. In the caregiver groups, the reported worse access to low-Phe products during the lockdown was linked to the perceived difficulty of maintaining the diet. However, such a relationship was not found among patients. In conclusion, significant differences in the perception of the pandemic lockdown and its impact on health and treatment-related issues were found.
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Affiliation(s)
- Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 60-356 Poznan, Poland
- Correspondence: ; Tel./Fax: +48-61-658-44-93
| | - Bożena Mikołuć
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona Str. 17, 15-274 Bialystok, Poland;
| | - Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital, Kamieńskiego Str. 73a, 51-124 Wroclaw, Poland;
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland; (Ł.K.); (J.W.)
| | - Bożena Didycz
- Outpatient Metabolic Clinic, University Children’s Hospital, 30-663 Cracow, Poland;
| | | | - Michał Patalan
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Joanna Jagłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Dębinki Str. 7, 80-211 Gdansk, Poland;
| | - Agnieszka Chrobot
- Voivodship Children Hospital, Chodkiewicza Str. 44, 85-667 Bydgoszcz, Poland;
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa Str. 1/2, 60-356 Poznan, Poland;
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland; (Ł.K.); (J.W.)
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OUP accepted manuscript. Nutr Rev 2022; 80:2100-2112. [DOI: 10.1093/nutrit/nuac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Silveira AM, Lima PL, Alves MRA, Soares RDL, Kanufre VDC, Rodrigues VDM, Starling ALP, Norton RDC, Aguiar MJBD. Overweight/obesity in adolescents with phenylketonuria: protective and predisposing factors. J Pediatr (Rio J) 2022; 98:104-110. [PMID: 34144002 PMCID: PMC9432224 DOI: 10.1016/j.jped.2021.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and factors associated with overweight/obesity development in adolescents with early diagnosed phenylketonuria treated exclusively by diet. METHODOLOGY In this cross-sectional study anthropometric measurements, serum phenylalanine levels, and 10 metabolites associated with lipid and carbohydrate metabolism were analyzed in 101 adolescents aged 10-20 years. Adolescents were categorized into overweight/obesity and eutrophic/low body mass index groups. These patients were compared using Student's t-test, Pearson's chi-square test, Wald's chi-square test for multivariate analysis. Further, to verify whether the prevalence of overweight/obesity found in the study population was similar to that in the general population, the authors compared the nutritional status of 46 patients aged 13-17 years with that of healthy students of the same age from the National School Health Survey using the chi-square test for adherence. The significance threshold was p < 0.5. RESULTS The prevalence of overweight/obesity in adolescents was 27.7%. There was no difference in prevalence between sexes. Older age was a protective factor and Increased Homeostasis Model Assessment Insulin Resistance index and high phenylalanine and low-density lipoprotein cholesterol levels were predictive factors for overweight/obesity. The equality hypothesis was not rejected in the comparison of nutritional states of 46 patients aged 13-17 years and healthy students of the same age. CONCLUSION The prevalence of overweight/obesity in phenylketonuria adolescents was similar to what is found in healthy adolescents.
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Affiliation(s)
- Adriana Márcia Silveira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Programa de Pós-Graduação em Ciências da Saúde - Saúde da Criança e do Adolescente, Ciências da Saúde, Belo Horizonte, MG, Brazil; Faculdade de Minas (FAMINAS-BH), Departamento de Nutrição, Belo Horizonte, MG, Brazil.
| | - Poliane Lopes Lima
- Faculdade de Minas (FAMINAS-BH), Departamento de Nutrição, Belo Horizonte, MG, Brazil
| | - Michelle Rosa Andrade Alves
- Pontifícia Universidade Católica de Minas Gerais (PUC-Minas), Departamento de Nutrição, Belo Horizonte, MG, Brazil
| | - Rosângelis Del Lama Soares
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), Belo Horizonte, MG, Brazil
| | - Viviane de Cássia Kanufre
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), EBSERH, Hospital das Clínicas, Serviço de Nutrição e Dietética, Belo Horizonte, MG, Brazil
| | - Valéria de Melo Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Ana Lúcia Pimenta Starling
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Rocksane de Carvalho Norton
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Marcos José Burle de Aguiar
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
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McWhorter N, Dhillon J, Hoffman J. Preliminary Investigation of Microbiome and Dietary Differences in Patients with Phenylketonuria on Enzyme Substitution Therapy Compared to Traditional Therapies. J Acad Nutr Diet 2021; 122:1283-1295.e3. [PMID: 34968752 DOI: 10.1016/j.jand.2021.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Phenylketonuria (PKU) is an inborn error of metabolism that impairs the function of the enzyme phenylalanine hydroxylase (PAH). Historical treatment includes limiting dietary phenylalanine (Phe) consumption while supplementing with medical food; however, this treatment has been associated with complications, such as nutritional deficiencies and disruptions in the gut microbiota. OBJECTIVE The study aim was to compare dietary and gut microbiome differences between adult patients on a traditional PKU diet to those receiving the enzyme substitution therapy Palynziq on a liberalized diet while controlling blood Phe levels to <600 μmol/L. DESIGN A cross-sectional study was conducted comparing patients on a traditional Phe-restricted diet with patients receiving Palynziq eating a liberalized diet. PARTICIPANTS/SETTING Six patients eating a traditional Phe-restricted diet with medical food and six patients on Palynziq eating a liberalized diet without medical food intake for >3 years were selected from the University of Kentucky Metabolic Clinic August to December 2019. MAIN OUTCOME MEASURES Nutrient intake from three-day diet records and fecal microbiome taxonomic abundances were analyzed. STATISTICAL ANALYSIS Mann-Whitney U-tests were used for dietary data analysis. Differential abundance analysis for microbiome taxa and pathway data was done using DESeq2 analysis. RESULTS Dietary data showed Palynziq patients consumed a lower percent of kilocalories from total protein and lower amounts of most micronutrients but consumed greater amounts of intact protein and cholesterol (P<0.05). Microbiome data revealed a greater abundance of the phylum Verrucomicrobia and genus Lachnobacterium in the Traditional group and a greater abundance of the genus Prevotella in the Palynziq group (P<0.05). Pathway analysis depicted greater enrichment in carotenoid and amino acid metabolism pathways in the Traditional group (P<0.05). Protein (%kcal), dietary fiber (g), fat (%kcal), linolenic acid (%DRI), and age were correlated with the underlying microbial community structure for both groups combined. CONCLUSIONS Patients with PKU treated with Palynziq on a liberalized diet manifest significant differences in diet composition compared to those treated with traditional Phe-restricted diets. Several of these dietary differences may affect the microbiome architecture.
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Affiliation(s)
- Nicole McWhorter
- Metabolic Dietitian, Department of Pediatrics, Division of Genetics and Metabolism, University of Kentucky, 138 Leader Ave., Lexington, KY 40508, USA, Synlogic Therapeutics, 301 Binney St #402, Cambridge, MA 02142.
| | - Jaapna Dhillon
- Assistant Professor, Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri-Columbia, Gwynn Hall, Room 312, 520 Hitt Street
| | - Jessie Hoffman
- Assistant Professor, Department of Human Nutrition, College of Arts & Sciences, Winthrop University, Dalton Hall 306A, Rock Hill, SC 29733
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Rodrigues C, Pinto A, Faria A, Teixeira D, van Wegberg AMJ, Ahring K, Feillet F, Calhau C, MacDonald A, Moreira-Rosário A, Rocha JC. Is the Phenylalanine-Restricted Diet a Risk Factor for Overweight or Obesity in Patients with Phenylketonuria (PKU)? A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103443. [PMID: 34684443 PMCID: PMC8538431 DOI: 10.3390/nu13103443] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 01/25/2023] Open
Abstract
Although there is a general assumption that a phenylalanine (Phe)-restricted diet promotes overweight in patients with phenylketonuria (PKU), it is unclear if this presumption is supported by scientific evidence. This systematic review aimed to determine if patients with PKU are at a higher risk of overweight compared to healthy individuals. A literature search was carried out on PubMed, Cochrane Library, and Embase databases. Risk of bias of individual studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the quality of the evidence for each outcome was assessed using the NutriGrade scoring system. From 829 articles identified, 15 were included in the systematic review and 12 in the meta-analysis. Body mass index (BMI) was similar between patients with PKU and healthy controls, providing no evidence to support the idea that a Phe-restricted diet is a risk factor for the development of overweight. However, a subgroup of patients with classical PKU had a significantly higher BMI than healthy controls. Given the increasing prevalence of overweight in the general population, patients with PKU require lifelong follow-up, receiving personalised nutritional counselling, with methodical nutritional status monitoring from a multidisciplinary team in inherited metabolic disorders.
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Affiliation(s)
- Catarina Rodrigues
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Alex Pinto
- Dietetic Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (A.M.)
| | - Ana Faria
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Diana Teixeira
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Annemiek M. J. van Wegberg
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;
| | - Kirsten Ahring
- Department of PKU, Copenhagen University Hospital, DK-2600 Glostrup, Denmark;
| | - François Feillet
- Department of Paediatrics, Reference Center for Inborn Errors of Metabolism, Hôpital d’Enfants Brabois, CHU Nancy, 54500 Vandoeuvre les Nancy, France;
| | - Conceição Calhau
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anita MacDonald
- Dietetic Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (A.M.)
| | - André Moreira-Rosário
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- Correspondence: (A.M.-R.); (J.C.R.); Tel.: +351-21-880-3000 (A.M.-R. & J.C.R.)
| | - Júlio César Rocha
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (C.R.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisboa, Portugal
- Correspondence: (A.M.-R.); (J.C.R.); Tel.: +351-21-880-3000 (A.M.-R. & J.C.R.)
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11
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Walkowiak M, Kałużny Ł, Mozrzymas R, Jamka M, Mikołuć B, Jagłowska J, Starostecka E, Nurgaliyeva R, Walkowiak J, Lisowska A. Helicobacter pylori Infection in Children with Phenylketonuria Does Not Depend on Metabolic Control and Is Not More Frequent Than in Healthy Subjects-A Cross-Sectional Study. CHILDREN-BASEL 2021; 8:children8080713. [PMID: 34438604 PMCID: PMC8394557 DOI: 10.3390/children8080713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
In a small preliminary study, phenylketonuria and poor metabolic control were suggested as risk factors for Helicobacter pylori infection in children as detected with an antigen stool test. We aimed to determine Helicobacter pylori prevalence in an adequately sized group of individuals with phenylketonuria and healthy subjects using the standard gold test (urea breath test). Further, we correlated Helicobacter pylori infection with metabolic control. The study comprised 103 individuals with phenylketonuria and 103 healthy subjects on whom a 13C urea breath test was performed. Blood phenylalanine levels in the preceding year were analysed. The infection rate did not differ between individuals with phenylketonuria and healthy subjects (10.7% vs 15.5%; p = 0.41). The frequency of testing and phenylalanine concentrations of Helicobacter pylori-positive and Helicobacter pylori-negative patients with phenylketonuria did not differ (p = 0.92 and p = 0.54, respectively). No associations were detected for body mass index or metabolic control. Forward stepwise regression models revealed that age (p = 0.0009-0.0016) was the only independent correlate of Helicobacter pylori infection with a relatively low fraction of the variability of the condition being explained (adjR2 = 0.0721-0.0754; model p = 0.020-0.023). In conclusion, Helicobacter pylori infection in phenylketonuria is not more frequent than in the general population. Moreover, it does not depend on metabolic control.
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Affiliation(s)
- Marek Walkowiak
- Department of Reproduction, Poznan University of Medical Sciences, Polna Str. 33, 60-535 Poznan, Poland;
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznan, Poland; (Ł.K.); (M.J.); (J.W.)
| | - Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital, Kamieńskiego Str. 73a, 51-124 Wrocław, Poland;
| | - Małgorzata Jamka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznan, Poland; (Ł.K.); (M.J.); (J.W.)
| | - Bożena Mikołuć
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona Str. 17, 15-274 Bialystok, Poland;
| | - Joanna Jagłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Dębinki Str. 7, 80-211 Gdansk, Poland;
| | - Ewa Starostecka
- The Regional Center of Rare Diseases, Polish Mother’s Memorial Hospital Research Institute, Rzgowska Str. 281/289, 93-338 Łodź, Poland;
| | - Roza Nurgaliyeva
- Department of Normal Physiology, West Kazakhstan Marat Ospanov Medical University, Maresyev Str. 68, Aktobe 030019, Kazakhstan;
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznan, Poland; (Ł.K.); (M.J.); (J.W.)
| | - Aleksandra Lisowska
- Department of Clinical Auxology and Pediatric Nursing, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznan, Poland
- Correspondence: ; Tel.: +48-61-8491385
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12
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Walkowiak D, Mikołuć B, Mozrzymas R, Kałużny Ł, Didycz B, Korycińska-Chaaban D, Patalan M, Jagłowska J, Chrobot A, Starostecka E, Zarębska J, Walkowiak J. The Impact of the COVID-19 Pandemic on the Perception of Health and Treatment-Related Issues among Patients with Phenylketonuria in Poland-The Results of a National Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126399. [PMID: 34199184 PMCID: PMC8296241 DOI: 10.3390/ijerph18126399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
There is agreement that the pandemic has affected the healthcare system and behaviour of patients. This study aims to identify problems encountered by patients with phenylketonuria (PKU) and their parents/caregivers during the six-week pandemic lockdown in Poland (15 March to 30 April 2020). To determine the factors that influenced health and treatment-related issues, as well as the respondents’ perception of the impact of the pandemic, study participants were asked to complete a non-validated online questionnaire comprising 31 questions (including 27 single-choice, two multiple-choice and two open-ended ones). A total of 571 patients or their parents completed the questionnaire, with 9.5% of respondents not performing any blood phenylalanine (Phe) test in the analysed period, 21.3% declaring a blood Phe increase, and 15.3% a decrease. Increased problems in contacting the doctor or dietitian were reported by 26.1% of subjects, whereas 39.3% of them felt restricted access to dietary products. Most (63.4%) participants were satisfied with remote contact with their PKU clinic. Better compliance was associated with higher odds of acceptance of remote contact and of reporting fewer problems with contacting the doctor, and with lower odds of missing Phe testing. Self-reported high stress was associated with higher odds of reporting the limited availability of low-Phe products and Phe-free formulas, as well as with increased Phe concentrations and non-PKU-related health problems. These patients also had poor dietary compliance and experienced more problems in contacting specialists. Health and treatment-related problems experienced during the pandemic lockdown were related to a higher intensity of stress in patient’s family and worse therapy compliance before the pandemic. Previous experience of remote visits resulted in a better perception of this method of contact. It seems that this form of communication should be popularized and improved to increase therapy effectiveness in case of different limitations in the future. Special attention should be paid to vulnerable patients who may be at extra risk when the provision of standard care is affected.
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Affiliation(s)
- Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego 39, 60-356 Poznan, Poland
- Correspondence: ; Tel./Fax: +48-61-658-44-93
| | - Bożena Mikołuć
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, 15-274 Bialystok, Poland;
| | - Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital, 51-124 Wrocław, Poland;
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (Ł.K.); (J.W.)
| | - Bożena Didycz
- Outpatient Metabolic Clinic, University Children’s Hospital, 30-663 Krakow, Poland;
| | | | - Michał Patalan
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Joanna Jagłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | | | - Ewa Starostecka
- The Regional Center of Rare Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Joanna Zarębska
- Upper Silesian Child Health Centre, 40-752 Katowice, Poland;
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (Ł.K.); (J.W.)
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13
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The Impact of the First 2020 COVID-19 Lockdown on the Metabolic Control of Patients with Phenylketonuria. Nutrients 2021; 13:nu13062024. [PMID: 34204602 PMCID: PMC8231121 DOI: 10.3390/nu13062024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
The present study assessed patients' metabolic control of phenylketonuria (PKU) during the first 2020 COVID-19 lockdown in Poland. Blood (phenylalanine) Phe results of the tests of 535 patients, performed in 2019 and in the first months of 2020, were analysed. The six-week lockdown period was compared to the preceding six-week period as well as to the two corresponding periods of 2019 (three non-lockdown periods). More patients failed to perform Phe tests in the lockdown period (32.7%) than in non-lockdown periods (15.6%, 15.1%, 17.2%; p < 0.001 for all). The median Phe levels for those patients who performed testing in all the four periods did not differ between periods. However, these patients tended to perform only one test during the lockdown (ORs: 1.43 to 1.60; 95% CI: from 1.01-2.04 to 1.11-2.30, p-value 0.02 to 0.005). Patients who did not take blood during the lockdown (46.7%) performed significantly fewer blood tests in the remaining periods (median <IQR>: 1 <0-1> vs. 2 <1-4>; p < 0.001). In conclusion, direct assessment of patients' compliance based upon Phe levels during the pandemic lockdown was not possible. Pre-pandemic non-compliant patients frequently failed to perform the test during the lockdown, whereas the previously compliant ones were more likely to perform only one test. This strongly suggests that metabolic control might have worsened.
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