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Harings T, Neininger MP, Eisenhofer S, Thiele AG, Kiess W, Bertsche A, Bertsche T, Beblo S. The impact of a child's inborn error of metabolism: the parents' perspectives on restrictions, discrimination, family planning, and emergency management. Orphanet J Rare Dis 2024; 19:313. [PMID: 39187849 PMCID: PMC11348755 DOI: 10.1186/s13023-024-03315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND To investigate the impact of children's inborn error of metabolism (IEMs) on the children's and their parents' lives from the parents' perspective. We focused on disease-related restrictions in various issues of daily life, experienced discrimination, parental family planning, and management of metabolic emergencies. METHODS We conducted a questionnaire-based survey with 108 parents of 119 children with IEM who attended a metabolic outpatient clinic. The children were categorized into 4 cohorts, based on increasing disease severity (cohort 1: IEMs with lowest severity, cohort 4: IEMs with highest severity), and compared by using Tobit regressions. RESULTS The severity of the child's IEM was associated with an increase in the intensity of perceived restrictions from the parents' perspective for themselves and their children in all aspects of life: in general, in contact with friends, in the pursuit of hobbies, in childcare/school/occupation, and due to emotional stress. The highest intensity of restrictions in all cohorts was found for the parents themselves in contact with friends (compared to cohort 1: cohort 2: c. 3.556, p = 0.002; cohort 3: c. 4.159, p = 0.003; cohort 4: c. 7.224, p < 0.001). Parents of 8% of children reported that their children were discriminated against because of IEM, with the highest proportion of affected children (43%) in cohort 4. Parental family planning decisions were influenced in 34% of parents, with fear of recurrence being a predominant aspect. Of the parents of children diagnosed with IEMs associated with metabolic emergencies, 68% stated that they felt well or very well prepared for the occurrence of a metabolic emergency, and 100% of parents were able to name the necessary action steps from memory. Nevertheless, 58% stated that they experienced an occurring emergency as rather or very stressful. CONCLUSIONS From the parents' perspective, the intensity of restrictions increased with the severity of the child's IEM. The study shows the high impact of IEM on parents of children with IEM and the daily challenges they face. These findings emphasize the importance of comprehensive support for parents of children with IEM.
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Affiliation(s)
- Tanjana Harings
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Martina P Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Simone Eisenhofer
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Alena G Thiele
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103, Leipzig, Germany
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Ferdinand-Sauerbruch-Strasse 1, 17475, Greifswald, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and Leipzig University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany.
| | - Skadi Beblo
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103, Leipzig, Germany
- Center for Rare Diseases, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 55, 04103, Leipzig, Germany
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Jahangiri Z, Rostampour N, Hovsepian S, Chegini R, Hashemipour M. Quality of Life in Patients with Phenylketonuria: A Systematic Review. Adv Biomed Res 2024; 13:15. [PMID: 38525399 PMCID: PMC10958725 DOI: 10.4103/abr.abr_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 03/26/2024] Open
Abstract
The impact of phenylketonuria (PKU) on Quality of life (QoL) has been a topic of interest in recent research. This article reviews current researches on the impact of PKU on QoL. The review examines factors that may influence QoL, such as age, metabolic control, and treatment adherence. In this systematic review study, relevant articles were identified using a search strategy built with the keywords phenylketonuria, PKU, or hyperphenylalaninemia (or their synonyms) and QoL in Web of Science, Scopus, and PubMed databases. After identifying the articles, duplicates, reviews, scientific abstracts, articles published in languages other than English, and non relevant studies were excluded. The search strategy identified 951 records from databases, and after excluding duplicates, irrelevant studies, and those published in non English languages, 26 records were left that contained data on 1816 patients with PKU/hyperphenylalaninemia. The studies included both children/adolescents and adults. Overall, the studies found that the QoL of PKU patients was comparable to normative data, but some aspects such as emotional health and school functioning were lower. Metabolic control was found to significantly correlate with QoL. Younger patients and men had better QoL in several studies, while late treated patients and those with lower education had worse outcomes. It is concluded that QOL in patients with PKU is similar to the general population. However, given the chronic nature of the condition, it is important to pay special attention to their QoL. Poor QOL is associated with female gender, lower education, older age, and poor metabolic control.
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Affiliation(s)
- Zahra Jahangiri
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Rostampour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Silva Hovsepian
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rojin Chegini
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ramos-Álvarez R, Kapp M, Bélanger-Quintana A, Rodríguez-Ruiz MM, Solano-Galvis CA, Campos Soto A, Ahring K, Waisbren SE. Parent knowledge regarding food selection for children with PKU: Results of a survey in the United States. Nutrition 2023; 116:112201. [PMID: 37804556 DOI: 10.1016/j.nut.2023.112201] [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: 04/10/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES Dietary treatment is the main therapy for most patients with phenylketonuria (PKU). Parental knowledge regarding food selection is crucial to ensure adequate metabolic control and brain development during childhood and to promote lifelong adherence and healthy dietary behavior in the offspring. The aims of this study were to assess whether parental or caregiver knowledge regarding nutritional selection for children with PKU is in accordance with medical recommendations and to evaluate factors that influence their level of knowledge. METHODS This was a cross-sectional observational study. An online or paper survey (N = 178) was distributed throughout the United States. The survey included a validated food selection questionnaire to assess whether the respondent adequately identified foods that require certain restrictions versus foods that can be consumed freely by an individual with PKU. RESULTS General knowledge of food selection among the caregivers was very high or high in nearly 60% (60-98th score percentile). Participants with the lowest scores in general knowledge of the PKU diet (quartile 1) were more likely to label allowed foods incorrectly. Respondents with the highest scores (quartile 4) were more likely to label limited foods correctly but incorrectly label allowed items. CONCLUSION Knowledge of restricted foods is important to avoid poor metabolic control, but knowledge of allowed foods can be just as important to allow for a diet that is diverse, palatable, and nutritionally balanced.
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Affiliation(s)
- Rodolfo Ramos-Álvarez
- Department of Social Psychology, Melilla Campus, University of Granada, Melilla, Spain.
| | - Maili Kapp
- Teaching Innovation Project, Melilla Campus, University of Granada, Melilla, Spain
| | - Amaya Bélanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Ramón y Cajal Hospital, CSUR, MetabERN, Madrid, Spain
| | | | | | - Antonio Campos Soto
- Department of Didactics and School Organization, Melilla Campus, University of Granada, Melilla, Spain
| | - Kirsten Ahring
- Center for PKU, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan E Waisbren
- Genetics and Metabolism Programs, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Harings T, Neininger MP, Eisenhofer S, Thiele AG, Kiess W, Bertsche A, Beblo S, Bertsche T. Parents' Perceptions Regarding Their Children's Medications and Expert-Assessed Drug-Related Problems in Pediatric Patients with Inborn Errors of Metabolism. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1873. [PMID: 38136075 PMCID: PMC10741610 DOI: 10.3390/children10121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
We aimed to explore parents' perceptions of their children's medication use for inborn errors of metabolism (IEM), including the importance of medication intake, potential complications, and concerns about adverse drug reactions (ADR). Additionally, we aimed to determine expert-assessed clinically relevant drug-related problems, particularly those attributable to IEM. We interviewed 108 parents of 119 pediatric patients with IEM using a questionnaire relating to their perceptions regarding their children's IEM medication. In affected siblings, a questionnaire was used for each child. We performed medication analyses to evaluate the patient's complete medication regimen for clinically relevant drug-related problems, including medication for conditions other than IEM. It was very important to the parents of 85% of the patients to use IEM medication exactly as prescribed. The parents of 41% of patients perceived complications in their children's use of IEM medication. The parents of 47% of patients reported fears concerning ADR because of IEM medication. Parents observed ADR in 27% of patients because of IEM medication. In 44% of patients, medication for conditions other than IEM was inadequate because of drug-related problems not associated with the IEM; a safe alternative existed in 21% of patients. In summary, almost half of the parents of patients with IEM reported complications with their child's IEM medication intake and fears of ADR. Medication analyses showed that drug-related problems occurred regardless of IEM, emphasizing the general need to prescribe and dispense adequate, child-appropriate medication to minimize clinically relevant drug-related problems in pediatric patients.
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Affiliation(s)
- Tanjana Harings
- Institute of Pharmacy, Clinical Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103 Leipzig, Germany; (T.H.); (S.E.); (T.B.)
- Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Martina Patrizia Neininger
- Institute of Pharmacy, Clinical Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103 Leipzig, Germany; (T.H.); (S.E.); (T.B.)
- Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Simone Eisenhofer
- Institute of Pharmacy, Clinical Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103 Leipzig, Germany; (T.H.); (S.E.); (T.B.)
- Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Alena Gerlinde Thiele
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103 Leipzig, Germany; (A.G.T.); (W.K.); (A.B.); (S.B.)
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103 Leipzig, Germany; (A.G.T.); (W.K.); (A.B.); (S.B.)
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103 Leipzig, Germany; (A.G.T.); (W.K.); (A.B.); (S.B.)
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Ferdinand-Sauerbruch-Strasse 1, 17475 Greifswald, Germany
| | - Skadi Beblo
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstrasse 20a, 04103 Leipzig, Germany; (A.G.T.); (W.K.); (A.B.); (S.B.)
| | - Thilo Bertsche
- Institute of Pharmacy, Clinical Pharmacy, Medical Faculty, Leipzig University, Bruederstrasse 32, 04103 Leipzig, Germany; (T.H.); (S.E.); (T.B.)
- Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
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Messina M, Maugeri L, Spoto G, Puccio R, Ruggieri M, Petralia S. Fully Integrated Point-of-Care Platform for the Self-Monitoring of Phenylalanine in Finger-Prick Blood. ACS Sens 2023; 8:4152-4160. [PMID: 37890867 PMCID: PMC10683505 DOI: 10.1021/acssensors.3c01384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023]
Abstract
Development of point-of-care platforms combining reliability and ease of use is a challenge for the evolution of sensing in healthcare technologies. Here, we report the development and testing of a fully integrated enzymatic colorimetric assay for the sensing of phenylalanine in blood samples from phenylketonuria patients. The platform works with a customized mobile app for data acquisition and visualization and comprises an electronic system and a disposable sensor. The sensing approach is based on specific enzymatic phenylalanine recognition, and the optical transduction method is based on in situ gold nanostructure formation. The phenylketonuria (PKU) smart sensor platform is conceived to perform self-monitoring on phenylalanine levels and real-time therapy tuning, thanks to the direct connection with clinicians. Validation of the technologies with a population of patients affected by PKU, together with the concurrent validation of the platform through centralized laboratories, has confirmed the good analytical performances in terms of sensitivity and specificity, robustness, and utility for phenylalanine sensing. The self-monitoring of phenylalanine for the daily identification of abnormal health conditions could facilitate rapid therapy tuning, improving the wellness of PKU patients.
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Affiliation(s)
- Maria
Anna Messina
- Expanded
Newborn Screening Laboratory, A.O.U Policlinico
“G. Rodolico—San Marco”, 95125 Catania, Italy
| | - Ludovica Maugeri
- Department
of Drug and Health Sciences, University
of Catania, 95125 Catania, Italy
| | | | | | - Martino Ruggieri
- Expanded
Newborn Screening Laboratory, A.O.U Policlinico
“G. Rodolico—San Marco”, 95125 Catania, Italy
- Unit
of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Salvatore Petralia
- Department
of Drug and Health Sciences, University
of Catania, 95125 Catania, Italy
- CNR-Institute
of Biomolecular Chemistry, 95126 Catania, Italy
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Maissen-Abgottspon S, Muri R, Hochuli M, Reismann P, Barta AG, Alptekin IM, Hermida-Ameijeiras Á, Burlina AP, Burlina AB, Cazzorla C, Carretta J, Trepp R, Everts R. Health-related quality of life in a european sample of adults with early-treated classical PKU. Orphanet J Rare Dis 2023; 18:300. [PMID: 37740225 PMCID: PMC10517574 DOI: 10.1186/s13023-023-02917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is a rare inborn error of metabolism affecting the catabolism of phenylalanine (Phe). To date, findings regarding health-related quality of life (HRQoL) in adults with early-treated classical PKU are discrepant. Moreover, little is known about metabolic, demographic, and cognitive factors associated with HRQoL. Hence, we aimed to investigate HRQoL and its association with demographic, metabolic, and cognitive characteristics in a large European sample of adults with early-treated classical PKU. RESULTS This cross-sectional study included 124 adults with early-treated classical PKU from Hungary, Italy, Spain, Switzerland, and Turkey. All participants prospectively completed the PKU quality of life questionnaire (PKU-QoL), a questionnaire specifically designed to evaluate the impact of PKU and its treatment on HRQoL in individuals with PKU. In addition, information about Phe levels (concurrent and past year), demographic (age and sex), and cognitive variables (intelligence quotient, IQ) were collected. Most domains revealed little or no impact of PKU on HRQoL and more than three-quarters of the patients rated their health status as good, very good, or excellent. Nevertheless, some areas of concern for patients were identified. Patients were worried about the guilt that they experience if they do not adhere to the dietary protein restriction and they were most concerned about high Phe levels during pregnancy. Further, tiredness was the most affected symptom, and the supplements' taste was considered a main issue for individuals with PKU. The overall impact of PKU on HRQoL was higher in women (U = 1315.5, p = .012) and in adults with a lower IQ (rs = - 0.448, p = .005). The overall impact of dietary protein restriction was higher in adults with higher concurrent Phe levels (rs = 0.272, p = .007) and higher Phe levels during the past year (rs = 0.280, p = .009). CONCLUSION The impact of PKU on most domains assessed in the PKU-QoL was considered to be low. These results likely reflect the successful implementation of the newborn screening resulting in the prevention of severe adverse long-term outcomes. However, a particular clinical focus should be given to patients with lower IQ, higher Phe levels, and women, as these variables were associated with a lower HRQoL.
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Affiliation(s)
- Stephanie Maissen-Abgottspon
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphaela Muri
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michel Hochuli
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Péter Reismann
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - András Gellért Barta
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ismail Mucahit Alptekin
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara University, Ankara, Turkey
| | - Álvaro Hermida-Ameijeiras
- Division of Internal Medicine, European Reference Network for Hereditary Metabolic Disorders (MetabERN), University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Alberto B Burlina
- Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy
| | - Chiara Cazzorla
- Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy
| | - Jessica Carretta
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Regula Everts
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Rocha JC, Ahring KK, Bausell H, Bilder DA, Harding CO, Inwood A, Longo N, Muntau AC, Pessoa ALS, Rohr F, Sivri S, Hermida Á. Expert Consensus on the Long-Term Effectiveness of Medical Nutrition Therapy and Its Impact on the Outcomes of Adults with Phenylketonuria. Nutrients 2023; 15:3940. [PMID: 37764724 PMCID: PMC10536918 DOI: 10.3390/nu15183940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Many adults with phenylketonuria (PKU) rely on medical nutrition therapy (MNT; low phenylalanine (Phe) diet with protein substitutes/medical foods) to maintain blood Phe concentrations within recommended ranges and prevent PKU-associated comorbidities. Despite disease detection through newborn screening and introduction of MNT as early as birth, adherence to MNT often deteriorates from childhood onwards, complicating the assessment of its effectiveness in the long term. Via a modified Delphi process, consensus (≥70% agreement) was sought on 19 statements among an international, multidisciplinary 13-member expert panel. After three iterative voting rounds, the panel achieved consensus on 17 statements related to the limitations of the long-term effectiveness of MNT (7), the burden of long-term reliance on MNT (4), and its potential long-term detrimental health effects (6). According to the expert panel, the effectiveness of MNT is limited in the long term, is associated with a high treatment burden, and demonstrates that adults with PKU are often unable to achieve metabolic control through dietary management alone, creating an unmet need in the adult PKU population.
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Affiliation(s)
- Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Kirsten K. Ahring
- Departments of Paediatrics and Clinical Genetics, PKU Clinic, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Heather Bausell
- Division of Genetics, Genomics, and Metabolism, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Deborah A. Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Utah Huntsman Mental Health Institute, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR 97239, USA
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Queensland Children’s Hospital, 501 Stanley St., South Brisbane, QLD 4101, Australia
- School of Nursing and Social Work, The University of Queensland, Chamberlain Building, St. Lucia, QLD 4072, Australia
| | - Nicola Longo
- Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ania C. Muntau
- Department of Pediatrics, University Children’s Hospital, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - André L. Santos Pessoa
- Albert Sabin Children’s Hospital, R. Tertuliano Sales, 544—Vila União, Fortaleza 60410-794, CE, Brazil
- Av. Dr. Silas Munguba, 1700—Itaperi, State University of Ceará (UECE), Fortaleza 60714-903, CE, Brazil
| | | | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Gevher Nesibe Cd., 06230 Ankara, Turkey
| | - Álvaro Hermida
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Faculty of Medicine, Clinical University Hospital of Santiago de Compostela, University of Santiago de Compostela, CIBERER, MetabERN, Institute of Clinical Research of Santiago de Compostela (IDIS), Rúa de San Francisco s/n, 15706 Santiago de Compostela, Spain
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Cognitive Functioning in Adults with Phenylketonuria in a Cohort of Spanish Patients. Behav Neurol 2023; 2023:9681740. [PMID: 36815863 PMCID: PMC9931468 DOI: 10.1155/2023/9681740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 02/10/2023] Open
Abstract
The early introduction of a low phenylalanine (Phe) diet has been demonstrated to be the most successful treatment in subjects with phenylketonuria (PKU), especially for preventing severe cognitive and neurological damages. However, it still concerns that even if treated in the first months of life with supplements and following a diet, they can show slight scores below people without PKU in neuropsychological assignments. We investigated 20 adults with classical PKU aged 19-48 years (mean age 29 years) and 20 heathy controls matched by age, gender, and years of education. Patients and controls were assessed with an extended neuropsychological battery, as well as psychological aspects and quality of life, also the last Phe level result was obtained. Results showed that the most affected cognitive domains are processing speed, executive functioning, memory, and also theory of mind, but very well-preserved verbal fluency, language, and visuospatial functioning. In quality of life, some significant results were seen specially in anxiety of Phe levels, anxiety of Phe levels during pregnancy, guilt if poor adherence to supplements, and if dietary protein restriction not followed. No significant results were obtained for the psychological variables. In conclusion, it has been shown that a combination of a low Phe diet, supplement intake, and keeping Phe levels in a low range seems appropriate to have the most normal and alike cognitive performance to persons without PKU.
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O'Shea ME, Sheehan Gilroy B, Greaney AM, MacDonald A. Moving through adulthood: The lived experience of Irish adults with PKU. Front Psychol 2022; 13:983154. [PMID: 36176784 PMCID: PMC9513515 DOI: 10.3389/fpsyg.2022.983154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria (PKU) living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years ago. This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework (1978) in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice.
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Affiliation(s)
- Mary-Ellen O'Shea
- School of Health and Social Sciences, Munster Technological University, Kerry, Ireland
- *Correspondence: Mary-Ellen O'Shea
| | | | - Anna-Marie Greaney
- School of Health and Social Sciences, Munster Technological University, Kerry, Ireland
| | - Anita MacDonald
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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Olofsson S, Gralén K, Hoxer C, Okhuoya P, Persson U. The impact on quality of life of diet restrictions and disease symptoms associated with phenylketonuria: a time trade-off and discrete choice experiment study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:993-1005. [PMID: 34842989 DOI: 10.1007/s10198-021-01415-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
Phenylketonuria (PKU) is a metabolic disorder leading to a deficiency in the metabolism of phenylalanine (Phe). Elevated Phe levels in the blood, tissue and brain may lead to emotional, cognitive, and physical symptoms in adults. To control blood Phe levels, most individuals with PKU need to follow a strict, life-long Phe-restricted diet. The main objective of this study was to estimate the impact of PKU-related disease symptoms and dietary restrictions on health-related quality of life (HRQoL). This study was designed as a web-based survey using the methods of Time Trade-Off (TTO) and Discrete Choice Experiment with duration (DCETTO) in a survey of the Swedish general population and population with PKU. Data were collected using questionnaires for TTO diet (n = 509), TTO symptoms (n = 507), and DCETTO (n = 1117). The disutility of diet restrictions ranged from 0.050 for a partially restricted diet without medical food to 0.193 for a fully restricted diet with medical food in the TTO (DCE: 0.043-0.108). The disutility of experiencing symptoms (emotional, cognitive and physical) ranged from 0.148 for mild symptoms to 0.593 for severe symptoms in the TTO (DCE: 0.122-1.522). The study shows that both diet and symptoms have a significant negative impact on HRQoL in PKU and that utility estimates are largely consistent across methods and samples.
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Affiliation(s)
- Sara Olofsson
- The Swedish Institute for Health Economics, IHE, Lund, Sweden.
| | - Katarina Gralén
- The Swedish Institute for Health Economics, IHE, Lund, Sweden
| | | | | | - Ulf Persson
- The Swedish Institute for Health Economics, IHE, Lund, Sweden
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11
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Minighin EC, de Sousa RCS, Ramos ALCC, Dias LTS, Labanca RA, de Araújo RLB. Evaluation of the Consumption of Fruits and Vegetables by Phenylketonurics in the Metabolic Control of Phenylalanine: An Integrative Review. J Med Food 2022; 25:487-494. [PMID: 35325557 DOI: 10.1089/jmf.2021.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Phenylketonuria (PKU) is an autosomal recessive disease caused by variants in the gene that encodes phenylalanine hydroxylase (PAH), limiting the metabolism of phenylalanine (Phe). When PAH activity is absent or hindered, Phe is not converted to tyrosine, leading to an accumulation of Phe in the blood, which can cause serious neurological complications. Once PKU is diagnosed, treatment should be started immediately, and the basis for this is dietary restriction of foods with high levels of Phe, associated with the use of protein substitutes and intake of foods with low protein content. This restriction accompanies patients throughout their lives, making their diets unpalatable and monotonous, which represents a major challenge for health professionals and patients, considering that these factors favor food transgression. In this context, the objective of this work was to carry out an integrative review based on evidence regarding the intake of fruits and vegetables, by phenylketonurics, taking into account the greater or lesser tolerance to Phe. Since, some researchers have dedicated themselves to evaluating the biochemical effect of unrestricted consumption of fruits and vegetables at PKU, unifying the information in this regard. It was observed that the intake of vegetable protein by patients with PKU has shown to be promising since the studies indicate that the intake of these proteins does not present adverse effects to the metabolic control of the Phe.
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Affiliation(s)
- Elaine Carvalho Minighin
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
| | - Roberto César Santos de Sousa
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Luiza Coeli Cruz Ramos
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
| | - Lorena Thais Souza Dias
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
| | - Renata Adriana Labanca
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel Linhares Bello de Araújo
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Pampulha Campus, Belo Horizonte, Minas Gerais, Brazil
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Measuring Burden of Illness in Phenylketonuria (PKU): Development of the PKU Symptom Severity and Impacts Scale as a Robust Patient-Reported Outcome. Adv Ther 2022; 39:971-991. [PMID: 34921666 PMCID: PMC8684342 DOI: 10.1007/s12325-021-01986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
Introduction Phenylketonuria (PKU) is a rare, metabolic genetic disorder that can cause various neuropsychological symptoms that often affect patients’ health-related quality of life, even for patients with good metabolic control. To date, no patient-reported outcomes (PRO) instrument combines the measurement of neuropsychological and dietary concepts to capture the broad impact of PKU on quality of life. This article presents the development of the PKU Symptom Severity and Impacts Scale (PKU-SSIS), a PRO instrument that is designed to evaluate neuropsychological symptoms and impacts in early-treated patients with PKU. Methods A draft instrument was developed based on a targeted literature review, PKU expert physician interviews, and an advisory board consisting of patients with PKU. Qualitative interviews combining concept elicitation/cognitive interviews were conducted with patients with classic PKU aged at least 15 years old. A separate sample of 20 patients with PKU completed the draft PKU-SSIS in a paper survey format, to enable preliminary assessment of any floor and ceiling effects. Results Patient interviews elicited four key symptom themes: neurocognitive function, emotional and behavioral, physical functioning, and physical health. Four impact themes were also identified: social function, physical health, emotions, and level of independence. No floor or ceiling effects were identified. Conclusion The final instrument included 22 items, covering three symptom domains (1. emotional, mood, and psychological; 2. (neuro)cognitive, executive, and intellectual function; and 3. physical health), and four impact domains (1. social relations, 2. level of independence, 3. general well-being, and 4. self-care). The PKU-SSIS will help to address an important gap in the evaluation of existing and future treatments for PKU.
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Becsei D, Hiripi R, Kiss E, Szatmári I, Arató A, Reusz G, Szabó AJ, Bókay J, Zsidegh P. Quality of life in children living with PKU - a single-center, cross-sectional, observational study from Hungary. Mol Genet Metab Rep 2021; 29:100823. [PMID: 34900594 PMCID: PMC8639791 DOI: 10.1016/j.ymgmr.2021.100823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Phenylketonuria (PKU) is an inherited error of metabolism, screened at 48–72 h of life since 1975 in Hungary. The patients have to keep a strict lifelong protein-restricted diet, resulting in PKU and its treatment can lead to social and financial burdens. The current study aimed to evaluate the health-related quality of life (HRQoL) of children living with PKU. Patients and methods A single-centre, cross-sectional, observational study was conducted at the Center of Newborn Screening and Inherited Metabolic Disorders of Budapest, Hungary, using the PKU-quality of life (PKU-QoL) questionnaire. Responses of 59 parents and 11 teenagers were collected. Numerous aspects regarding HRQoL were analysed according to clinical compliance and severity. The patients were classified into groups with good or suboptimal adherence based on regular phenylalanine (Phe) values. The online officially translated versions of the adolescent or parental PKU-QoL questionnaire were used and analysed anonymously. Differences in HRQoL were compared - PKU vs. Hyperphenylalaninaemia (HPA) and good vs. suboptimal adherence. Results Twenty-five of 32 examined parameters had no or little impact on HRQoL. The most frequently reported symptom was irritability. Food enjoyment was the most impacted domain, with a major severity score in the adolescent group (median 62,5, IQR: 25–75). The emotional impact was scored at moderate severity by both the adolescents and parents. Classical PKU patients with good metabolic control were more frequently tired than HPA patients (0,0027). The group with poor metabolic adherence showed more frequent tiredness (p = 0,03), slow thinking (p = 0,018) and anxiety (p = 0,015). Conclusion Overall, our patients showed an excellent HRQoL; most domains (29/36) were reported as little/no impacted. Worse QoL was found in patients with suboptimal metabolic control. Particular attention should be paid to the emotional health of PKU patients.
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Key Words
- Children
- DBS, dried blood spot
- DPR, dietary protein restriction
- GMP, glycomacropeptide
- HPA, hyperphenylalaninaemia
- HRQoL
- HRQoL, health-related quality of life
- Health-related quality of life
- IQ, intelligence quotient
- IQR, interquartile range
- PAH, phenylalanine hydroxylase
- PKU
- PKU, phenylketonuria
- Parents
- Phenylketonuria
- QoL, quality of life,
- SD, standard deviation
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Affiliation(s)
- Dóra Becsei
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Réka Hiripi
- Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest 1085, Hungary
| | - Erika Kiss
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Ildiko Szatmári
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - András Arató
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - György Reusz
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Attila J Szabó
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary.,ELKH-SE Pediatrics and Nephrology Research Group, Budapest, Hungary
| | - János Bókay
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Petra Zsidegh
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
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Burton BK, Skalicky A, Baerwald C, Bilder DA, Harding CO, Ilan AB, Jurecki E, Longo N, Madden DT, Sivri HS, Wilcox G, Thomas J, Delaney K. A non-interventional observational study to identify and validate clinical outcome assessments for adults with phenylketonuria for use in clinical trials. Mol Genet Metab Rep 2021; 29:100810. [PMID: 34815941 PMCID: PMC8591457 DOI: 10.1016/j.ymgmr.2021.100810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Current clinical outcome assessments (COAs) are not effectively capturing the complex array of symptoms of adults with phenylketonuria (PKU). This study aimed to identify concepts of interest relevant to adults with PKU. Based on these concepts, COAs for patient-reported outcomes (PROs), observer-reported outcomes (ObsROs), and clinician-reported outcomes (ClinROs) were selected or developed and content validity was assessed. Materials and methods Concept-elicitation interviews were conducted with an international cohort of adults with PKU (n = 30), family member observers (n = 14), and clinical experts (n = 8). Observers and clinical experts were included to overcome the risk of lack of self-awareness among adults with PKU. The concepts of interests endorsed by ≥30% of patients, observers, and/or clinical experts were selected, mapped to items in existing COAs, and used to develop global impression items for patients, observers, and clinicians. Next, the content validity of the COAs and global impression items was evaluated by cognitive interviews with patients (n = 22), observers (n = 11), and clinical experts (n = 8). All patients were categorized according to blood phenylalanine (Phe) levels (i.e., <600 μmol/L, 600–1200 μmol/L, and >1200 μmol/L). Results Concepts of interests were identified across four domains: emotional, cognitive, physical, and behavioral. After mapping, eight existing COAs were selected based on the concept coverage (six PROs, one ObsRO, and one ClinRO). The six PRO measures were considered as potentially fit-for-purpose. The ObsRO measure was not deemed relevant for use in observers of adults with PKU and only a subscale of the ClinRO measure was considered valid for assessing adults with PKU by clinicians. Due to the lack of existing COAs covering all concepts of interests, global impression items for symptom severity and change in symptoms were developed, which were limited to one question covering in total 14 concepts. Upon validation, some of the patient and observer global impression items were excluded as they were subject to lack of insight or could not be reported by observers. Due to the limited interaction time between clinician and patient, use of the clinician global impression items was not supported. Conclusion Existing COAs relevant to adults with PKU were selected and PKU-specific global impression items were developed by mapping the most frequently identified concepts of interests from internationally-conducted in-depth interviews. Future studies should address the appropriateness of the selected COAs and global impression items to assess if these can be used as efficacy endpoints in PKU clinical trials.
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Key Words
- ADHD RS-IV, Attention Deficit Hyperactivity Disorders Rating Scale-IV
- ADHD, Attention Deficit Hyperactivity Disorder
- Adults
- CAARS-O:Long, Conners' Adult ADHD Rating Scales-Observer Report Long Version
- CGI, Clinician Global Impression
- COAs, Clinical Outcome Assessments
- COIs, Concepts Of Interests
- ClinROs, Clinician-Reported Outcomes
- Clinical outcome assessments
- Clinician-reported outcomes
- FDA, Food and Drug Administration
- HRQoL, Health-Related Quality of Life
- IRB, Institutional Review Board
- Neuro-QoL, Quality of Life in Neurological Disorders
- OGI, Observer Global Impression
- ObsROs, Observer-Reported Outcomes
- Observer-reported outcomes
- PAH, Phenylalanine Hydroxylase
- PGI, Patient Global Impression
- PKU
- PKU, Phenylketonuria
- PKU-QOL, PKU Quality of Life
- PROMIS, Patient Reported Outcome Measurement Information System
- PROs, Patient-Reported Outcomes
- Patient-reported outcomes
- Phe, Phenylalanine
- Phenylketonuria
- QoL, Quality of Life
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Affiliation(s)
- Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne Skalicky
- Patient-Centered Research, Evidera, Seattle, WA, USA
| | - Christoph Baerwald
- Rheumatology Unit, Department of Internal Medicine, Neurology and Dermatology, University Medical Center Leipzig, Leipzig, Germany
| | - Deborah A Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Cary O Harding
- Department of Medical and Molecular Genetics, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | - H Serap Sivri
- Hacettepe University Faculty of Medicine, Division of Pediatric Metabolism, Ankara, Turkey
| | - Gisela Wilcox
- School of Medical Sciences, University of Manchester & The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janet Thomas
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Cano A, Resseguier N, Ouattara A, De Lonlay P, Arnoux JB, Brassier A, Schiff M, Pichard S, Fabre A, Hoebeke C, Guffon N, Fouilhoux A, Broué P, Touati G, Dobbelaere D, Mention K, Labarthe F, Tardieu M, De Parscau L, Feillet F, Bonnemains C, Kuster A, Labrune P, Barth M, Damaj L, Lamireau D, Berbis J, Chabrol B, Auquier P. Health Status of French Young Patients with Inborn Errors of Metabolism with Lifelong Restricted Diet. J Pediatr 2020; 220:184-192.e6. [PMID: 32145964 DOI: 10.1016/j.jpeds.2020.01.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe the health status of young patients affected by inborn errors of metabolism that require adherence to a restricted diet (IEMRDs) and to describe and compare their self- and proxy (parent)-reported quality of life (QoL) with reference values. STUDY DESIGN A cross-sectional study was conducted in 2015-2017 in patients affected by IEMRDs (except phenylketonuria) younger than 18 years. Data collection was based on medical records, clinical examinations, parents' and children's interviews, and self-reported questionnaires. Measurements included clinical and healthcare data, child and family environment data, and self- and proxy (parent)-reported QoL. RESULTS Of the 633 eligible participants, 578 were recruited (50.3% boys; mean age: 8.7 years); their anthropometric status did not differ from the general population. Approximately one-half of them had at least 1 complication of the disease. Their self-reported global QoL did not differ from that of the general population. However, relations with friends and leisure activities QoL domains were negatively impacted, whereas relations with medical staff, relations with parents, and self-esteem QoL domains were positively impacted. Their proxy (parent)-reported QoL was negatively impacted. CONCLUSIONS Young patients affected by IEMRDs present a high rate of clinical complications. Although their proxy (parent)-reported QoL was negatively impacted, their self-reported QoL was variably impacted (both positively and negatively). These results may inform counseling for those who care for affected patients and their families.
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Affiliation(s)
- Aline Cano
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Noemie Resseguier
- Department of Epidemiology and Health Economics, AP-HM/EA 3279 CEReSS (Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie), Aix-Marseille Univ, Marseille, France.
| | - Abdoulaye Ouattara
- Department of Epidemiology and Health Economics, AP-HM/EA 3279 CEReSS (Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie), Aix-Marseille Univ, Marseille, France
| | - Pascale De Lonlay
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Jean-Baptiste Arnoux
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Anais Brassier
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Manuel Schiff
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Robert Debré Hospital, Paris, France
| | - Samia Pichard
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Robert Debré Hospital, Paris, France
| | - Alexandre Fabre
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Celia Hoebeke
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Nathalie Guffon
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Femme Mère Enfant Hospital, Lyon, France
| | - Alain Fouilhoux
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Femme Mère Enfant Hospital, Lyon, France
| | - Pierre Broué
- Department of Pediatric Hepatology and Metabolism, Reference Center of Inherited Metabolic Disorders, Purpan Hospital, Toulouse, France
| | - Guy Touati
- Department of Pediatric Hepatology and Metabolism, Reference Center of Inherited Metabolic Disorders, Purpan Hospital, Toulouse, France
| | - Dries Dobbelaere
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Jeanne de Flandre Hospital, Lille, France
| | - Karine Mention
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Jeanne de Flandre Hospital, Lille, France
| | - Francois Labarthe
- Department of Pediatrics, Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, Tours, France
| | - Marine Tardieu
- Department of Pediatrics, Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, Tours, France
| | - Loïc De Parscau
- Department of Pediatrics, Competence Center of Inherited Metabolic Disorders, Brest Hospital, Brest, France
| | - Francois Feillet
- Department of Pediatrics, Reference Center of Inherited Metabolic Disorders, Brabois Hospital, Nancy, France
| | - Chrystèle Bonnemains
- Department of Pediatrics, Reference Center of Inherited Metabolic Disorders, Brabois Hospital, Nancy, France
| | - Alice Kuster
- Department of Pediatric Reanimation, Competence Center of Inherited Metabolic Disorders, Nantes Hospital, Nantes, France
| | - Philippe Labrune
- Department of Pediatrics, Reference Center of Rare Liver Disease, Antoine Beclere Hospital, Clamart, France
| | - Magalie Barth
- Department of Pediatrics, Competence Center of Inherited Metabolic Disorders, Angers Hospital, Angers, France
| | - Lena Damaj
- Department of Pediatrics, Competence Center of Inherited Metabolic Disorders, Rennes Hospital, Rennes, France
| | - Delphine Lamireau
- Department of Pediatrics, Competence Center of Inherited Metabolic Disorders, Pellegrin Hospital, Bordeaux, France
| | - Julie Berbis
- Department of Epidemiology and Health Economics, AP-HM/EA 3279 CEReSS (Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie), Aix-Marseille Univ, Marseille, France
| | - Brigitte Chabrol
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Pascal Auquier
- Department of Epidemiology and Health Economics, AP-HM/EA 3279 CEReSS (Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie), Aix-Marseille Univ, Marseille, France
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Barta AG, Sumánszki C, Turgonyi Z, Kiss E, Simon E, Serfőző C, Reismann P. Health Related Quality of Life assessment among early-treated Hungarian adult PKU patients using the PKU-QOL adult questionnaire. Mol Genet Metab Rep 2020; 23:100589. [PMID: 32346514 PMCID: PMC7183227 DOI: 10.1016/j.ymgmr.2020.100589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022] Open
Abstract
Background: The implementation of neonatal screening and the early initiation of lifelong therapy have helped to prevent severe complications and enabled much more favorable outcomes for early-treated phenylketonuria (ETPKU) patients. However, PKU patients tend to develop subtle cognitive and psychosocial abnormalities and the strict dietary therapy can present financial and social burden. Thus, PKU is expected to affect the quality of life (QoL) of these patients. There is insufficient evidence regarding the relationship between metabolic control and Health-Related QoL (HRQoL). We aimed to assess the effect of short- and long-term therapy on QoL among Hungarian adult PKU patients using the standardized PKU-specific PKU-QoL questionnaire. Methods: We conducted a single-centre, cross-sectional, observational study in Hungary. We included adult PKU patients treated with diet and amino acid supplements only. Patients reported HRQoL using the standardized adult PKU-QoL questionnaire and mean blood Phe concentrations were assessed for three different time periods: the previous 10 years, the previous year and concentration at the time of completing the questionnaire. The correlation between patients’ QoL scores and their Phe levels was assessed. The classical PKU group was further divided into “good” and “suboptimal” adherence groups based on individual mean Phe levels in the examined time period. We evaluated differences in QoL among the two subgroups of classical PKU patients. QoL scores between classical and non-classical patients were also compared. Results: Data from 88 adult patients were analysed (66 had classical PKU). No median PKU-QoL score reached major or severe impact/frequent symptoms in any domain. The highest scores (meaning larger burden) were mostly related to emotional impact of PKU and disease management. When performing correlation analysis between Phe levels and QoL scores by all patients we found weak to fair positive correlation in several domains either short or long term. Patients with classical PKU reported greater financial impact of PKU than patients with less severe PKU. Classical PKU patients with good therapy adherence tended to report better HRQoL scores than patients with suboptimal adherence. Conclusion: We conclude that patients showed good HRQoL using the PKU-specific questionnaire. Our study demonstrates that suboptimal metabolic control is negatively associated with patients' HRQoL.
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Key Words
- AAS, amino acid supplements
- Adult
- ETPKU, early-treated phenylketonuria
- Early treated
- GMP, glycomacropeptide
- HPA, hyperphenylalaninaemia
- HRQoL
- HRQoL, health related quality of life
- Health related quality of life
- IQR, interquartile range
- PKU
- PKU, phenylketonuria
- PKU-QoL, Phenylketonuria Quality of Life questionnaires
- Phe, phenylalanine
- Phenylketonuria
- SD, standard deviation
- Tyr, tyrosine
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Affiliation(s)
- András Gellért Barta
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Csaba Sumánszki
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Zsófia Turgonyi
- Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest 1085, Hungary
| | - Erika Kiss
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Erika Simon
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Csilla Serfőző
- Department of Ophthalmology, Semmelweis University, Mária street 39, Budapest 1085, Hungary
| | - Péter Reismann
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
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17
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Borghi L, Moreschi C, Toscano A, Comber P, Vegni E. The PKU & ME study: A qualitative exploration, through co-creative sessions, of attitudes and experience of the disease among adults with phenylketonuria in Italy. Mol Genet Metab Rep 2020; 23:100585. [PMID: 32257816 PMCID: PMC7125347 DOI: 10.1016/j.ymgmr.2020.100585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Phenylketonuria (PKU) is a hereditary metabolic disease that can be diagnosed and successfully treated from birth with a lifelong phenylalanine-restricted dietary regimen. However, optimal adherence to diet remains an issue and often progressively decreases after adolescence. The study aimed to explore the experience of adults living with PKU in order to gain insights related to their adherence to diet and engagement in managing their condition. Methods The study adopted a qualitative methodology in sessions that combined specifically designed co-creation exercises with focus group discussion. Adults with early-treated classic PKU were enrolled for 2 different sessions - one for adherent and one for non-adherent patients. The verbatim notes of both sessions and focus group were analyzed using content analysis. Results Twelve adherent and nine non-adherent adults with PKU participated. Besides the behavioral dictates of following a strict diet, adherent adults reported a positive mental approach and organizational rigor; they seemed aware of the consequences of high-phenylalanine levels, reporting that it can affect mood and consequently social interactions which they value highly. In the non-adherent group, the individuals seemed to not fully accept their disease: they were aware of the consequences of non-adherence in children but not in adults, they felt the management of PKU was an individual burden and they experienced a feeling of 'diversity' in the social context (related to eating) that caused emotional distress. PKU seemed a very influential element of the identity both for adherent and non-adherent adults, but with different consequences for the two groups. Finally, all participants reported the desire to be assisted in a healthcare setting dedicated to adults. Conclusions The findings expand the understanding of the psychological experience of adult patients with PKU in relation to their disease and its dietary requirements, highlighting specific factors that might drive tailored educational or psychological intervention to improve adherence and engagement in the care process.
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Affiliation(s)
- Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Carlotta Moreschi
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Alessandra Toscano
- Atstrat, Consulting Company focused on Co-creation sessions, Patient Support Programmes Design, Via Galllarate 105, 20151 Milan, Italy
| | - Peter Comber
- Atstrat, Consulting Company focused on Co-creation sessions, Patient Support Programmes Design, Via Galllarate 105, 20151 Milan, Italy
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
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