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Ashe K, Kelso W, Farrand S, Panetta J, Fazio T, De Jong G, Walterfang M. Psychiatric and Cognitive Aspects of Phenylketonuria: The Limitations of Diet and Promise of New Treatments. Front Psychiatry 2019; 10:561. [PMID: 31551819 PMCID: PMC6748028 DOI: 10.3389/fpsyt.2019.00561] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/17/2019] [Indexed: 12/30/2022] Open
Abstract
Phenylketonuria (PKU) is a recessive disorder of phenylalanine metabolism due to mutations in the gene for phenylalanine hydroxylase (PAH). Reduced PAH activity results in significant hyperphenylalaninemia, which leads to alterations in cerebral myelin and protein synthesis, as well as reduced levels of serotonin, dopamine, and noradrenaline in the brain. When untreated, brain development is grossly disrupted and significant intellectual impairment and behavioral disturbance occur. The advent of neonatal heel prick screening has allowed for diagnosis at birth, and the institution of a phenylalanine restricted diet. Dietary treatment, particularly when maintained across neurodevelopment and well into adulthood, has resulted in markedly improved outcomes at a cognitive and psychiatric level for individuals with PKU. However, few individuals can maintain full dietary control lifelong, and even with good control, an elevated risk remains of-in particular-mood, anxiety, and attentional disorders across the lifespan. Increasingly, dietary recommendations focus on maintaining continuous dietary treatment lifelong to optimize psychiatric and cognitive outcomes, although the effect of long-term protein restricted diets on brain function remains unknown. While psychiatric illness is very common in adult PKU populations, very little data exist to guide clinicians on optimal treatment. The advent of new treatments that do not require restrictive dietary management, such as the enzyme therapy Pegvaliase, holds the promise of allowing patients a relatively normal diet alongside optimized mental health and cognitive functioning.
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Affiliation(s)
- Killian Ashe
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Julie Panetta
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tim Fazio
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Gerard De Jong
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne and North-Western Mental Health, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Teraishi T, Kajiwara M, Hori H, Sasayama D, Hidese S, Matsuo J, Ishida I, Kajiwara Y, Ozeki Y, Ota M, Hattori K, Higuchi T, Kunugi H. 13C-phenylalanine breath test and serum biopterin in schizophrenia, bipolar disorder and major depressive disorder. J Psychiatr Res 2018; 99:142-150. [PMID: 29454221 DOI: 10.1016/j.jpsychires.2018.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/23/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
Phenylalanine is required for the synthesis of the neurotransmitters dopamine, noradrenaline, and adrenaline. The rate-limiting step for phenylalanine metabolism is catalyzed by phenylalanine hydroxylase (PAH) and its cofactor tetrahydrobiopterin. We aimed to detect altered phenylalanine metabolism in major psychiatric disorders using the l-[1-13C]phenylalanine breath test (13C-PBT) and serum biopterin levels. We also investigated association of PAH mutations with schizophrenia and phenylalanine metabolism. 13C-phenylalanine (100 mg) was orally administered, and the breath 13CO2/12CO2 ratio was monitored for 120 min in four groups: 103 patients with schizophrenia (DSM-IV), 39 with bipolar disorder, 116 with major depressive disorder (MDD), and 241 healthy controls. Serum biopterin levels were measured by high performance liquid chromatography. Mutation screening of PAH exons was performed by direct sequencing in 46 schizophrenia patients. Association analysis was performed using six tag single nucleotide polymorphisms and the PAH Arg53His mutation by TaqMan assays in 616 schizophrenia patients and 1194 healthy controls. Analyses of covariance controlling for age, sex, and body weight showed that the index for the amount of exhaled 13CO2 was significantly lower in the schizophrenia group than in the other three groups (all p < 0.05). Biopterin levels in schizophrenia and MDD were significantly lower than those in controls. Biopterin levels correlated with 13C-PBT indices in controls. PAH polymorphisms were not associated with schizophrenia or 13C-PBT indices. 13C-PBT revealed reduced phenylalanine metabolism in schizophrenia, though we obtained no evidence of involvement of PAH polymorphism. Serum biopterin levels were lower in schizophrenia and MDD, warranting further investigation.
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Affiliation(s)
- Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Masahiro Kajiwara
- Yokohama University of Pharmacy, 601 Matano-cho, Totsuka-ku, Yokohama, Kanagawa, 245-0066, Japan; Tri-X Biomedical, Inc., 4-12-5-406, Minamiyawata, Ichikawa, Chiba, 272-0023, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Shinsuke Hidese
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Yasuhiro Kajiwara
- Yokohama University of Pharmacy, 601 Matano-cho, Totsuka-ku, Yokohama, Kanagawa, 245-0066, Japan
| | - Yuji Ozeki
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, 321-0293, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Teruhiko Higuchi
- National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.
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Mathai AJ, Kanwar J, Okusaga O, Fuchs D, Lowry CA, Peng X, Giegling I, Hartmann AM, Konte B, Friedl M, Gragnoli C, Reeves GM, Groer MW, Rosenthal RN, Rujescu D, Postolache TT. Blood Levels of Monoamine Precursors and Smoking in Patients with Schizophrenia. Front Public Health 2016; 4:182. [PMID: 27626030 PMCID: PMC5003942 DOI: 10.3389/fpubh.2016.00182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/15/2016] [Indexed: 01/08/2023] Open
Abstract
Smoking is highly prevalent in patients with schizophrenia and exerts a negative impact on cardiovascular mortality in these patients. Smoking has complex interactions with monoamine metabolism through the ability of cigarette smoke to suppress Type 1 T helper cell (Th1) type immunity, the immunophenotype that is implicated in phenylalanine hydroxylase (PAH) dysfunction and tryptophan (Trp) breakdown to kynurenine (Kyn) via indoleamine 2,3-dioxygenase. Nicotine also induces tyrosine hydroxylase (TH) gene expression, leading to increased synthesis of catecholamines. Furthermore, there is evidence for PAH dysfunction in schizophrenia. This study aimed to compare the plasma levels of selected monoamine precursors and their metabolites in smokers vs. non-smokers in a large sample of patients with schizophrenia. We measured plasma phenylalanine (Phe), tyrosine (Tyr), Trp, and Kyn levels using high-performance liquid chromatography and calculated Phe:Tyr and Kyn:Trp ratios in 920 patients with schizophrenia. Analysis of variance and linear regression analyses were used to compare these endpoints between three groups of patients with schizophrenia: (1) current smokers, (2) past smokers, and (3) non-smokers. There were significant differences among the three groups with regards to Tyr levels [F(2,789) = 3.77, p = 0.02], with current smokers having lower Tyr levels when compared with non-smokers (p = 0.02). Kyn levels and Kyn:Trp ratio were different among the three groups [F(2,738) = 3.17, p = 0.04, F(2,738) = 3.61, p = 0.03] with current smokers having lower Kyn levels (p = 0.04) and higher Kyn:Trp ratio (p = 0.02) when compared with past smokers. These findings need to be replicated with protocols that include healthy controls to further elucidate the neurobiological underpinnings of altered Tyr and Kyn levels in smokers. Results do suggest potential molecular links between schizophrenia and smoking that may represent biomarkers and treatment targets for reducing an important modifiable cause of general morbidity and mortality in patients with schizophrenia.
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Affiliation(s)
- Ashwin Jacob Mathai
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeths Hospital Psychiatry Residency Training Program, Washington, DC, USA
| | - Jyoti Kanwar
- Mood and Anxiety Program, University of Maryland School of Medicine , Baltimore, MD , USA
| | - Olaoluwa Okusaga
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University , Innsbruck , Austria
| | - Christopher A Lowry
- Department of Integrative Physiology, Center for Neuroscience, University of Colorado Boulder , Boulder, CO , USA
| | - Xiaoqing Peng
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeths Hospital Psychiatry Residency Training Program, Washington, DC, USA
| | - Ina Giegling
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
| | - Annette M Hartmann
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
| | - Bettina Konte
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
| | - Marion Friedl
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
| | - Claudia Gragnoli
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Gloria M Reeves
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland Child and Adolescent Mental Health Innovations Center, Baltimore, MD, USA
| | | | - Richard N Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Dan Rujescu
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
| | - Teodor T Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA; VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA; Rocky Mountain MIRECC, Denver, CO, USA
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Teraishi T, Hori H, Sasayama D, Matsuo J, Ogawa S, Ota M, Hattori K, Kajiwara M, Higuchi T, Kunugi H. (13)C-tryptophan breath test detects increased catabolic turnover of tryptophan along the kynurenine pathway in patients with major depressive disorder. Sci Rep 2015; 5:15994. [PMID: 26524975 PMCID: PMC4630584 DOI: 10.1038/srep15994] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022] Open
Abstract
Altered tryptophan-kynurenine (KYN) metabolism has been implicated in major depressive disorder (MDD). The L-[1-(13)C]tryptophan breath test ((13)C-TBT) is a noninvasive, stable-isotope tracer method in which exhaled (13)CO2 is attributable to tryptophan catabolism via the KYN pathway. We included 18 patients with MDD (DSM-IV) and 24 age- and sex-matched controls. (13)C-tryptophan (150 mg) was orally administered and the (13)CO2/(12)CO2 ratio in the breath was monitored for 180 min. The cumulative recovery rate during the 180-min test (CRR0-180; %), area under the Δ(13)CO2-time curve (AUC; %*min), and the maximal Δ(13)CO2 (Cmax; %) were significantly higher in patients with MDD than in the controls (p = 0.004, p = 0.008, and p = 0.002, respectively). Plasma tryptophan concentrations correlated negatively with Cmax in both the patients and controls (p = 0.020 and p = 0.034, respectively). Our results suggest that the (13)C-TBT could be a novel biomarker for detecting a subgroup of MDD with increased tryptophan-KYN metabolism.
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Affiliation(s)
- Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
| | - Masahiro Kajiwara
- Yokohama College of Pharmacy, 601 Matano-cho, Totsuka-ku, Yokohama, Kanagawa, 245-0066, Japan.,Tri-X Biomedical, Inc., 4-12-5-406, Minamiyawata, Ichikawa, Chiba, 272-0023, Japan
| | - Teruhiko Higuchi
- National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
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Okusaga O, Muravitskaja O, Fuchs D, Ashraf A, Hinman S, Giegling I, Hartmann AM, Konte B, Friedl M, Schiffman J, Hong E, Reeves G, Groer M, Dantzer R, Rujescu D, Postolache TT. Elevated levels of plasma phenylalanine in schizophrenia: a guanosine triphosphate cyclohydrolase-1 metabolic pathway abnormality? PLoS One 2014; 9:e85945. [PMID: 24465804 PMCID: PMC3897774 DOI: 10.1371/journal.pone.0085945] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/04/2013] [Indexed: 02/07/2023] Open
Abstract
Background Phenylalanine and tyrosine are precursor amino acids required for the synthesis of dopamine, the main neurotransmitter implicated in the neurobiology of schizophrenia. Inflammation, increasingly implicated in schizophrenia, can impair the function of the enzyme Phenylalanine hydroxylase (PAH; which catalyzes the conversion of phenylalanine to tyrosine) and thus lead to elevated phenylalanine levels and reduced tyrosine levels. This study aimed to compare phenylalanine, tyrosine, and their ratio (a proxy for PAH function) in a relatively large sample of schizophrenia patients and healthy controls. Methods We measured non-fasting plasma phenylalanine and tyrosine in 950 schizophrenia patients and 1000 healthy controls. We carried out multivariate analyses to compare log transformed phenylalanine, tyrosine, and phenylalanine:tyrosine ratio between patients and controls. Results Compared to controls, schizophrenia patients had higher phenylalanine (p<0.0001) and phenylalanine: tyrosine ratio (p<0.0001) but tyrosine did not differ between the two groups (p = 0.596). Conclusions Elevated phenylalanine and phenylalanine:tyrosine ratio in the blood of schizophrenia patients have to be replicated in longitudinal studies. The results may relate to an abnormal PAH function in schizophrenia that could become a target for novel preventative and interventional approaches.
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Affiliation(s)
- Olaoluwa Okusaga
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Olesja Muravitskaja
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University, Innsbruck, Austria
| | - Ayesha Ashraf
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sarah Hinman
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ina Giegling
- Section of Molecular and Clinical Neurobiology, Ludwig Maximilians University, Munich, Germany
| | - Annette M. Hartmann
- Section of Molecular and Clinical Neurobiology, Ludwig Maximilians University, Munich, Germany
| | - Bettina Konte
- Section of Molecular and Clinical Neurobiology, Ludwig Maximilians University, Munich, Germany
| | - Marion Friedl
- Section of Molecular and Clinical Neurobiology, Ludwig Maximilians University, Munich, Germany
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Elliot Hong
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- University of Maryland Child and Adolescent Mental Health Innovations Center, Baltimore, Maryland, United States of America
| | - Maureen Groer
- University of South Florida, Tampa, Florida, United States of America
| | - Robert Dantzer
- The University of Texas, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Dan Rujescu
- Section of Molecular and Clinical Neurobiology, Ludwig Maximilians University, Munich, Germany
- Department of Psychiatry, University of Halle-Wittenberg, Halle, Germany
| | - Teodor T. Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- University of Maryland Child and Adolescent Mental Health Innovations Center, Baltimore, Maryland, United States of America
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, United States of America
- VISN 19 MIRECC, Denver, Colorado, United States of America
- * E-mail:
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Effects of dietary nutrients on volatile breath metabolites. J Nutr Sci 2013; 2:e34. [PMID: 25191584 PMCID: PMC4153095 DOI: 10.1017/jns.2013.26] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
Breath analysis is becoming increasingly established as a means of assessing metabolic,
biochemical and physiological function in health and disease. The methods available for
these analyses exploit a variety of complex physicochemical principles, but are becoming
more easily utilised in the clinical setting. Whilst some of the factors accounting for
the biological variation in breath metabolite concentrations have been clarified, there
has been relatively little work on the dietary factors that may influence them. In
applying breath analysis to the clinical setting, it will be important to consider how
these factors may affect the interpretation of endogenous breath composition. Diet may
have complex effects on the generation of breath compounds. These effects may either be
due to a direct impact on metabolism, or because they alter the gastrointestinal flora.
Bacteria are a major source of compounds in breath, and their generation of H2,
hydrogen cyanide, aldehydes and alkanes may be an indicator of the health of their
host.
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