1
|
Christ SE, Arnold G, Lichter-Konecki U, Berry GT, Grange DK, Harding CO, Jurecki E, Levy H, Longo N, Morotti H, Sacharow S, Thomas J, White DA. Initial results from the PHEFREE longitudinal natural history study: Cross-sectional observations in a cohort of individuals with phenylalanine hydroxylase (PAH) deficiency. Mol Genet Metab 2024; 143:108541. [PMID: 39059270 DOI: 10.1016/j.ymgme.2024.108541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Over fifty years have passed since the last large scale longitudinal study of individuals with PAH deficiency in the U.S. Since then, there have been significant changes in terms of treatment recommendations as well as treatment options. The Phenylalanine Families and Researchers Exploring Evidence (PHEFREE) Consortium was recently established to collect a more up-to-date and extensive longitudinal natural history in individuals with phenylketonuria across the lifespan. In the present paper, we describe the structure and methods of the PHEFREE longitudinal study protocol and report cross-sectional data from an initial sample of 73 individuals (5 months to 54 years of age) with PAH deficiency who have enrolled. Looking forward, the study holds the promise for advancing the field on several fronts including the validation of novel neurocognitive tools for assessment in individuals with PKU as well as evaluation of the long-term effects of changes in metabolic control (e.g., effects of Phe-lowering therapies) on outcome.
Collapse
Affiliation(s)
- Shawn E Christ
- University of Missouri, Columbia, MO, United States of America
| | | | | | - Gerard T Berry
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Dorothy K Grange
- Washington University School of Medicine, St. Louis, MO, United States of America
| | - Cary O Harding
- Oregon Health & Science University, Portland, OR, United States of America.
| | - Elaina Jurecki
- National PKU Alliance, San Ramon, CA, United States of America
| | - Harvey Levy
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicola Longo
- University of Utah, Salt Lake City, UT, United States of America
| | - Hadley Morotti
- Oregon Health & Science University, Portland, OR, United States of America
| | - Stephanie Sacharow
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Janet Thomas
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Desiree A White
- Washington University in St. Louis, St. Louis, MO, United States of America
| |
Collapse
|
2
|
Mardani-Hamooleh M, Heidari H. Life story of Iranian parents of a child with phenylketonuria: a qualitative study. J Community Genet 2023; 14:419-427. [PMID: 37277551 PMCID: PMC10444926 DOI: 10.1007/s12687-023-00653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
Parents of a child with phenylketonuria (PKU) face many challenges in childcare. It is crucial for health care workers to understand the situation of parents of a child with PKU and their needs. The purpose of this study was to explore the life story of parents with a child with PKU. This qualitative study has been done with a conventional content analysis approach. Twenty-four parents were selected purposefully. A semi-structured interview was conducted. Data analysis identified three main themes, which included parental reactions, consequences of a child with PKU in parents, and parents' needs. Parents of children with PKU can be considered people at risk for mental health because of their feelings of isolation and their lonely struggle to manage the disease and its effects on their child. This study shows that mothers need more support due to the misconceptions in and attitudes of their social environment. Therefore, it is necessary to understand this group, their needs and lives, and provide further support and promote empathy in the health system for the parents.
Collapse
Affiliation(s)
- Marjan Mardani-Hamooleh
- School of Nursing and Midwifery, Department of Nursing, Iran University of Medical Sciences, Tehran, Iran
| | - Haydeh Heidari
- School of Nursing and Midwifery, Modeling in Health Research Center, Department of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| |
Collapse
|
3
|
Cunningham A, Rohr F, Splett P, Mofidi S, Bausell H, Stembridge A, Kenneson A, Singh RH. Nutrition management of PKU with pegvaliase therapy: update of the web-based PKU nutrition management guideline recommendations. Orphanet J Rare Dis 2023; 18:155. [PMID: 37349772 DOI: 10.1186/s13023-023-02751-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The web-based GMDI/SERN PKU Nutrition Management Guideline, published before approval of pegvaliase pharmacotherapy, offers guidance for nutrition management of individuals with phenylketonuria (PKU) treated with dietary therapy and/or sapropterin. An update of this guideline aims to provide recommendations that improve clinical outcomes and promote consistency and best practice in the nutrition management of individuals with PKU receiving pegvaliase therapy. Methodology includes: formulation of a research question; review, critical appraisal, and abstraction of peer-reviewed studies and unpublished practice literature; expert input through Delphi surveys and a Nominal Group process; and external review by metabolic experts. RESULTS Recommendations, summary statements, and strength of evidence are included for each of the following topics: (1) initiating a pegvaliase response trial, (2) monitoring therapy response and nutritional status, (3) managing pegvaliase treatment after response to therapy, (4) education and support for optimal nutrition with pegvaliase therapy, and (5) pegvaliase therapy during pregnancy, lactation, and adolescence. Findings, supported by evidence and consensus, provide guidance for nutrition management of individuals receiving pegvaliase therapy for PKU. Recommendations focus on nutrition management by clinicians, as well as the challenges for individuals with PKU as a result of therapy changes. CONCLUSIONS Successful pegvaliase therapy allows the possibility for individuals with PKU to consume an unrestricted diet while still maintaining the benefits of blood phenylalanine control. This necessitates a perspective change in education and support provided to individuals in order to achieve healthy nutrient intake that supports optimal nutritional status. The updated guideline, and companion Toolkit for practical implementation of recommendations, is web-based, allowing for utilization by health care providers, researchers, and collaborators who advocate and care for individuals with PKU. These guidelines are meant to be followed always taking into account the provider's clinical judgement and considering the individual's specific circumstances. Open access is available at the Genetic Metabolic Dietitians International ( https://GMDI.org ) and Southeast Regional Genetics Network ( https://managementguidelines.net ) websites.
Collapse
Affiliation(s)
- Amy Cunningham
- Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave SL-31, New Orleans, LA, USA.
| | | | | | - Shideh Mofidi
- Maria Fareri Children's Hospital/Westchester, New York Medical College, Hawthorne, NY, USA
| | - Heather Bausell
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adrya Stembridge
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Aileen Kenneson
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Rani H Singh
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| |
Collapse
|
4
|
Schwartz IVD, Quesada AA, Ribeiro EM, Martins AM, Vilela DRF, Pessoa A. Neuropsychological and quality of life outcomes in PKU patients: expert recommendations of assessment tools in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2023. [PMID: 37336507 PMCID: PMC10371414 DOI: 10.1055/s-0043-1768677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Phenylketonuria (PKU) is an inborn error of metabolism caused by deficient activity of phenylalanine hydroxylase. In Brazil, the National Neonatal Screening Program enables early treatment of patients with PKU, which prevents them from developing severe neurological damage and mental disabilities. However, between 20 and 30% of early-treated patients with PKU present focal cognitive deficits, including deficits in working memory, processing speed, and psychiatric symptoms such as anxiety, depression, and attention deficit hyperactivity disorder (ADHD). Therefore, age-specific neuropsychiatric and cognitive tests are important components of PKU patient care. To date, there are no officially approved guidelines or recommendations of tools in Portuguese validated for use in Brazil that could be applied to assess these parameters in patients with PKU. OBJECTIVE To recommend tools validated for use in Brazil that can be used in daily clinical practice to assess quality of life and neuropsychological outcomes in patients with PKU. METHODS Six Brazilian experts discussed about eligible tools based on their clinical experience, the feasibility of their use in clinical routines, and their availability in public health services. Before the meeting, an independent review of the literature was conducted to identify the currently validated tools in Brazil, using the MEDLINE and SciELO databases. RESULTS The experts recommended nine tools to assess quality of life (Peds-QL, SF-36 or WHOQOL-bref), executive function (BRIEF or Bayley-III), IQ (SONR 2½-7[a] or WASI) and ADHD (MTA-SNAP-IV and ASRS). CONCLUSION These instruments may be easily incorporated into clinical practice and improve the quality of multidisciplinary care of patients with PKU.
Collapse
Affiliation(s)
- Ida Vanessa Doederlein Schwartz
- Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil
| | | | | | | | | | - André Pessoa
- Hospital Albert Sabin, Fortaleza CE, Brazil
- Universidade Estadual do Ceará, Fortaleza CE, Brazil
| |
Collapse
|
5
|
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.
Collapse
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
Collapse
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
| |
Collapse
|
6
|
Rocha JC, Bausell H, Bélanger-Quintana A, Bernstein L, Gökmen-Özel H, Jung A, MacDonald A, Rohr F, van Dam E, Heddrich-Ellerbrok M. Development of a practical dietitian road map for the nutritional management of phenylketonuria (PKU) patients on pegvaliase. Mol Genet Metab Rep 2021; 28:100771. [PMID: 34094869 PMCID: PMC8167196 DOI: 10.1016/j.ymgmr.2021.100771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background The metabolic dietitian/nutritionist (hereafter 'dietitian') plays an essential role in the nutritional management of patients with phenylketonuria (PKU), including those on pegvaliase. Currently, more educational support and clinical experience is needed to ensure that dietitians are prepared to provide optimal nutritional management and counselling of pegvaliase-treated patients. Methods Via a face-to-face data-review meeting, followed by a virtual consolidation meeting, a group of expert dietitians and one paediatrician discussed and developed a series of recommendations on the nutritional evaluation and management of patients receiving pegvaliase. The consensus group consisted of 10 PKU experts: six dietitians and one paediatrician from Europe and three dietitians from the US. One European and three US dietitians had experience with pegvaliase-treated patients. Results The consensus group recommended that a physician, dietitian and nurse are part of the pegvaliase treatment team. Additionally, a psychologist/counsellor should be included if available. Practical proposals for the nutritional evaluation of pegvaliase-treated patients at baseline, during the induction and titration phases and for long-term maintenance were developed. The consensus group suggested assessment of blood Phe at least monthly or every 2 weeks in the event of low blood Phe (i.e., blood Phe <30 μmol/L). It may be appropriate to increase blood Phe monitoring when adjusting protein intake and/or pegvaliase dose. It was recommended that natural protein intake is increased by 10-20 g increments if blood Phe concentrations decrease to <240 μmol/L in patients who are not meeting the dietary reference intake for natural protein of 0.8 g/kg. It was proposed that with pegvaliase treatment blood Phe levels could be maintained <240 μmol/L but more evidence on the safety of achieving physiological blood Phe levels is necessary before any recommendation on the lower blood Phe target can be given. Finally, both patients and dietitians should have access to educational resources to optimally support patients receiving pegvaliase. Conclusion This practical road map aims to provide initial recommendations for dietitians monitoring patients with PKU prescribed pegvaliase. Given that practical experience with pegvaliase is still limited, nutritional recommendations will require regular updating once more evidence is available and clinical experience evolves.
Collapse
Affiliation(s)
- Júlio César Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculty of Medical Sciences, University of Lisbon, Lisbon, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Heather Bausell
- Division of Clinical Nutrition & Genetics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Laurie Bernstein
- Department of Pediatrics Section of Clinical Genetics and Metabolism, Aurora, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Hülya Gökmen-Özel
- Nutrition and Dietetics Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Alexandra Jung
- Competence Center for Rare Metabolic Diseases, Charité – University Hospital Berlin, Berlin, Germany
| | - Anita MacDonald
- Department of Dietetics, Birmingham Women's and Children's Hospital, Birmingham, UK
| | | | - Esther van Dam
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | | |
Collapse
|
7
|
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.
Collapse
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
Collapse
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
| |
Collapse
|
8
|
Vicente F, Jurecki E, Giovannetti D, Ferreira AR, Leite E, Giugliani L, Acquadro C. Linguistic Validation of the Phenylketonuria - Quality of Life (PKU-QOL) Questionnaire Into Brazilian Portuguese. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2019. [DOI: 10.1590/2326-4594-jiems-2018-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|