1
|
Russo GL, Puleo S, Cavella S, Scala I, Fidaleo M, Di Monaco R. Advancements in food science for Phenylketonuria (PKU) management: a comprehensive review. Crit Rev Food Sci Nutr 2024:1-15. [PMID: 38818634 DOI: 10.1080/10408398.2024.2360075] [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: 06/01/2024]
Abstract
This review systematically explores the pivotal role of food science and technology as a support for Phenylketonuria (PKU) dietary management. It delves into the genetic and metabolic underpinnings of PKU, highlighting the crucial need for stringent dietary regulation to manage phenylalanine levels and mitigate neurological complications. Through bibliometric analysis and current product evaluations, it identifies trends in PKU food research, emphasizing recent innovations in food formulations such as glycomacropeptide (GMP) supplements and higher appealing low-phenylalanine food products. Furthermore, it accentuates the sensory and consumer aspects of PKU dietary solutions, underscoring the importance of palatability for adherence. Notably, the review introduces 3D food printing as an emerging technology for creating personalized, nutrient-optimized, and sensory-appealing foods for PKU patients, offering a new horizon in dietary management. This comprehensive assessment underscores the dynamic interplay between nutritional science, food technology, and sensory evaluation in improving the quality of life for individuals with PKU.
Collapse
Affiliation(s)
- Giovanni Luca Russo
- Department of Agricultural Sciences, Unit of Food Science and Technology, University of Naples Federico II, Portici, Italy
| | - Sharon Puleo
- Department of Agricultural Sciences, Unit of Food Science and Technology, University of Naples Federico II, Portici, Italy
| | - Silvana Cavella
- Department of Agricultural Sciences, Unit of Food Science and Technology, University of Naples Federico II, Portici, Italy
| | - Iris Scala
- Department of Maternal and Child Health, Federico II University Hospital, Naples, Italy
| | - Marcello Fidaleo
- Department for Innovation in Biological, Agro-Food, and Forest Systems, University of Tuscia, Viterbo, Italy
| | - Rossella Di Monaco
- Department of Agricultural Sciences, Unit of Food Science and Technology, University of Naples Federico II, Portici, Italy
| |
Collapse
|
2
|
Pinto A, Daly A, Rocha JC, Ashmore C, Evans S, Ilgaz F, Hickson M, MacDonald A. Natural Protein Intake in Children with Phenylketonuria: Prescription vs. Actual Intakes. Nutrients 2023; 15:4903. [PMID: 38068761 PMCID: PMC10708375 DOI: 10.3390/nu15234903] [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: 10/26/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
In phenylketonuria (PKU), an important component of the UK dietary management system is a 50 mg phenylalanine (Phe)/1 g protein exchange system used to allocate the Phe/natural protein intakes according to individual patient tolerance. Any foods containing protein ≤ 0.5 g/100 g or fruits/vegetables containing Phe ≤ 75 mg/100 g are allowed without measurement or limit. In children with PKU, we aimed to assess the difference between the prescribed natural protein intake and their actual consumed intake, and to calculate the natural protein/Phe intake from foods given without measurement or restriction. Over a 6-month duration, three one-day diet diaries were collected every month by caregivers of children with PKU at the beginning of a follow-up study. Dietary intakes of Phe, as well as natural and total protein intakes, were calculated using Nutritics® (v5.09). Weekly blood Phe spots were collected by caregivers. The target blood Phe level was ≤360 μmol/L for ages up to 12 years and ≤600 μmol/L for ages ≥12 years. Sixteen early treated children (69% females) with PKU were recruited. The median age was 11 years (range: 9-13), and most had classical PKU (n = 14/16). A median of 18 (range 12-18) one-day diaries and 22 blood spots were analysed for each subject over 6 months. The median prescribed natural protein was 6 g/day (range: 3-27), but when calculated, the actual median intake from all foods consumed was 10 g/day (range: 4-37). The median prescribed Phe was 300 mg/day (range: 150-1350), but the actual median intake was 500 mg/day (range: 200-1850). The median difference between the prescribed and actual natural protein daily intakes was +4 g/day (range: -2.5 to +11.5), with a median percentage increase of 40% for natural protein/Phe intake (p < 0.001). The median blood Phe level was 250 μmol/L (range 20-750), with 91% of blood Phe levels within the target range. Only one patient (11 years) had less than 75% of their blood Phe levels within the target range. The UK Phe exchange system provides flexibility in the dietary management of PKU. With this method, the actual natural protein intake was 167% higher than the prescribed amount. Although this led to a variable daily protein intake, the majority of children (n = 15/16) experienced no deterioration in their metabolic control.
Collapse
Affiliation(s)
- Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
- Plymouth Institute of Health and Care Research, Faculty of Health, University of Plymouth, Plymouth PL6 8BH, UK;
| | - Anne Daly
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
| | - Júlio César Rocha
- Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal;
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, (FCM), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitario de Lisboa Central, 1169-045 Lisboa, Portugal
| | - Catherine Ashmore
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
| | - Fatma Ilgaz
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, 06100 Ankara, Turkey
| | - Mary Hickson
- Plymouth Institute of Health and Care Research, Faculty of Health, University of Plymouth, Plymouth PL6 8BH, UK;
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (C.A.); (S.E.); (F.I.); (A.M.)
- Plymouth Institute of Health and Care Research, Faculty of Health, University of Plymouth, Plymouth PL6 8BH, UK;
| |
Collapse
|
3
|
Adams AD, Fiesco-Roa MÓ, Wong L, Jenkins GP, Malinowski J, Demarest OM, Rothberg PG, Hobert JA. Phenylalanine hydroxylase deficiency treatment and management: A systematic evidence review of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100358. [PMID: 37470789 DOI: 10.1016/j.gim.2022.12.005] [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: 12/05/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Elevated serum phenylalanine (Phe) levels due to biallelic pathogenic variants in phenylalanine hydroxylase (PAH) may cause neurodevelopmental disorders or birth defects from maternal phenylketonuria. New Phe reduction treatments have been approved in the last decade, but uncertainty on the optimal lifespan goal Phe levels for patients with PAH deficiency remains. METHODS We searched Medline and Embase for evidence of treatment concerning PAH deficiency up to September 28, 2021. Risk of bias was evaluated based on study design. Random-effects meta-analyses were performed to compare IQ, gestational outcomes, and offspring outcomes based on Phe ≤ 360 μmol/L vs > 360 μmol/L and reported as odds ratio and 95% CI. Remaining results were narratively synthesized. RESULTS A total of 350 studies were included. Risk of bias was moderate. Lower Phe was consistently associated with better outcomes. Achieving Phe ≤ 360 μmol/L before conception substantially lowered the risk of negative effect to offspring in pregnant individuals (odds ratio = 0.07, 95% CI = 0.04-0.14; P < .0001). Adverse events due to pharmacologic treatment were common, but medication reduced Phe levels, enabling dietary liberalization. CONCLUSIONS Reduction of Phe levels to ≤360 μmol/L through diet or medication represents effective interventions to treat PAH deficiency.
Collapse
Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Division of Maternal-Fetal Medicine, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Moisés Ó Fiesco-Roa
- Programa de Maestría y Doctorado en Ciencias Médicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico; Laboratorio de Citogenética, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | | | | | | | - Paul G Rothberg
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Judith A Hobert
- University of Utah School of Medicine, Salt Lake City, UT; ARUP Laboratories, Salt Lake City, UT
| |
Collapse
|
4
|
Delsoglio M, Capener R, MacDonald A, Daly A, Ashmore C, Ellerton C, Donald S, Gaff L, VanDorp L, Skeath R, Newby C, Dunning G, Dale C, Hunjan I, White L, Allen H, Hubbard GP, Stratton RJ. Evaluation of a New Glycomacropeptide-Based Protein Substitute in Powdered and Liquid Format in Patients with PKU. Nutrients 2023; 15:3580. [PMID: 37630769 PMCID: PMC10459497 DOI: 10.3390/nu15163580] [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: 06/23/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Good adherence to a Phe-restricted diet supplemented with an adequate amount of a protein substitute (PS) is important for good clinical outcomes in PKU. Glycomacropeptide (cGMP)-PSs are innovative, palatable alternatives to amino acid-based PSs (AA-PS). This study aimed to evaluate a new cGMP-PS in liquid and powder formats in PKU. (2) Methods: Children and adults with PKU recruited from eight centres were prescribed at least one serving/day of cGMP-PS for 7-28 days. Adherence, acceptability, and gastrointestinal tolerance were recorded at baseline and the end of the intervention. The blood Phe levels reported as part of routine care during the intervention were recorded. (3) Results: In total, 23 patients (powder group, n = 13; liquid group, n = 10) completed the study. The majority assessed the products to be palatable (77% of powder group; 100% of liquid group) and well tolerated; the adherence to the product prescription was good. A total of 14 patients provided blood Phe results during the intervention, which were within the target therapeutic range for most patients (n = 11) at baseline and during the intervention. (4) Conclusions: These new cGMP-PSs were well accepted and tolerated, and their use did not adversely affect blood Phe control.
Collapse
Affiliation(s)
- Marta Delsoglio
- Research and Innovation, Nutricia Ltd., White Horse Business Park, Trowbridge BA14 0XQ, UK
| | - Rebecca Capener
- Research and Innovation, Nutricia Ltd., White Horse Business Park, Trowbridge BA14 0XQ, UK
| | - Anita MacDonald
- Dietetic Department, Birmingham Children’s Hospital, Birmingham B4 6NH, UK
| | - Anne Daly
- Dietetic Department, Birmingham Children’s Hospital, Birmingham B4 6NH, UK
| | - Catherine Ashmore
- Dietetic Department, Birmingham Children’s Hospital, Birmingham B4 6NH, UK
| | - Charlotte Ellerton
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Sarah Donald
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Lisa Gaff
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Louise VanDorp
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Camille Newby
- Bristol University Hospitals NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Georgina Dunning
- Bristol University Hospitals NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Clare Dale
- Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - Inderdip Hunjan
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD5 0NA, UK
| | - Lucy White
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Heather Allen
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Gary P. Hubbard
- Research and Innovation, Nutricia Ltd., White Horse Business Park, Trowbridge BA14 0XQ, UK
| | - Rebecca J. Stratton
- Research and Innovation, Nutricia Ltd., White Horse Business Park, Trowbridge BA14 0XQ, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| |
Collapse
|
5
|
Mele S, Martelli F, Lin J, Kanca O, Christodoulou J, Bellen HJ, Piper MDW, Johnson TK. Drosophila as a diet discovery tool for treating amino acid disorders. Trends Endocrinol Metab 2023; 34:85-105. [PMID: 36567227 DOI: 10.1016/j.tem.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Amino acid disorders (AADs) are a large group of rare inherited conditions that collectively impact one in 6500 live births, often resulting in rapid neurological decline and death during infancy. For several AADs, including phenylketonuria, dietary modification prevents physiological deterioration and ameliorates symptoms. Despite this remarkable potential for treatment success, dietary therapy for most AADs remains largely unexplored. Although animal models have provided novel insights into AAD mechanisms, few have been used for therapeutic diet discovery. Here, we find that of all the animal models, Drosophila is particularly well suited for nutrigenomic disease modelling, having amino acid pathways conserved with humans, exceptional genetic tractability, and the unique availability of a synthetic customisable diet.
Collapse
Affiliation(s)
- Sarah Mele
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Felipe Martelli
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Jiayi Lin
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Duncan Neurological Research Institute of Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - John Christodoulou
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria 3052, Australia
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Duncan Neurological Research Institute of Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Matthew D W Piper
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia.
| | - Travis K Johnson
- School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia.
| |
Collapse
|
6
|
Glycomacropeptide in PKU-Does It Live Up to Its Potential? Nutrients 2022; 14:nu14040807. [PMID: 35215457 PMCID: PMC8875363 DOI: 10.3390/nu14040807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
The use of casein glycomacropeptide (CGMP) as a protein substitute in phenylketonuria (PKU) has grown in popularity. CGMP is derived from κ casein and is a sialic-rich glycophosphopeptide, formed by the action of chymosin during the production of cheese. It comprises 20–25% of total protein in whey products and has key biomodulatory properties. In PKU, the amino acid sequence of CGMP has been adapted by adding the amino acids histidine, leucine, methionine, tyrosine and tryptophan naturally low in CGMP. The use of CGMP compared to mono amino acids (L-AAs) as a protein substitute in the treatment of PKU promises several potential clinical benefits, although any advantage is supported only by evidence from non-PKU conditions or PKU animal models. This review examines if there is sufficient evidence to support the bioactive properties of CGMP leading to physiological benefits when compared to L-AAs in PKU, with a focus on blood phenylalanine control and stability, body composition, growth, bone density, breath odour and palatability.
Collapse
|
7
|
Zhao M, He H, Ma A, Hou T. Sources, chemical synthesis, functional improvement and applications of food-derived protein/peptide-saccharide covalent conjugates: a review. Crit Rev Food Sci Nutr 2022; 63:5985-6004. [PMID: 35089848 DOI: 10.1080/10408398.2022.2026872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Proteins/peptides and saccharides are two kinds of bioactive substances in nature. Recently, increasing attention has been paid in understanding and utilizing covalent interactions between proteins/peptides and saccharides. The products obtained through covalent conjugation of proteins/peptides to saccharides are shown to have enhanced functional attributes, such as better gelling property, thermostability, and water-holding capacity. Additionally, food-derived protein/peptide-saccharide covalent conjugates (PSCCs) also have biological activities, such as antibacterial, antidiabetic, anti-osteoporosis, anti-inflammatory, anti-cancer, immune regulatory, and other activities that are widely used in the functional food industry. Moreover, PSCCs can be used as packaging or delivery materials to improve the bioavailability of bioactive substances, which expands the development of food-derived protein and saccharide resources. Thus, this review was aimed to first summarize the current status of sources, classification structures of natural PSCCs. Second, the methods of chemical synthesis, reaction conditions, characterization and reagent formulations that improve the desired functional characteristics of food-derived PSCCs were introduced. Third, functional properties such as emulsion, edible films/coatings, and delivery of active substance, bio-activities such as antioxidant, anti-osteoporosis, antidiabetic, antimicrobial of food-derived PSCCs were extensively discussed.
Collapse
Affiliation(s)
- Mengge Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Ministry of Education, Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Wuhan, China
| | - Hui He
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Ministry of Education, Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Wuhan, China
| | - Aimin Ma
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Ministry of Education, Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Wuhan, China
| | - Tao Hou
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Ministry of Education, Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Wuhan, China
| |
Collapse
|
8
|
Lim JY, Amit N, Ali NM, Leong HY, Mohamad M, Rajikan R. Effect of nutritional intervention on nutritional status among children with disorders of amino acid and nitrogen metabolism (AANMDs): A scoping review. Intractable Rare Dis Res 2021; 10:246-256. [PMID: 34877236 PMCID: PMC8630465 DOI: 10.5582/irdr.2021.01124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Disorders of amino acid and nitrogen metabolism (AANMDs) occur due to an enzyme deficiency in a normal biochemical pathway. Nutritional intervention is recognized as the mainstay of treatment for children diagnosed with AANMD. Hence, this scoping review aimed to identify the nutritional interventions available in managing AANMD disorders and their effects on nutritional status. A systematic search using PRISMA Extension for Scoping Reviews (PRISMA-ScR) method was conducted across 4 databases: PubMed, ScienceDirect (Elsevier), EBSCOhost and Cochrane Central Register of Controlled Trials (CENTRAL). Inclusion criteria for the study to be selected are: subjects aged less than 18-year-old, article published in English, utilized an experimental design and published within the past 20 years. A total of 22 articles were included in this review. The majority of the subjects are boys (55.6%) and employed a randomized controlled trial (RCT) study design (45.4%). Nutritional interventions were categorized into 4 categories which are: "protein substitute" (n = 5), "protein substitute with modified composition" (n = 6), "nutrient supplementation (n=8)", and "distribution and dosage of protein substitute (n = 3)". The most frequently assessed outcomes were biochemical parameters that gauge the effectiveness of metabolic control (68.2%). Overall, "protein substitute enriched with inhibitive amino acids", "long-chain polyunsaturated fatty acids supplementation", and "evenly distributed protein substitute" demonstrated beneficial effects towards the nutritional status, especially in terms of biochemical parameters. In summary, nutritional intervention plays a significant role in improving the nutritional status of AANMD patients. Further investigations of nutritional intervention among AANMD children using a meta-analysis approach are necessary for better comprehension of their impact in management of AANMD disorders.
Collapse
Affiliation(s)
- Jing Ying Lim
- Dietetics Program & Centre of Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noh Amit
- Clinical Psychology and Behavioural Health Program & Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazlena Mohamad Ali
- Institute of IR4.0 (IIR4.0), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Huey Yin Leong
- Genetics Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Maslina Mohamad
- Dietetics & Food Service Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Roslee Rajikan
- Dietetics Program & Centre of Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
9
|
Pena MJ, Costa R, Rodrigues I, Martins S, Guimarães JT, Faria A, Calhau C, Rocha JC, Borges N. Unveiling the Metabolic Effects of Glycomacropeptide. Int J Mol Sci 2021; 22:ijms22189731. [PMID: 34575895 PMCID: PMC8470927 DOI: 10.3390/ijms22189731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
For many years, the main nitrogen source for patients with phenylketonuria (PKU) was phenylalanine-free amino acid supplements. Recently, casein glycomacropeptide (GMP) supplements have been prescribed due to its functional and sensorial properties. Nevertheless, many doubts still persist about the metabolic effects of GMP compared to free amino acids (fAA) and intact proteins such as casein (CAS). We endeavour to compare, in rats, the metabolic effects of different nitrogen sources. Twenty-four male Wistar rats were fed equal energy density diets plus CAS (control, n = 8), fAA (n = 8) or GMP (n = 8) for 8 weeks. Food, liquid intake and body weight were measured weekly. Blood biochemical parameters and markers of glycidic metabolism were assessed. Glucagon-like peptide-1 (GLP-1) was analysed by ELISA and immunohistochemistry. Food intake was higher in rats fed CAS compared to fAA or GMP throughout the treatment period. Fluid intake was similar between rats fed fAA and GMP. Body weight was systematically lower in rats fed fAA and GMP compared to those fed CAS, and still, from week 4 onwards, there were differences between fAA and GMP. None of the treatments appeared to induce consistent changes in glycaemia, while insulin levels were significantly higher in GMP. Likewise, the production of GLP-1 was higher in rats fed GMP when compared to fAA. Decreased urea, total protein and triglycerides were seen both in fAA and GMP related to CAS. GMP also reduced albumin and triglycerides in comparison to CAS and fAA, respectively. The chronic consumption of the diets triggers different metabolic responses which may provide clues to further study potential underlying mechanisms.
Collapse
Affiliation(s)
- Maria João Pena
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (M.J.P.); (R.C.); (I.R.); (J.T.G.)
| | - Raquel Costa
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (M.J.P.); (R.C.); (I.R.); (J.T.G.)
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Ilda Rodrigues
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (M.J.P.); (R.C.); (I.R.); (J.T.G.)
| | - Sandra Martins
- Department of Clinical Pathology, São João Hospital Centre, 4200-319 Porto, Portugal;
- Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - João Tiago Guimarães
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; (M.J.P.); (R.C.); (I.R.); (J.T.G.)
- Department of Clinical Pathology, São João Hospital Centre, 4200-319 Porto, Portugal;
- Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Ana Faria
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (A.F.); (C.C.); (J.C.R.)
- CINTESIS—Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (A.F.); (C.C.); (J.C.R.)
- CINTESIS—Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
- Unidade Universitária Lifestyle Medicine da José de Mello Saúde by NOVA Medical School, 1169-056 Lisboa, Portugal
| | - Júlio César Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (A.F.); (C.C.); (J.C.R.)
- CINTESIS—Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisboa, Portugal
| | - Nuno Borges
- CINTESIS—Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
- Correspondence:
| |
Collapse
|
10
|
Kanufre V, Almeida MF, Barbosa CS, Carmona C, Bandeira A, Martins E, Rocha S, Guimas A, Ribeiro R, MacDonald A, Pinto A, Rocha JC. Metabolic Control of Patients with Phenylketonuria in a Portuguese Metabolic Centre Comparing Three Different Recommendations. Nutrients 2021; 13:3118. [PMID: 34578995 PMCID: PMC8469656 DOI: 10.3390/nu13093118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Blood phenylalanine (Phe) is used as the primary marker to evaluate metabolic control. Our study aimed to describe the metabolic control of patients with phenylketonuria (PKU) comparing three different treatment recommendations (European guidelines/US guidelines/Portuguese consensus). This was a retrospective, observational, single centre study in patients with PKU collecting data on blood Phe levels from 2017. Nutritional intake data and sapropterin (BH4) prescription were collected at the last appointment of 2017. The final sample studied included 87 patients (48% females) [13 hyperphenylalaninemia; 47 mild PKU; 27 classical PKU] with a median age of 18 y (range: 1-36 y). The median number of blood Phe measurements for patients was 21 (range: 6-89). In patients aged < 12 y, the median blood Phe level was 300 μmol/L (range 168-480) and 474 μmol/L (range 156-1194) for patients ≥ 12 y. Overall, a median of 83% of blood Phe levels were within the European PKU guidelines target range. In patients aged ≥ 12 years, there was a higher median % of blood Phe levels within the European PKU guidelines target range (≥12 y: 84% vs. <12 y: 56%). In children < 12 y with classical PKU (n = 2), only 34% of blood Phe levels were within target range for all 3 guidelines and 49% with mild PKU (n = 11). Girls had better control than boys (89% vs. 66% median Phe levels within European Guidelines). Although it is clear that 50% or more patients were unable to achieve acceptable metabolic control on current treatment options, a globally agreed upper Phe target associated with optimal outcomes for age groups is necessary. More studies need to examine how clinics with dissimilar resources, different therapeutic Phe targets and frequency of monitoring relate to metabolic control.
Collapse
Affiliation(s)
- Viviane Kanufre
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), School of Medicine, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Belo Horizonte 30130-100, Brazil
- Hospital das Clínicas, UFMG, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, Brazil
| | - Manuela Ferreira Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Catarina Sousa Barbosa
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Carla Carmona
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Anabela Bandeira
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Esmeralda Martins
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Sara Rocha
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Arlindo Guimas
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Rosa Ribeiro
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.M.); (A.P.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.M.); (A.P.)
| | - Júlio César Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal
- Centre for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
| |
Collapse
|
11
|
Pena MJ, Pinto A, de Almeida MF, de Sousa Barbosa C, Ramos PC, Rocha S, Guimas A, Ribeiro R, Martins E, Bandeira A, Dias CC, MacDonald A, Borges N, Rocha JC. Continuous use of glycomacropeptide in the nutritional management of patients with phenylketonuria: a clinical perspective. Orphanet J Rare Dis 2021; 16:84. [PMID: 33581730 PMCID: PMC7881530 DOI: 10.1186/s13023-021-01721-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background In phenylketonuria (PKU), modified casein glycomacropeptide supplements (CGMP-AA) are used as an alternative to the traditional phenylalanine (Phe)-free L-amino acid supplements (L-AA). However, studies focusing on the long-term nutritional status of CGMP-AA are lacking. This retrospective study evaluated the long-term impact of CGMP-AA over a mean of 29 months in 11 patients with a mean age at CGMP-AA onset of 28 years (range 15–43) [8 females; 2 hyperphenylalaninaemia (HPA), 3 mild PKU, 3 classical PKU and 3 late-diagnosed]. Outcome measures included metabolic control, anthropometry, body composition and biochemical parameters. Results CGMP-AA, providing 66% of protein equivalent intake from protein substitute, was associated with no significant change in blood Phe with CGMP-AA compared with baseline (562 ± 289 µmol/L vs 628 ± 317 µmol/L; p = 0.065). In contrast, blood tyrosine significantly increased on CGMP-AA (52.0 ± 19.2 μmol/L vs 61.4 ± 23.8 μmol/L; p = 0.027). Conclusions Biochemical nutritional markers remained unchanged which is an encouraging finding in adults with PKU, many of whom are unable to maintain full adherence with nutritionally fortified protein substitutes. Longitudinal, prospective studies with larger sample sizes are necessary to fully understand the metabolic impact of using CGMP-AA in PKU.
Collapse
Affiliation(s)
- Maria João Pena
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal
| | - Alex Pinto
- Department of Dietetics, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.,Faculty of Health and Human Sciences, University of Plymouth, Plymouth, PL6 8BH, UK
| | - Manuela Ferreira de Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário Do Porto (CHUP), 4099-028, Porto, Portugal.,Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal.,UMIB/ICBAS/UP), Unit for Multidisplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313, Porto, Portugal
| | - Catarina de Sousa Barbosa
- Centro de Genética Médica, Centro Hospitalar Universitário Do Porto (CHUP), 4099-028, Porto, Portugal.,Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal
| | - Paula Cristina Ramos
- Centro de Genética Médica, Centro Hospitalar Universitário Do Porto (CHUP), 4099-028, Porto, Portugal.,Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal
| | - Sara Rocha
- Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal
| | - Arlindo Guimas
- Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal
| | - Rosa Ribeiro
- Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal.,UMIB/ICBAS/UP), Unit for Multidisplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313, Porto, Portugal
| | - Esmeralda Martins
- Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal.,UMIB/ICBAS/UP), Unit for Multidisplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313, Porto, Portugal
| | - Anabela Bandeira
- Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), 4200-450, Porto, Portugal.,Department of Community Medicine, Information and Health Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
| | - Anita MacDonald
- Department of Dietetics, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Nuno Borges
- Center for Health Technology and Services Research (CINTESIS), 4200-450, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180, Porto, Portugal
| | - Júlio César Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário Do Porto (CHUP), 4099-028, Porto, Portugal. .,Centro de Referência na área das Doenças Hereditárias do Metabolismo, CHUP, 4099-001, Porto, Portugal. .,Center for Health Technology and Services Research (CINTESIS), 4200-450, Porto, Portugal. .,Nutrition and Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056, Lisbon, Portugal.
| |
Collapse
|
12
|
Casein glycomacropeptide is well tolerated in healthy adults and changes neither high-sensitive C-reactive protein, gut microbiota nor faecal butyrate: a restricted randomised trial. Br J Nutr 2020; 125:1374-1385. [PMID: 32967742 DOI: 10.1017/s0007114520003736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Casein glycomacropeptide (CGMP) is a bioactive milk-derived peptide with potential anti-inflammatory effects. Animal studies suggest that CGMP may work by altering gut microbiota composition and enhancing butyrate production. Its effects on intestinal homoeostasis, microbiota and metabolites in humans are unknown. The aim of the present study was to assess both the intestinal and systemic immunomodulatory effects of orally ingested CGMP. We hypothesised that daily oral CGMP intake would reduce high-sensitive C-reactive protein (hsCRP) in healthy adults. In a single-centre limited but randomised, double-blinded, reference-controlled study, we compared the effects of a 4-week intervention of either 25 g of oral powder-based chocolate-flavoured CGMP or a reference drink. We included twenty-four healthy adults who all completed the study. CGMP had no systemic or intestinal immunomodulatory effects compared with a reference drink, with regard to either hsCRP or faecal calprotectin level, faecal microbiota composition or faecal SCFA content. CGMP ingestion did not affect satiety or body weight, and it caused no severe adverse events. The palatability of CGMP was acceptable, and adherence was high. CGMP did not induce or change gastrointestinal symptoms. In conclusion, we found no immunomodulatory effects of CGMP in healthy adults. In a minor group of healthy adults, oral ingestion of 25 g of CGMP during 4 weeks was safe, well tolerated, had acceptable palatability and was without any effects on body weight.
Collapse
|
13
|
Wiedemann A, Oussalah A, Jeannesson É, Guéant JL, Feillet F. [Phenylketonuria, from diet to gene therapy]. Med Sci (Paris) 2020; 36:725-734. [PMID: 32821049 DOI: 10.1051/medsci/2020127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The prognosis for phenylketonuria (PKU) has been improved by neonatal screening and dietary management via a low-phenylalanine diet. This treatment must be followed throughout life, which induces severe compliance problems. Drug treatment with sapropterin (or BH4) has come to help a reduced percentage of patients who respond to this drug. A subcutaneous enzyme therapy is available in the USA and has obtained European marketing authorization, but generates significant side effects, which limits its effectiveness. New therapeutic options for PKU are currently being developed, in particular gene therapy. The purpose of this article is to take stock of the pathophysiology and the various new therapeutic modalities currently in development.
Collapse
Affiliation(s)
- Arnaud Wiedemann
- Centre de référence des maladies métaboliques, Service de pédiatrie, CHRU de Nancy, 54000 Nancy, France - Inserm UMR_S 1256 (NGERE, Nutrition Génétique et Exposition aux Risques Environnementaux), Faculté de médecine de Nancy, Université de Lorraine, 54000 Nancy, France
| | - Abderrahim Oussalah
- Inserm UMR_S 1256 (NGERE, Nutrition Génétique et Exposition aux Risques Environnementaux), Faculté de médecine de Nancy, Université de Lorraine, 54000 Nancy, France - Département de médecine moléculaire, Laboratoire de biochimie et de biologie moléculaire nutrition, CHRU de Nancy, 54000 France
| | - Élise Jeannesson
- Inserm UMR_S 1256 (NGERE, Nutrition Génétique et Exposition aux Risques Environnementaux), Faculté de médecine de Nancy, Université de Lorraine, 54000 Nancy, France - Département de médecine moléculaire, Laboratoire de biochimie et de biologie moléculaire nutrition, CHRU de Nancy, 54000 France
| | - Jean-Louis Guéant
- Inserm UMR_S 1256 (NGERE, Nutrition Génétique et Exposition aux Risques Environnementaux), Faculté de médecine de Nancy, Université de Lorraine, 54000 Nancy, France - Département de médecine moléculaire, Laboratoire de biochimie et de biologie moléculaire nutrition, CHRU de Nancy, 54000 France
| | - François Feillet
- Centre de référence des maladies métaboliques, Service de pédiatrie, CHRU de Nancy, 54000 Nancy, France - Inserm UMR_S 1256 (NGERE, Nutrition Génétique et Exposition aux Risques Environnementaux), Faculté de médecine de Nancy, Université de Lorraine, 54000 Nancy, France
| |
Collapse
|
14
|
Rocha JC, Calhau C, MacDonald A. Reply to Jakovac; Severity of COVID-19 infection in patients with phenylketonuria: is vitamin D status protective? Am J Physiol Endocrinol Metab 2020; 318:E890-E891. [PMID: 32479158 PMCID: PMC7276976 DOI: 10.1152/ajpendo.00195.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Júlio César Rocha
- Nutrition & Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Conceição Calhau
- Nutrition & Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Anita MacDonald
- Department of Dietetics, Birmingham Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
15
|
Douglas TD, Nucci AM, Berry AM, Henes ST, Singh RH. Large neutral amino acid status in association with P:T ratio and diet in adult and pediatric patients with phenylketonuria. JIMD Rep 2019; 50:50-59. [PMID: 31741827 PMCID: PMC6850973 DOI: 10.1002/jmd2.12076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Intake of large neutral amino acids (LNAA) may inhibit phenylalanine (PHE) transport across the blood brain barrier and assist with blood PHE control in patients with phenylketonuria (PKU). We evaluated the interrelationship between LNAA in plasma and diet on Phe:Tyr (P:T) ratio in patients with PKU and the influence of dietary factors on plasma LNAA markers. METHODS Plasma amino acid values and 3-day food record analysis from two studies (34 male/30 female; age 4.6-47 years) were examined. For pediatrics (<18 years) and adults (≥18 years) the relationship between P:T ratio, plasma LNAA, and dietary intake patterns were investigated. RESULTS Dietary factors influencing P:T ratio included intake of total protein (g/kg), medical food (MF) protein (g/kg, % below Rx), and LNAA (g) in the full cohort (P < .05). Associations were found between plasma valine and other dietary and plasma LNAA in pediatrics (P < .05) and plasma LNAA with dietary LNAA intake in adults (P = .019). Plasma P:T ratio was inversely associated with plasma LNAA concentrations in both age groups (P < .05). Aside from histidine in pediatrics (P = .024), plasma LNAA did not differ by having plasma PHE levels within or above the therapeutic range (120-360 μmol/L). Plasma LNAA in both age groups was similar to reported healthy control values. CONCLUSION P:T ratio is significantly tied to dietary LNAA, adherence to MF Rx, and plasma LNAA concentrations. Additionally, P:T ratio and valine may be effective clinical proxies for determining LNAA metabolic balance and LNAA quality of the diet in patients with PKU.
Collapse
Affiliation(s)
| | - Anita M. Nucci
- Department of NutritionGeorgia State UniversityAtlantaGeorgia
| | - Ann M. Berry
- Department of NutritionGeorgia State UniversityAtlantaGeorgia
| | - Sarah T. Henes
- Department of NutritionGeorgia State UniversityAtlantaGeorgia
| | - Rani H. Singh
- Department of Human GeneticsEmory UniversityAtlantaGeorgia
| |
Collapse
|