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Yilmaz Nas O, Ashmore C, Evans S, Pinto A, Daly A, Yabancı Ayhan N, MacDonald A. Phenylalanine-Free Infant Formula in Patients with Phenylketonuria: A Retrospective Study. Nutrients 2024; 16:2204. [PMID: 39064647 PMCID: PMC11279558 DOI: 10.3390/nu16142204] [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: 05/27/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
The long-term efficacy and use of phenylalanine-free infant amino acid formula (PFIF) is understudied. This retrospective, longitudinal study evaluated PFIF (PKU Start: Vitaflo International) in children with phenylketonuria, collecting data on metabolic control, growth, dietary intake, and symptoms and the child's experience with PFIF. Twenty-five children (12 males, 48%) with a median age of 3.6 years (2.0-6.2 years) were included. During 24 months follow-up, children maintained normal growth and satisfactory metabolic control. The protein intake from protein substitutes increased from 2.7 at 6 months to 2.8 g/kg/day at 24 months, while natural protein decreased from 0.6 to 0.4 g/kg/day. By 24 months, most children (n = 16, 64%) had stopped PFIF, while nine (36%) continued with a median intake of 450 mL/day (Q1:300 mL, Q3: 560 mL). Children who continued PFIF after 24 months of age had higher energy and fat intakes with higher weight/BMI z-scores compared with those who stopped earlier (p < 0.05). Constipation was reported in 44% of infants but improved with age. Initial difficulty with PFIF acceptance was reported in 20% of infants but also improved with time. Prolonged use of PFIF in pre-school children may contribute to poor feeding patterns and overweight; thus, replacing the majority of the protein equivalent provided by PFIF with a weaning protein substitute by 12 months and discontinuing PFIF before 2 years is recommended.
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Affiliation(s)
- Ozlem Yilmaz Nas
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
- Department of Nutrition and Dietetics, Ankara Yildirim Beyazit University, Ankara 06760, Turkey
- Department of Nutrition and Dietetics, Ankara University, Ankara 06760, Turkey;
| | - Catherine Ashmore
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
| | - Sharon Evans
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
| | - Alex Pinto
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
| | | | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (C.A.); (S.E.); (A.P.); (A.D.); (A.M.)
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Bokayeva K, Jamka M, Walkowiak D, Duś-Żuchowska M, Herzig KH, Walkowiak J. Vitamin Status in Patients with Phenylketonuria: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:5065. [PMID: 38791104 PMCID: PMC11120668 DOI: 10.3390/ijms25105065] [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: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The published data on the vitamin status of patients with phenylketonuria (PKU) is contradictory; therefore, this systematic review and meta-analysis evaluated the vitamin status of PKU patients. A comprehensive search of multiple databases (PubMed, Web of Sciences, Cochrane, and Scopus) was finished in March 2024. The included studies compared vitamin levels between individuals diagnosed with early-treated PKU and healthy controls while excluding pregnant and lactating women, untreated PKU or hyperphenylalaninemia cases, control groups receiving vitamin supplementation, PKU patients receiving tetrahydrobiopterin or pegvaliase, and conference abstracts. The risk of bias in the included studies was assessed by the Newcastle-Ottawa scale. The effect sizes were expressed as standardised mean differences. The calculation of effect sizes with 95% CI using fixed-effects models and random-effects models was performed. A p-value < 0.05 was considered statistically significant. The study protocol was registered in the PROSPERO database (CRD42024519589). Out of the initially identified 11,086 articles, 24 met the criteria. The total number of participants comprised 770 individuals with PKU and 2387 healthy controls. The meta-analyses of cross-sectional and case-control studies were conducted for vitamin B12, D, A, E, B6 and folate levels. PKU patients demonstrated significantly higher folate levels (random-effects model, SMD: 1.378, 95% CI: 0.436, 2.320, p = 0.004) and 1,25-dihydroxyvitamin D concentrations (random-effects model, SMD: 2.059, 95% CI: 0.250, 3.868, p = 0.026) compared to the controls. There were no significant differences in vitamin A, E, B6, B12 or 25-dihydroxyvitamin D levels. The main limitations of the evidence include a limited number of studies and their heterogeneity and variability in patients' compliance. Our findings suggest that individuals with PKU under nutritional guidance can achieve a vitamin status comparable to that of healthy subjects. Our study provides valuable insights into the nutritional status of PKU patients, but further research is required to confirm these findings and explore additional factors influencing vitamin status in PKU.
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Affiliation(s)
- Kamila Bokayeva
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Małgorzata Jamka
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego Str. 39, 60-356 Poznań, Poland;
| | - Monika Duś-Żuchowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
| | - Karl-Heinz Herzig
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
- Research Unit of Biomedicine and Internal Medicine, Biocenter of Oulu, Medical Research Center, Oulu University Hospital, University of Oulu, Aapistie Str. 5, 90220 Oulu, Finland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (K.B.); (M.J.); (M.D.-Ż.); (K.-H.H.)
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Pavale S, Dalei SK, Sokhal P, Biswas B, Meena K, Adlakha N. Engineering phenylalanine ammonia lyase to limit feedback inhibition by cinnamate and enhance biotransformation. Biotechnol J 2024; 19:e2300275. [PMID: 37861236 DOI: 10.1002/biot.202300275] [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: 06/08/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
Phenylalanine ammonia-lyase (PAL) is a crucial enzyme for various biotechnology applications, such as producing phenols, antioxidants, and nutraceuticals. However, feedback inhibition from its product, cinnamic acid, limits its forward reaction rate. Therefore, this study aims to address the feedback inhibition in PAL using enzyme engineering strategies. Random and site-directed mutagenesis approaches were utilized to screen mutant enzymes with ameliorated tolerance against cinnamic acid. A thermotolerant and cinnamate-tolerant mutant was rationally identified using a high throughput screening method and subsequent biochemical characterization. We evaluated cinnamate affinity among the seven rationally selected mutations, and the T102E mutation was identified as the most promising mutant. This mutant showed a six-fold reduction in the affinity of PAL for cinnamic acid and a two-fold increase in operational stability compared with native PAL. Furthermore, the enzyme was immobilized on carbon nanotubes to increase its robustness and reusability. The immobilized mutant PAL showed greater efficiency in the deamination of phenylalanine present in protein hydrolysate than its free form. The rationale behind the enhancement of cinnamate tolerance was validated using molecular dynamic simulations. Overall, the knowledge of the sequence-function relationship of PAL was applied to drive enzyme engineering to develop highly tolerant PAL.
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Affiliation(s)
- Siddhi Pavale
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
| | - Sudipt Kumar Dalei
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
| | - Preeti Sokhal
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
| | - Biswambhar Biswas
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
| | - Kunal Meena
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
| | - Nidhi Adlakha
- Synthetic Biology and Bioprocessing group, Regional Centre for Biotechnology, NCR-Biotech Cluster, Faridabad, India
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Faverzani JL, Guerreiro G, Hammerschmidt TG, Lopes FF, Coelho DDM, Sitta A, Mescka CP, Deon M, Wajner M, Vargas CR. Increased peripheral of brain-derived neurotrophic factor levels in phenylketonuric patients treated with l-carnitine. Arch Biochem Biophys 2023; 749:109792. [PMID: 37863349 DOI: 10.1016/j.abb.2023.109792] [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: 08/25/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
Phenylketonuria (PKU) is the most common inherited metabolic disorders caused by severe deficiency or absence of phenylalanine hydroxylase activity that converts phenylalanine (Phe) to tyrosine. PKU patients were treated with a Phe restricted diet supplemented with a special formula containing l-carnitine (L-car), well-known antioxidant compound. The lack of treatment can cause neurological and cognitive impairment, as severe mental retardation, neuronal cell loss and synaptic density reduction. Although Phe has been widely demonstrated to be involved in PKU neurotoxicity, the mechanisms responsible for the CNS injury are still not fully known. In this work, we evaluated markers of neurodegeneration, namely BDNF (brain-derived neurotrophic factor), PAI-1 total (Plasminogen activator inhibitor-1 total), Cathepsin D, PDGF AB/BB (platelet-derived growth factor), and NCAM (neuronal adhesion molecule) in plasma of PKU patients at early and late diagnosis and under treatment. We found decreased Phe levels and increased L-car concentrations in PKU patients treated with L-car compared to the other groups, indicating that the proposed treatment was effective. Furthermore, we found increased BDNF levels in the patients under treatment compared to patients at early diagnosis, and a positive correlation between BDNF and L-car and a negative correlation between BDNF and Phe. Our results may indicate that in PKU patients treated with L-car there is an attempt to adjust neuronal plasticity and recover the damage suffered, reflecting a compensatory response to brain injury.
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Affiliation(s)
- Jéssica Lamberty Faverzani
- Programa de Pós-Graduação Em Ciências Farmacêuticas, Universidade Federal Do Rio Grande Do Sul, Avenida Ipiranga, 2752, CEP 90610-000, Porto Alegre, RS, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil.
| | - Gilian Guerreiro
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Tatiane Grazieli Hammerschmidt
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Franciele Fátima Lopes
- Programa de Pós-Graduação Em Ciências Farmacêuticas, Universidade Federal Do Rio Grande Do Sul, Avenida Ipiranga, 2752, CEP 90610-000, Porto Alegre, RS, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Daniella de Moura Coelho
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Angela Sitta
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Caroline Paula Mescka
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Marion Deon
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Moacir Wajner
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil; Programa de Pós-Graduação Em Ciências Biológicas: Bioquímica, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2600, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Carmen Regla Vargas
- Programa de Pós-Graduação Em Ciências Farmacêuticas, Universidade Federal Do Rio Grande Do Sul, Avenida Ipiranga, 2752, CEP 90610-000, Porto Alegre, RS, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil; Programa de Pós-Graduação Em Ciências Biológicas: Bioquímica, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2600, CEP 90035-003, Porto Alegre, RS, Brazil.
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Bulut FD, Kor D, Kilavuz S, Cicek E, Koseci B, Kara E, Burgac E, Kaplan İ, Onenli Mungan N. Actions speak louder than words: Home visits and its effect on dietary adherence in patients with phenylketonuria. J Paediatr Child Health 2023; 59:1238-1243. [PMID: 37700622 DOI: 10.1111/jpc.16488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
AIM Phenylketonuria (PKU) is an inherited metabolic disorder in which accumulation of phenylalanine (Phe) leads to poor neurological outcomes without treatment. Dietary therapy is the main treatment and nonadherence is associated with elevated blood Phe levels and correspondingly poor neuropsychiatric outcomes. This study aimed to examine the effect of home visits on blood Phe levels in PKU patients. METHODS Sixty-five paediatric PKU patients who were on low-phenylalanine diet were visited monthly at home for 6 months. At each visit, dietary education was provided, patients' height and weight were measured and blood samples were collected. RESULTS Twenty-eight (43.1%) patients had classic PKU and 37 (56.9%) had moderate PKU. Blood Phe levels decreased statistically significant at first, second, fifth, and sixth months compared with screening visit. Blood Phe levels in moderate PKU patients decreased significantly at the last visit unlike classic PKU patients. A significant decrease in blood Phe levels was observed in patients older than 10 years. Anthropometric parameters improved. CONCLUSIONS Dietary nonadherence is the main treatment failure in PKU. Home visits for education are a promising way to improve treatment outcomes by providing quality education, better assessment, and correction of mistakes but they should be ongoing and supported by different interventions that address patients' special needs.
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Affiliation(s)
- Fatma Derya Bulut
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Deniz Kor
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Sebile Kilavuz
- Pediatric Metabolism Department, Başakşehir Çam ve Sakura City Research and Education Hospital, İstanbul, Turkey
| | - Ebru Cicek
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Burcu Koseci
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Esra Kara
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Ezgi Burgac
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - İrem Kaplan
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
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Kazemi M, Aboutalebzadeh S, Mojaverian SP, Samani SA, Kouhsari F, PourvatanDoust S, Salimi A, Savarolyia M, Najafi A, Hosseini SS, Khodaiyan F. Valorization of pistachio industrial waste: Simultaneous recovery of pectin and phenolics, and their application in low-phenylalanine cookies for phenylketonuria. Int J Biol Macromol 2023; 249:126086. [PMID: 37532194 DOI: 10.1016/j.ijbiomac.2023.126086] [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: 05/20/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023]
Abstract
This study introduces a sustainable approach to simultaneously produce pectin and phenolic compounds from pistachio industrial waste and applies them in the formulation of low-phenylalanine cookies. The co-optimization process was performed using the microwave-assisted technique and a Box-Behnken design, considering four variables and two responses: pectin yield and total phenolic content (TPC). The co-optimized condition (microwave power of 700 W, irradiation time of 210 s, pH level of 1.02, and LSR of 20 mL/g) resulted in a pectin yield of 15.85 % and a TPC of 10.12 %. The pectin obtained under co-optimized condition was evaluated for its physicochemical, structural, and thermal properties and the phenolic extract for its antiradical activity. Characterization of the pectin sample revealed a high degree of esterification (44.21 %) and a galacturonic acid-rich composition (69.55 %). The average molecular weight of the pectin was determined to be 640.236 kDa. FTIR and 1H NMR spectroscopies confirmed the structure of pectin, with an amorphous nature and high thermal stability observed through XRD and DSC analysis. Additionally, the extract exhibited significant antiradical activity comparable to butylated hydroxyanisole and ascorbic acid. The isolated ingredients were used to formulate low-protein, low-phenylalanine cookies for phenylketonuria patients. The addition of 0.5 % pectin and 1 mL/g extract led to increased moisture content (from 9.05 to 12.89 %) and specific volume (from 7.28 to 9.90 mL/g), decreased hardness (from 19.44 to 10.39 N × 102), and improved antioxidant properties (from 5.15 % to 44.60 % inhibition) of the cookies. Importantly, there was no significant increase observed in the phenylalanine content of the samples with pectin and extract addition. Furthermore, sensory evaluation scores demonstrated significantly higher scores for taste, odor, texture, and overall acceptability in cookies enriched with 0.5 % pectin and 1 mL/g extract, with scores of 4.53, 3.93, 4.40, and 4.60, respectively.
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Affiliation(s)
- Milad Kazemi
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Engineering, University of Tehran, Karaj, Iran
| | - Sahar Aboutalebzadeh
- Department of Food Science and Technology, Faculty of Agricultural Engineering, Agricultural Science and Natural Resources of Sari University, Mazandaran, Iran
| | - Seyede Parastoo Mojaverian
- Department of Food Science and Technology, Faculty of Agricultural Engineering, Agricultural Science and Natural Resources of Sari University, Mazandaran, Iran
| | - Sara Amiri Samani
- Department of Food Science and Technology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Fatemeh Kouhsari
- Department of Food Science, Engineering and Technology, College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - Sepideh PourvatanDoust
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Atiyeh Salimi
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Engineering, University of Tehran, Karaj, Iran
| | - Mohamad Savarolyia
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Engineering, University of Tehran, Karaj, Iran
| | - Amin Najafi
- Department of Food Science, Engineering and Technology, College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - Seyed Saeid Hosseini
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Engineering, University of Tehran, Karaj, Iran
| | - Faramarz Khodaiyan
- Bioprocessing and Biodetection Laboratory, Department of Food Science and Engineering, University of Tehran, Karaj, Iran.
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Ghasemi N, Alavi Namvar M, Mansori K. Evaluation of Decayed, Missing due to Caries, and Filled Teeth Index in Children with Phenylketonuria in Comparison to Normal Population. Turk Arch Pediatr 2023; 58:413-417. [PMID: 37357455 PMCID: PMC10441068 DOI: 10.5152/turkarchpediatr.2023.22304] [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: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Management of patients with phenylketonuria mainly includes limiting the content of phenylalanine in the diet. Therefore, the purpose of this study was to investigate oral problems in children with phenylketonuria compared to the healthy population as a case-control study. MATERIALS AND METHODS The subjects of the case and control groups were selected according to the inclusion criteria. First, the oral cavity and tooth were examined by a specialist dentist to indicate the decayed, missing due to caries, and filled teeth index in both groups. To inves- tigate the level of phenylalanine and evaluate other laboratory examinations, 2 mL of blood and saliva samples was taken from the subjects. Blood and saliva phenylalanine levels were measured by high-performance liquid chromatography. Phosphorus, calcium, and pH levels were investigated through calorimetric measurement. The data were analyzed using Statistical Package for Social Sciences software. RESULTS There was no significant difference between the case and control groups in terms of age and sex. The average level of calcium and phosphorus in the case group was higher than in the control group. Also, the average decayed, missing due to caries, and filled teeth index in the case group was not significantly different compared to the control group. None of the above-investigated indicators had a significant relationship with each other. On the other hand, it was found that there was a positive and significant relationship between phenylalanine in blood, saliva, and pH as well as between saliva phenylalanine with decayed, missing due to caries, and filled teeth. CONCLUSION The results of this study indicate a significant effect of phenylketonuria disease on calcium, phosphorus, and oral pH levels in children.
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Affiliation(s)
- Nikoo Ghasemi
- Zanjan University of Medical Sciences Faculty of Dentistry, Zanjan, Iran
| | - Mahsa Alavi Namvar
- Department of Oral and Maxillofacial Medicine, Zanjan University of Medical Sciences Faculty of Dentistry, Zanjan, Iran
| | - Kamyar Mansori
- Department of Epidemiology and Biostatistics, Zanjan University of Medical Sciences Faculty of Medicine, Zanjan, Iran
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