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Shaikh MG, Barrett TG, Bridges N, Chung R, Gevers EF, Goldstone AP, Holland A, Kanumakala S, Krone R, Kyriakou A, Livesey EA, Lucas-Herald AK, Meade C, Passmore S, Roche E, Smith C, Soni S. Prader-Willi syndrome: guidance for children and transition into adulthood. Endocr Connect 2024; 13:e240091. [PMID: 38838713 PMCID: PMC11301552 DOI: 10.1530/ec-24-0091] [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: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Prader-Willi syndrome (PWS) is a rare orphan disease and complex genetic neurodevelopmental disorder, with a birth incidence of approximately 1 in 10,000-30,000. Management of people with PWS requires a multi-disciplinary approach, ideally through a multi-disciplinary team (MDT) clinic with community support. Hypotonia, poor feeding and faltering growth are characteristic features in the neonatal period, followed by hyperphagia and risk of rapid weight gain later in childhood. Children and adolescents (CA) with PWS usually display developmental delay and mild learning disability and can develop endocrinopathies, scoliosis, respiratory difficulties (both central and obstructive sleep apnoea), challenging behaviours, skin picking, and mental health issues, especially into adulthood. This consensus statement is intended to be a reference document for clinicians managing children and adolescents (up to 18 years of age) with PWS. It considers the bio-psycho-social domains of diagnosis, clinical assessment, and management in the paediatric setting as well as during and after transition to adult services. The guidance has been developed from information gathered from peer-reviewed scientific reports and from the expertise of a range of experienced clinicians in the United Kingdom and Ireland involved in the care of patients with PWS.
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Affiliation(s)
- M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Timothy G Barrett
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Robin Chung
- Research Working Group, Prader-Willi Syndrome Association, Northampton, UK
| | - Evelien F Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinologyResearch Group, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Anthony Holland
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Ruth Krone
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
| | - E Anne Livesey
- Royal Alexandra Children’s Hospital, Brighton, UK
- Sussex Community NHS Trust, Brighton, UK
| | - Angela K Lucas-Herald
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Christina Meade
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
| | | | - Edna Roche
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
- The University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland
| | - Chris Smith
- Royal Alexandra Children’s Hospital, Brighton, UK
| | - Sarita Soni
- Learning Disability Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK
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Skrzypek M, Kowal K, Glibowski P, Dzida G, Nowosad K, Krzyszycha R, Soczyńska K, Przybysz O. Analysis of the Diet Quality and Nutritional State of Children, Youth, and Young Adults with Prader-Willi Syndrome: A Polish Multiple Case Study. Nutrients 2023; 15:3811. [PMID: 37686843 PMCID: PMC10490043 DOI: 10.3390/nu15173811] [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: 07/14/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Given the lack of data on dietary quality in young individuals with Prader-Willi syndrome (PWS) in Poland, a multiple case study was conducted in which anthropometric measurements and 7-day dietary records were collected from 20 subjects with PWS. The study group consisted of 8 females and 12 males with a mean age of 14.8 years and a mean BMI of 21.6. Based on BMI analysis, five subjects were overweight, including two subjects who were obese. The study showed that 35% of the subjects had energy intakes above the recommended levels. Protein deficiency was found in one subject in the analyzed diets. However, fat intake was excessive in four subjects, and the majority exceeded the recommended intake of saturated fatty acids. Vitamin E and B12 deficiencies were found in 40% and 85% of the subjects, respectively. All subjects had inadequate intakes of vitamin D and iodine, while the majority had deficiencies in sodium and copper intakes. Calcium intake was deficient in 35% of the subjects. However, most subjects met recommendations for the intakes of other minerals, vitamins, and fiber. These findings confirm the suboptimal dietary patterns of Polish individuals with PWS, with deficits observed in the intake of certain vitamins and minerals.
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Affiliation(s)
- Michał Skrzypek
- Faculty of Health Sciences, Vincent Pol University in Lublin, Choiny 2 Str., 20-816 Lublin, Poland
| | - Katarzyna Kowal
- Collegium Medicum, Jan Długosz University in Czestochowa, 13/15 Armii Krajowej Str., 42-200 Częstochowa, Poland;
| | - Paweł Glibowski
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 8 Skromna Str., 20-704 Lublin, Poland; (P.G.); (K.N.)
| | - Grzegorz Dzida
- Diabetes Division, Chair and Department of Internal Diseases, Medical University of Lublin, 16 Staszica Str., 20-081 Lublin, Poland;
| | - Karolina Nowosad
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, 8 Skromna Str., 20-704 Lublin, Poland; (P.G.); (K.N.)
| | - Renata Krzyszycha
- Department of Clinical Dietetics, Medical University of Lublin, 1 Al. Racławickie Str., 20-059 Lublin, Poland;
| | - Klaudia Soczyńska
- Nutrition Division, Independent Public Clinical Hospital No 4, 8 Jaczewskiego Str., 20-954 Lublin, Poland; (K.S.); (O.P.)
| | - Olga Przybysz
- Nutrition Division, Independent Public Clinical Hospital No 4, 8 Jaczewskiego Str., 20-954 Lublin, Poland; (K.S.); (O.P.)
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3
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Couto-Rosende Y, Garcia-Tirado D, Palacio-Marco M, Caixàs A, Corripio R. A Personalized Approach to Determining the Caloric Needs of Children with Prader-Willi Syndrome Treated with Growth Hormone. J Clin Med 2023; 12:3967. [PMID: 37373659 DOI: 10.3390/jcm12123967] [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: 03/23/2023] [Revised: 05/18/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Prader-Willi Syndrome (PWS) is the most frequent cause of genetic obesity. Early reports indicate that children with PWS require 20-40% fewer calories than healthy children to maintain adequate growth. Growth hormone treatment for children with PWS, approved in 2000, affects the body composition and probably affects energy requirements. This retrospective cross-sectional study analyzed the caloric intake in children with PWS aged from 6 months to 12 years old who underwent growth hormone treatment, comparing the patients' caloric intake calculated from parent-recorded dietary intake versus the recommended caloric intake for healthy children, taking into account the age, sex, height, weight, and physical activity. We analyzed the data from 25 patients (13 (52%) boys; mean age, 6.72 ± 2.81 y; median age at starting growth hormone treatment, 1.4 y (IQR: 0.78-2.29); 17 (68%) normal weight and 8 (32%) overweight or obese). The mean daily energy intake was 1208 ± 186 kcal/d, representing 96.83% ± 18.66 of the recommended caloric intake for healthy children. The caloric intake in children with PWS treated with growth hormone was very similar to that recommended for healthy children; thus, we should rethink the dietary recommendations for these children.
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Affiliation(s)
- Yolanda Couto-Rosende
- Paediatric Digestive Disease Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain
| | - Diana Garcia-Tirado
- Paediatric Digestive Disease Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain
| | - Mónica Palacio-Marco
- Paediatric Endocrinology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain
| | - Assumpta Caixàs
- Endocrinology and Diabetes Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain
| | - Raquel Corripio
- Paediatric Endocrinology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain
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Brunvoll SH, Flote VG, Halset EH, Bertheussen GF, Skjerven H, Lømo J, Thune I, Hjartåker A. Normal and unusual days for dietary intake during the 12 months after a breast cancer diagnosis in women. Eur J Nutr 2022; 61:3873-3885. [PMID: 35750881 PMCID: PMC9596503 DOI: 10.1007/s00394-022-02925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
Purpose There are several reasons to report days as being unusual with regard to dietary intake, including special occasions and celebrations. For breast cancer patients during the 12 month post-surgery period, unusual days may also include days that are affected by being a cancer patient. The aim of this study was to study dietary intake on “normal” and “unusual” days, and to study what is reported in “free text fields” of a food diary. Methods Women (n = 456), mean age 55.5 years newly diagnosed with invasive breast cancer (stage I/II) were included in this clinical study. “Normal” and “unusual” days in general, over time and during the week and weekends were studied using repeated administration of a 7-day pre-coded food diary. Results The breast cancer patients reported 26% of all days as unusual. The intake of energy, most nutrients, especially alcohol and sugar, red and processed meat, and sweets, cakes, and snacks was 5–126% higher, whereas intake of fiber, fruit and berries, vegetables, and dairy products was 7–17% lower on unusual than on normal days (P < 0.001). The same pattern was seen for normal/unusual days during the weekdays, weekends and over time. Finally, 99% of the breast cancer patients used the free text fields to report additional intake with a mean energy of 1.1 MJ/day. Conclusion For breast cancer patients during the 12-month post-surgery period, unusual days are important drivers of total intake, especially for alcohol. The free text fields in the pre-coded food diary contributed substantially to the total intake.
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Affiliation(s)
- Sonja H. Brunvoll
- Department of Nutrition, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Vidar G. Flote
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Eline H. Halset
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Gro F. Bertheussen
- Department of Physical Medicine and Rehabilitation, St Olav University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helle Skjerven
- Department of Research, Vestre Viken Hospital Trust, Drammen, Norway
| | - Jon Lømo
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Inger Thune
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsö, Norway
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5
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Meade C, Martin R, McCrann A, Lyons J, Roche E. Dietary intake and growth in children with Prader-Willi syndrome. J Hum Nutr Diet 2021; 34:784-791. [PMID: 33835604 DOI: 10.1111/jhn.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/25/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of Prader-Willi Syndrome (PWS) requires strict dietary supervision to prevent obesity, avoid micronutrient deficiencies and ensure optimal growth. The present study aimed to examine the growth and dietary intake of children with PWS. METHODS All children with genetically confirmed PWS attending Children's Health Ireland (CHI) at Tallaght (n = 44) were invited to participate. Anthropometry was performed and body composition measured using bioelectrical impedance analysis. Three-day food diaries were used to evaluate dietary intake and the presence of early feeding issues was assessed. Serum haemoglobin, ferritin and vitamin D levels were measured. RESULTS Nineteen children participated, with a mean (range) age of 7.6 (0.6-18.1) years. Most were female (n = 14, 74%). Twenty-percent (n = 3) were underweight, 60% (n = 9) were healthy weight, n = 1 was overweight and n = 2 were obese. Mean (range) percentage body fat was 25.7% (10%-40%). Eigthy-three percent reported early feeding issues. Ninety-four percent (n = 16) achieved ≤ 100% of estimated average requirement (EAR) for energy. Mean daily energy intake for ≤ 5 years old was 722 kcal (9 kcal cm-1 /72-112% EAR); for those ≥ 12 years, it was 1203 kcal (8.3 kcal cm-1 /41%-82% EAR). Suboptimal calcium, vitamin D, iron, zinc and fibre intake was evident. Iron deficiency anaemia and vitamin D insufficiency occurred in two children. CONCLUSIONS The present study provides the first Irish data for PWS and shows that energy intake does not appear to be excessive, with four in five patients being underweight or of a normal BMI. Suboptimal dietary intake of several micronutrients was evident and biochemical nutrient deficiencies were present.
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Affiliation(s)
- Christina Meade
- Department of Nutrition and Dietetics, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, Ireland
| | - Ruth Martin
- Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Ireland
| | - Ann McCrann
- Department of Paediatric Growth Diabetes and Endocrinology, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, Ireland
| | | | - Edna Roche
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Johansen AMW, Myhre JB, Hjartåker A, Andersen LF. Validation of energy intake recorded by a 7-day pre-coded food diary against measured energy expenditure in a group of Norwegian adults. PLoS One 2019; 14:e0215638. [PMID: 30998755 PMCID: PMC6472777 DOI: 10.1371/journal.pone.0215638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/07/2019] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to validate energy intake (EI) reported by a pre-coded food diary (PFD) against energy expenditure (EE) measured by the ActiReg system consisting of an activity and position monitor and a calculation program (ActiCalc). Dietary intake was recorded by the PFD and EE was measured by the ActiReg system over a 7-day period. One hundred and twenty adult participants completed the study, 42 men and 78 women. The average group EI was 17% lower compared to measured EE. The 95% limits of agreement were 6.7 and -2.9 MJ/day. Of all participants, 68% were classified as acceptable reporters, 29% as underreporters and only 3% as overreporters. Fifty percent of the men and 30% of the women were classified into the same quartile for EI and EE, whereas 5% of both men and women were ranked in the opposite quartile by the two methods (weighted kappa coefficient = 0.29). Pearson correlation coefficient between reported EI and measured EE was 0.49 (p<0.001). High BMI was related to larger underreporting when EE was low. Furthermore, this study found that PFD underestimates EI on the group level with an average of 17% and showed large variation in the validity of the PFD on the individual level.
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Affiliation(s)
| | - Jannicke Borch Myhre
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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7
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Duis J, van Wattum PJ, Scheimann A, Salehi P, Brokamp E, Fairbrother L, Childers A, Shelton AR, Bingham NC, Shoemaker AH, Miller JL. A multidisciplinary approach to the clinical management of Prader-Willi syndrome. Mol Genet Genomic Med 2019; 7:e514. [PMID: 30697974 PMCID: PMC6418440 DOI: 10.1002/mgg3.514] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Prader–Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000–1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient‐centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family‐centered care. Methods Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support. Results Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic. Conclusion Establishment of clinics motivates collaboration to provide evidence‐based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of “Centers of Excellence.” We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.
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Affiliation(s)
- Jessica Duis
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pieter J van Wattum
- Department of Psychiatry, Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Clifford Beers Clinic, New Haven, Connecticut
| | - Ann Scheimann
- Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Parisa Salehi
- Division of Endocrinology and Diabetes, Seattle Children's, University of Washington, Seattle, Washington
| | - Elly Brokamp
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura Fairbrother
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Anna Childers
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Althea Robinson Shelton
- Neuro-Sleep Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nathan C Bingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ashley H Shoemaker
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer L Miller
- Pediatric Endocrinology, University of Florida, Gainesville, Florida
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Baraghithy S, Smoum R, Drori A, Hadar R, Gammal A, Hirsch S, Attar-Namdar M, Nemirovski A, Gabet Y, Langer Y, Pollak Y, Schaaf CP, Rech ME, Gross-Tsur V, Bab I, Mechoulam R, Tam J. Magel2 Modulates Bone Remodeling and Mass in Prader-Willi Syndrome by Affecting Oleoyl Serine Levels and Activity. J Bone Miner Res 2019; 34:93-105. [PMID: 30347474 DOI: 10.1002/jbmr.3591] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/30/2018] [Accepted: 09/08/2018] [Indexed: 12/17/2022]
Abstract
Among a multitude of hormonal and metabolic complications, individuals with Prader-Willi syndrome (PWS) exhibit significant bone abnormalities, including decreased BMD, osteoporosis, and subsequent increased fracture risk. Here we show in mice that loss of Magel2, a maternally imprinted gene in the PWS critical region, results in reduced bone mass, density, and strength, corresponding to that observed in humans with PWS, as well as in individuals suffering from Schaaf-Yang syndrome (SYS), a genetic disorder caused by a disruption of the MAGEL2 gene. The low bone mass phenotype in Magel2-/- mice was attributed to reduced bone formation rate, increased osteoclastogenesis and osteoclast activity, and enhanced trans-differentiation of osteoblasts to adipocytes. The absence of Magel2 in humans and mice resulted in reduction in the fatty acid amide bone homeostasis regulator, N-oleoyl serine (OS), whose levels were positively linked with BMD in humans and mice as well as osteoblast activity. Attenuating the skeletal abnormalities in Magel2-/- mice was achieved with chronic administration of a novel synthetic derivative of OS. Taken together, Magel2 plays a key role in modulating bone remodeling and mass in PWS by affecting OS levels and activity. The use of potent synthetic analogs of OS should be further tested clinically as bone therapeutics for treating bone loss. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Saja Baraghithy
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reem Smoum
- Medicinal Chemistry Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Drori
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rivka Hadar
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaad Gammal
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shira Hirsch
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Malka Attar-Namdar
- Bone Laboratory, Institute for Dental Research, Faculty of Dentistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alina Nemirovski
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yankel Gabet
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yshaia Langer
- Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yehuda Pollak
- Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Christian Patrick Schaaf
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Megan Elizabeth Rech
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Varda Gross-Tsur
- Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Itai Bab
- Bone Laboratory, Institute for Dental Research, Faculty of Dentistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Mechoulam
- Medicinal Chemistry Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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9
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Mackenzie ML, Triador L, Gill JK, Pakseresht M, Mager D, Field CJ, Haqq AM. Dietary intake in youth with prader-willi syndrome. Am J Med Genet A 2018; 176:2309-2317. [PMID: 30216657 DOI: 10.1002/ajmg.a.40491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/12/2018] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Dietary management is important to prevent severe obesity in individuals with Prader-Willi syndrome (PWS); however, few studies have examined dietary intake and quality in youth with PWS. Our objective was to estimate intake of essential nutrients and diet quality in youth with PWS compared to those without PWS. Three-day food records were used to estimate intake of energy, nutrients, nutrient-density, foods, and adherence to healthy eating guidelines. Data were presented as medians and interquartile ranges with Mann-Whitney U and Fisher's test used to compare between groups with p < .05 considered significant. Youth with (n = 23) and without (n = 23) PWS were similar in age and sex distribution. The PWS group had a lower energy intake (p ≤ .001), higher nutrient density (p = .003), and better adherence to guidelines (p = .007) compared to the control group. The proportion with nutrient intake from food below Estimated Average Requirement or Adequate Intake were similar between groups. Fiber, vitamin D, calcium, and potassium intake were below recommendations in 50% or more in both groups. The inclusion of supplement intake lowered the proportion below recommendations, except for fiber and potassium. Youth with PWS had a similar nutrient intake as those without PWS despite a lower energy intake, which could be attributed to higher diet quality. However, more than half of youth with PWS were at risk of inadequate fiber, vitamin D, calcium, and potassium intake. A greater emphasis on nutrient-dense foods would improve nutrient intake, but supplements may be warranted in youth with PWS who do not meet recommendations.
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Affiliation(s)
| | - Lucila Triador
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jasmeena K Gill
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammadreza Pakseresht
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Mager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Woods SG, Knehans A, Arnold S, Dionne C, Hoffman L, Turner P, Baldwin J. The associations between diet and physical activity with body composition and walking a timed distance in adults with Prader-Willi syndrome. Food Nutr Res 2018; 62:1343. [PMID: 29942245 PMCID: PMC6010474 DOI: 10.29219/fnr.v62.1343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background Research on aging in Prader–Willi syndrome (PWS) is limited, although people with PWS are living longer. Individuals with PWS present with high fat mass, low lean mass, and low levels of physical activity (PA). Previous reports in children and young adults with PWS show inadequate nutrient intake and body fat percentage indicating obesity. Previous studies in PWS rarely included individuals beyond young adulthood, especially studies conducted in the United States. This study includes adults from 18 to 62 years of age, and includes 19 of the estimated 60 adult individuals with PWS in Oklahoma. Because individuals with PWS are living longer, information must be provided on aging with PWS. This study is a report of the initial data for a planned longitudinal study on aging with PWS. Objective Determine associations between body composition, diet, PA, and a timed walk for adults with PWS, and to assess adequacy of dietary intake for those individuals aging with PWS. Design This cross-sectional investigation determined dietary habits, PA, and body composition of adults with PWS, and tested associations between these variables. Results Participants ranged in age from 18 to 62 years. They had healthier body composition, at 26.8% body fat, than previously reported. Mean body mass index (BMI) was in the overweight range at 26.7. Those who consumed higher amounts of fat (as a percent of total kilocalories) had statistically significant lower body fat percentage, but this may simply reflect that individuals with lower body fat percentages felt freer to consume fat. Mean steps taken per day was 7631.7 steps but only 16% of participants met healthy PA recommendations despite participating in daily structured exercise. All participants’ diets met Dietary Guidelines for macronutrient distribution, but 80% were deficient in calcium, 100% were deficient in dietary vitamin D, and 87% were deficient in fiber. Sample size was small, so it was difficult to reach statistical significance, despite seeing clinical significance. Conclusions Recommend working toward healthy PA recommendations for all age groups by decreasing time in sedentary activity. Recommend increasing vitamin A and D fortified dairy products and high-fiber foods, and consider dietary supplementation, especially for calcium, vitamin D, and fiber.
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Affiliation(s)
- Susan G Woods
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Allen Knehans
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sandra Arnold
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carol Dionne
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Leah Hoffman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peggy Turner
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jonathan Baldwin
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Khan MJ, Gerasimidis K, Edwards CA, Shaikh MG. Mechanisms of obesity in Prader-Willi syndrome. Pediatr Obes 2018; 13:3-13. [PMID: 27863129 DOI: 10.1111/ijpo.12177] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Abstract
Obesity is the most common cause of metabolic complications and poor quality of life in Prader-Willi syndrome (PWS). Hyperphagia and obesity develop after an initial phase of poor feeding and failure to thrive. Several mechanisms for the aetiology of obesity in PWS are proposed, which include disruption in hypothalamic pathways of satiety control resulting in hyperphagia, aberration in hormones regulating food intake, reduced energy expenditure because of hypotonia and altered behaviour with features of autism spectrum disorder. Profound muscular hypotonia prevents PWS patients from becoming physically active, causing reduced muscle movements and hence reduced energy expenditure. In a quest for the aetiology of obesity, recent evidence has focused on several appetite-regulating hormones, growth hormone, thyroid hormones and plasma adipocytokines. However, despite advancement in understanding of the genetic basis of PWS, there are contradictory data on the role of satiety hormones in hyperphagia and data regarding dietary intake are limited. Mechanistic studies on the aetiology of obesity and its relationship with disease pathogenesis in PWS are required. . In this review, we focused on the available evidence regarding mechanisms of obesity and potential new areas that could be explored to help unravel obesity pathogenesis in PWS.
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Affiliation(s)
- M J Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.,Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - K Gerasimidis
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C A Edwards
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M G Shaikh
- Department of Endocrinology, Royal Hospital for Children, Glasgow, UK
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12
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Bakker NE, Siemensma EPC, Koopman C, Hokken-Koelega ACS. Dietary Energy Intake, Body Composition and Resting Energy Expenditure in Prepubertal Children with Prader-Willi Syndrome before and during Growth Hormone Treatment: A Randomized Controlled Trial. Horm Res Paediatr 2016; 83:321-31. [PMID: 25764996 DOI: 10.1159/000374113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dietary management is a difficult but key aspect of care in children with Prader-Willi syndrome (PWS). We therefore investigated the effect of growth hormone (GH) treatment on reported energy intake in children with PWS, in relation with body composition, resting energy expenditure (REE) and hormone levels. METHODS In a randomized controlled GH trial including 47 children with PWS, we assessed 5-day dietary records and dual-energy X-ray absorptiometry for body composition. REE was calculated by Müller's equation, based on fat mass, fat free mass and gender. RESULTS Baseline energy intake of children with PWS was lower than normal daily energy requirements (p < 0.001), and decreased with age to 50% in prepubertal children. Energy intake in infants [m/f: 11/8; median (interquartile range [IQR]) age 2.7 years (1.5-3.2)] increased after 1 year of GH treatment (p = 0.008); this tended to be higher in the GH group than in the untreated group (p = 0.07). In prepubertal children [m/f: 14/14; median (IQR) age 6.8 years (5.1-8.1)], the increase in energy intake was higher in the GH group, but this was not different compared to the untreated group. REE was not different between the GH group and the untreated group. Increase in energy intake during 2 years of GH treatment was correlated with lower fat percentage standard deviation scores (p = 0.037) and higher adiponectin levels (p = 0.007). CONCLUSION Our study demonstrates that parents of children with PWS are very well capable of restricting energy intake up to 50% compared to daily energy requirements for age- and sex-matched healthy children. GH treatment was associated with a slight increase in energy intake, but also improved body composition and adiponectin levels, which suggests a protective effect of GH treatment.
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Affiliation(s)
- N E Bakker
- Dutch Growth Research Foundation/Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
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13
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Rubin DA, Nowak J, McLaren E, Patiño M, Castner DM, Dumont-Driscoll MC. Nutritional intakes in children with Prader-Willi syndrome and non-congenital obesity. Food Nutr Res 2015; 59:29427. [PMID: 26652260 PMCID: PMC4676362 DOI: 10.3402/fnr.v59.29427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Individuals with Prader-Willi syndrome (PWS) have extremely regulated diets to prevent the development of morbid obesity. OBJECTIVE This study evaluated potential deficiencies in macro and micronutrients in a cohort of youth with PWS and compared them to a group of children with non-congenital obesity and to US national recommendations. DESIGN Participants were 32 youth with PWS (age=10.8±2.6 years, body fat=46.7±10.1%) and 48 children without PWS but classified as obese (age=9.7±1.2 years, body fat=43.4±5.7%). Participants' parents completed a training session on food recording before completing a 3-day food record during a typical week including a weekend day and two weekdays, as well as a screening form indicating nutritional supplements use. RESULTS Youth with PWS reported less calories (1,312±75 vs. 1,531±61 kcal, p=0.03), carbohydrate (175±10 vs. 203±8 g), and sugars (67±5 vs. 81±4 g; p=0.04 for both) than obese. Youth with PWS consumed more vegetables (1.1±0.1 vs. 0.6±0.1 cups) and more of them met the daily recommendation (p<0.01 for both). Likewise, youth with PWS consumed more calcium than obese (899±53 vs. 752±43 mg) and more of them met the recommended daily dose (p=0.04 for both). The majority of participants in this study did not meet the vitamin D recommendation. CONCLUSION Despite consuming less calories, youth with PWS had a similar proportion of macronutrients in their diet as children with obesity. Micronutrient deficiencies in calcium and vitamin D in youth with PWS were noted despite a third of youth with PWS consuming multivitamin supplements. Special attention must be paid to the diets of youth with PWS and with obesity to ensure they are meeting micronutrient needs during this period of growth and development.
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Affiliation(s)
- Daniela A Rubin
- Department of Kinesiology, California State University, Fullerton, CA, USA;
| | - Jill Nowak
- Department of Endocrinology, Children's Hospital of Orange County, Orange, CA, USA
| | - Erin McLaren
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Monzeratt Patiño
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Diobel M Castner
- Department of Kinesiology, California State University, Fullerton, CA, USA
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14
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Griggs JL, Sinnayah P, Mathai ML. Prader–Willi syndrome: From genetics to behaviour, with special focus on appetite treatments. Neurosci Biobehav Rev 2015; 59:155-72. [DOI: 10.1016/j.neubiorev.2015.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 12/22/2022]
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15
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Miller JL, Lynn CH, Shuster J, Driscoll DJ. A reduced-energy intake, well-balanced diet improves weight control in children with Prader-Willi syndrome. J Hum Nutr Diet 2012; 26:2-9. [PMID: 23078343 DOI: 10.1111/j.1365-277x.2012.01275.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with Prader-Willi syndrome (PWS) have a predictable pattern of weight gain, with obesity beginning in early childhood and worsening as they get older and hyperphagia increases. Data on the most effective dietary modifications are scant and primarily anecdotal. As part of a longitudinal study investigating the natural history of PWS, we evaluated the effect of a well-balanced, energy-restricted diet on body composition and weight in young children with PWS. METHODS Sixty-three children, aged 2-10 years, with genetically proven PWS participated in the present study. These children had measurements of body composition by dual-energy X-ray absorptiometry and resting energy expenditure (REE), as well as a 3-day diet history analysis both before and after intervention. Energy calculations were based on the individual's REE, with the recommendation that the macronutrients of the diet consist of 30% fat, 45% carbohydrates and 25% protein, with at least 20 g of fibre per day. RESULTS Thirty-three families adhered to our dietary recommendations for both energy intake and macronutrient distribution. Those 33 children had lower body fat (19.8% versus 41.9%; P < 0.001) and weight management (body mass index SD score 0.3 versus 2.23; P < 0.001) than those whose parents followed the energy intake recommendations but did not alter the macronutrient composition of the diet. Those who followed our recommendations also had a lower respiratory quotient (0.84 versus 0.95; P = 0.002). CONCLUSIONS Our recommendation for an energy-restricted diet with a well-balanced macronutrient composition and fibre intake improves both weight and body composition in children with PWS compared to a simple energy-restricted diet.
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Affiliation(s)
- J L Miller
- University of Florida, Department of Pediatrics, Gainesville, FL 32608, USA.
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Cataletto M, Angulo M, Hertz G, Whitman B. Prader-Willi syndrome: A primer for clinicians. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2011; 2011:12. [PMID: 22008714 PMCID: PMC3217845 DOI: 10.1186/1687-9856-2011-12] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/18/2011] [Indexed: 01/25/2023]
Abstract
The advent of sensitive genetic testing modalities for the diagnosis of Prader-Willi syndrome has helped to define not only the phenotypic features of the syndrome associated with the various genotypes but also to anticipate clinical and psychological problems that occur at each stage during the life span. With advances in hormone replacement therapy, particularly growth hormone children born in circumstances where therapy is available are expected to have an improved quality of life as compared to those born prior to growth hormone. This manuscript was prepared as a primer for clinicians-to serve as a resource for those of you who care for children and adults with Prader-Willi syndrome on a daily basis in your practices. Appropriate and anticipatory interventions can make a difference.
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Affiliation(s)
- Mary Cataletto
- The Prader-Willi Syndrome Center at Winthrop University Hospital, 120 Mineola Blvd,-Suite 210, Mineola, N,Y, 11501, USA.
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