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Elango R. Protein Requirements in Humans: A Need for Reassessment. J Nutr 2023; 153:3355-3356. [PMID: 37918672 DOI: 10.1016/j.tjnut.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Rajavel Elango
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Gomes M, Almeida MF, Barbosa CS, Gama MI, Peres M, Pinto É, MacDonald A, Rocha JC. Total Protein Intake in Patients with PKU: Adequacy Evaluation According to the European PKU Guidelines from 2017. Nutrients 2023; 15:4883. [PMID: 38068741 PMCID: PMC10707753 DOI: 10.3390/nu15234883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
In PKU, the protein requirements are contentious. In 2018, we evaluated the protein intake in patients with PKU. Ninety-nine early treated patients aged 19.3 ± 8.2 years (54% males) were studied. A total of 24 had hyperphenylalaninemia (HPA), 48 mild and 27 classical PKU. All had an annual nutritional status evaluation. A total of 83% were on diet therapy only, and 17% were on diet with tetrahydrobiopterin therapy. Anthropometry, metabolic control and nutritional intake [total protein (TP, g/kg), natural protein (NP, g/kg), protein equivalent from protein substitutes (PE, g/kg)] were collected. TP adequacy (TPA) was calculated as a % of WHO (2007) safe levels of protein intake. Results were compared with the European PKU Guidelines (EPG). The median % contribution NP of TP intake was 53% [31-100]. Most patients (78%) had a TP intake above the EPG recommendations. The median TPA was 171% [146-203], with 79% [51-165] from NP and 84% [0-109] from PE. A TPA of 100-140% was observed in 16 (16%) patients. Only n = 6 (6%) patients had a TPA < 100%. These results emphasize the heterogeneity of PKU. More research is needed to understand the necessity of a single protein recommendation for all, as a 'one-size-fits-all' solution might not be appropriate.
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Affiliation(s)
- Melanie Gomes
- Nephrocare Portugal, Fresenius Medical Care Nutrition Departament, Rua Professor Salazar de Sousa, Lote 12, 1750-233 Lisboa, Portugal;
| | - Manuela Ferreira Almeida
- Centro de Genética Médica Jacinto Magalhães, Centro Hospitalar Universitário de Santo António, 4099-028 Porto, Portugal; (M.F.A.); catarina-s-@hotmail.com (C.S.B.)
- Centro de Referência Para as Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de Santo António, 4099-028 Porto, Portugal
- Unidade Multidisciplinar de Investigação em Biomedicina, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Catarina Sousa Barbosa
- Centro de Genética Médica Jacinto Magalhães, Centro Hospitalar Universitário de Santo António, 4099-028 Porto, Portugal; (M.F.A.); catarina-s-@hotmail.com (C.S.B.)
| | - Maria Inês Gama
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
| | - Maria Peres
- National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal;
| | - Élia Pinto
- Faculdade de Medicina, Universidade do Porto, FMUP, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | | | - Júlio César Rocha
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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McWhorter N, Ndugga-Kabuye MK, Puurunen M, Ernst SL. Complications of the Low Phenylalanine Diet for Patients with Phenylketonuria and the Benefits of Increased Natural Protein. Nutrients 2022; 14:4960. [PMID: 36500989 PMCID: PMC9740314 DOI: 10.3390/nu14234960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Phenylketonuria (PKU) is an inherited disorder in which phenylalanine (Phe) is not correctly metabolized leading to an abnormally high plasma Phe concentration that causes profound neurologic damage if left untreated. The mainstay of treatment for PKU has centered around limiting natural protein in the diet while supplementing with medical foods in order to prevent neurologic injury while promoting growth. This review discusses several deleterious effects of the low Phe diet along with benefits that have been reported for patients with increased natural protein intake while maintaining plasma Phe levels within treatment guidelines.
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Optimising amino acid absorption: essential to improve nitrogen balance and metabolic control in phenylketonuria. Nutr Res Rev 2018; 32:70-78. [PMID: 30284526 PMCID: PMC6536823 DOI: 10.1017/s0954422418000173] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
It has been nearly 70 years since the discovery that strict adherence to a diet low in phenylalanine prevents severe neurological sequelae in patients with phenylalanine hydroxylase deficiency (phenylketonuria; PKU). Today, dietary treatment with restricted phenylalanine intake supplemented with non-phenylalanine amino acids to support growth and maintain a healthy body composition remains the mainstay of therapy. However, a better understanding is needed of the factors that influence N balance in the context of amino acid supplementation. The aim of the present paper is to summarise considerations for improving N balance in patients with PKU, with a focus on gaining greater understanding of amino acid absorption, disposition and utilisation. In addition, the impact of phenylalanine-free amino acids on 24 h blood phenylalanine/tyrosine circadian rhythm is evaluated. We compare the effects of administering intact protein v. free amino acid on protein metabolism and discuss the possibility of improving outcomes by administering amino acid mixtures so that their absorption profile mimics that of intact protein. Protein substitutes with the ability to delay absorption of phenylalanine and tyrosine, mimicking physiological absorption kinetics, are expected to improve the rate of assimilation into protein and minimise fluctuations in quantitative plasma amino acid levels. They may also help maintain normal glycaemia and satiety sensation. This is likely to play an important role in improving the management of patients with PKU.
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