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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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Daly A, Adam S, Allen H, Ash J, Dale C, Dixon M, Dunlop C, Ellerton C, Evans S, Firman S, Ford S, Freedman F, Gribben J, Howe S, Khan F, McDonald J, McStravick N, Nguyen P, Oxley N, Skeath R, Simpson E, Terry A, Woodall A, White L, MacDonald A. UK Dietary Practices for Tyrosinaemias: Time for Change. Nutrients 2022; 14:nu14245202. [PMID: 36558364 PMCID: PMC9787818 DOI: 10.3390/nu14245202] [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: 10/08/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
In the UK, different dietary systems are used to calculate protein or tyrosine/phenylalanine intake in the dietary management of hereditary tyrosinaemia, HTI, II and III (HT), with no systematic evidence comparing the merits and inadequacies of each. This study aimed to examine the current UK dietary practices in all HTs and, using Delphi methodology, to reach consensus agreement about the best dietary management system. Over 12 months, five meetings were held with UK paediatric and adult dietitians working in inherited metabolic disorders (IMDs) managing HTs. Eleven statements on the dietary system for calculating protein or tyrosine/phenylalanine intake were discussed. Dietitians from 12 of 14 IMD centres caring for HT patients participated, and 7/11 statements were agreed with one Delphi round. Nine centres (three abstentions) supported a 1 g protein exchange system for all foods except fruit and vegetables. The same definitions used in the UK for phenylketonuria (PKU) were adopted to define when to calculate foods as part of a protein exchange system or permit them without measurement. Fruit and vegetables contain a lower amount of tyrosine/phenylalanine per 1 g of protein than animal and cereal foods. The correlation of tyrosine vs. phenylalanine (mg/100 g) for vegetables and fruits was high (r = 0.9). In Delphi round 2, agreement was reached to use the tyrosine/phenylalanine analyses of fruits/vegetables, for their allocation within the HT diet. This allowed larger portion sizes of measured fruits and vegetables and increased the variety of fruit and vegetables that could be eaten without measurement. In HTs, a combined dietary management system will be used: 1 g protein exchanges for cereal and milk protein sources and tyrosine/phenylalanine exchanges for fruit and vegetables. Intensive, systematic communication with IMD dietitians and reappraisal of the evidence has redefined and harmonised HT dietary practice across the UK.
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Affiliation(s)
- Anne Daly
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
- Correspondence:
| | - Sarah Adam
- Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Heather Allen
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Jane Ash
- University Hospital of Wales, Cardiff CF4 4XW, UK
| | - Clare Dale
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Marjorie Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | | | - Charlotte Ellerton
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Sarah Firman
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EU, UK
| | - Suzanne Ford
- Southmead Hospital North Bristol Trust, Bristol BS10 5NB, UK
| | - Francine Freedman
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Joanna Gribben
- Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Sara Howe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Farzana Khan
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford BD5 0NA, UK
| | - Joy McDonald
- Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | | | - Patty Nguyen
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Natalia Oxley
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford BD5 0NA, UK
| | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Emma Simpson
- Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
| | - Allyson Terry
- Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Alison Woodall
- Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Lucy White
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
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Efficacy of a New Low-Protein Multimedia Diet App for PKU. Nutrients 2022; 14:nu14112182. [PMID: 35683982 PMCID: PMC9182776 DOI: 10.3390/nu14112182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with phenylketonuria (PKU) require a phenylalanine/protein-restricted diet, with limited food choice. Interpreting food labels, calculating protein intake, and determining food suitability are complex and confusing tasks. A mobile multi-media low-protein diet app was developed to guide food choice, label interpretation, and protein calculation. ‘PKU Bite’® includes >1100 specialist and regular low-protein foods, is colour-coded for suitability, and features a protein calculator. A 12-week randomised controlled trial assessed app efficacy, compared with written/pictorial material, in 60 parents/caregivers of children with PKU, aged 1−16 years, and 21 adolescents with PKU. Questionnaires examined self-efficacy and label-reading knowledge; food records evaluated natural-protein intake, compared with prescriptions. There was no difference between groups in label-reading knowledge or self-efficacy, but there was a trend for improved accuracy of dietary protein calculation, when using the app (baseline/12-weeks: app 35%/48%; control 39%/35%). Parents of children <10 years of age (median 5.5 years), were most likely to use the app to check the phenylalanine/protein content of a food or to verify suitability of foods. Whilst the app was popular (43%), so too was contacting the dietitian (43%), using written/pictorial information (24%), or using social media (18%). This is the first dietary app for PKU to be studied in a systematic way as well as validated by healthcare professionals. It is a useful adjunct to existing resources and will be a valuable tool for educating parents of younger children.
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Nitrogen Balance after the Administration of a Prolonged-Release Protein Substitute for Phenylketonuria as a Single Dose in Healthy Volunteers. Nutrients 2021; 13:nu13093189. [PMID: 34579066 PMCID: PMC8466970 DOI: 10.3390/nu13093189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 01/21/2023] Open
Abstract
Nitrogen balance is the difference between nitrogen excreted as urea and nitrogen ingested, mainly in proteins. Increased circulating concentrations of amino acids (AA) in the bloodstream are usually associated with proportional increases in the production and excretion of urea. Previously, we reported results from a randomized, controlled, single-dose, crossover trial in healthy adult volunteers (n = 30) (Trial Registration: ISRCTN11016729), in which a Test product (prolonged-release AA mixture formulated with Physiomimic Technology™ (PT™)) significantly slowed down the release and reduced the peak plasma concentrations of essential AAs compared with a free AA mixture (Reference product) while maintaining essential AA bioavailability. Here, we report an assessment of the nitrogen balance from the same study. The amount of nitrogen contained in plasma AAs, levels of blood urea nitrogen (BUN) (p < 0.0001) and changes in BUN (p < 0.0001) were smaller after the Test product compared with the Reference product. These findings suggest that the production of urea in proportion to systemic AA availability was significantly smaller after the administration of the Test product compared with the Reference product and that the test product conferred the increased utilization of AAs for protein synthesis and reduced their oxidation and conversion to urea. In the clinical setting, it is possible that the effects of PT™ observed on the disposition of free AAs in this study may translate to health benefits in terms of physiological body composition and growth if used for the treatment of subjects with phenylketonuria (PKU). Further investigation in patients with PKU is warranted.
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Kraleva D, Evans S, Pinto A, Daly A, Ashmore C, Pointon-Bell K, Rocha JC, MacDonald A. Protein Labelling Accuracy for UK Patients with PKU Following a Low Protein Diet. Nutrients 2020; 12:nu12113440. [PMID: 33182603 PMCID: PMC7696494 DOI: 10.3390/nu12113440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 01/02/2023] Open
Abstract
A phenylalanine (protein)-restricted diet is the primary treatment for phenylketonuria (PKU). Patients are dependent on food protein labelling to successfully manage their condition. We evaluated the accuracy of protein labelling on packaged manufactured foods from supermarket websites for foods that may be eaten as part of a phenylalanine-restricted diet. Protein labelling information was evaluated for 462 food items (“free from”, n = 159, regular, n = 303), divided into 16 food groups using supermarket website data. Data collection included protein content per portion/100 g when food was “as sold”, “cooked” or “prepared”; cooking methods, and preparation instructions. Labelling errors affecting protein content were observed in every food group, with overall protein labelling unclear in 55% (n = 255/462) of foods. There was misleading, omitted, or erroneous (MOE) information in 43% (n = 68/159) of “free from” foods compared with 62% (n = 187/303) of regular foods, with fewer inaccuracies in “free from” food labelling (p = 0.007). Protein analysis was available for uncooked weight only but not cooked weight for 58% (n = 85/146) of foods; 4% (n = 17/462) had misleading protein content. There was a high rate of incomplete, misleading, or inaccurate data affecting the interpretation of the protein content of food items on supermarket websites. This could adversely affect metabolic control of patients with PKU and warrants serious consideration.
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Affiliation(s)
- Dilyana Kraleva
- Faculty of Health, Education & Life Sciences, Birmingham City University City South Campus, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK; (D.K.); (K.P.-B.)
| | - Sharon Evans
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.P.); (A.D.); (C.A.)
| | - Alex Pinto
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.P.); (A.D.); (C.A.)
| | - Anne Daly
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.P.); (A.D.); (C.A.)
| | - Catherine Ashmore
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.P.); (A.D.); (C.A.)
| | - Kiri Pointon-Bell
- Faculty of Health, Education & Life Sciences, Birmingham City University City South Campus, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK; (D.K.); (K.P.-B.)
| | - Júlio César Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal;
- Center for Health Technology and Services Research (CINTESIS), R. Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Anita MacDonald
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.P.); (A.D.); (C.A.)
- Correspondence:
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Uniformity of Food Protein Interpretation Amongst Dietitians for Patients with Phenylketonuria (PKU): 2020 UK National Consensus Statements. Nutrients 2020; 12:nu12082205. [PMID: 32722073 PMCID: PMC7468820 DOI: 10.3390/nu12082205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
In phenylketonuria (PKU), variable dietary advice provided by health professionals and social media leads to uncertainty for patients/caregivers reliant on accurate, evidence based dietary information. Over four years, 112 consensus statements concerning the allocation of foods in a low phenylalanine diet for PKU were developed by the British Inherited Metabolic Disease Dietitians Group (BIMDG-DG) from 34 PKU treatment centres, utilising 10 rounds of Delphi consultation to gain a majority (≥75%) decision. A mean of 29 UK dietitians (range: 18-40) and 18 treatment centres (range: 13-23) contributed in each round. Statements encompassed all foods/food groups divided into four categories based on defined protein/phenylalanine content: (1) foods high in protein/phenylalanine (best avoided); (2) foods allowed without restriction including fruit/vegetables containing phenylalanine ≤75 mg/100 g and most foods containing protein ≤0.5 g/100 g; (3) foods that should be calculated/weighed as an exchange food if they contain protein exchange ingredients (categorized into foods with a protein content of: >0.1 g/100 g (milk/plant milks only), >0.5 g/100 g (bread/pasta/cereal/flours), >1 g/100 g (cook-in/table-top sauces/dressings), >1.5 g/100 g (soya sauces)); and (4) fruit/vegetables containing phenylalanine >75 mg/100 g allocated as part of the protein/phenylalanine exchange system. These statements have been endorsed and translated into practical dietary management advice by the medical advisory dietitians for the National Society for PKU (NSPKU).
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MacDonald A, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts SC, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz F, van Spronsen FJ. PKU dietary handbook to accompany PKU guidelines. Orphanet J Rare Dis 2020; 15:171. [PMID: 32605583 PMCID: PMC7329487 DOI: 10.1186/s13023-020-01391-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism caused by deficiency in the enzyme phenylalanine hydroxylase that converts phenylalanine into tyrosine. Main body In 2017 the first European PKU Guidelines were published. These guidelines contained evidence based and/or expert opinion recommendations regarding diagnosis, treatment and care for patients with PKU of all ages. This manuscript is a supplement containing the practical application of the dietary treatment. Conclusion This handbook can support dietitians, nutritionists and physicians in starting, adjusting and maintaining dietary treatment.
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Affiliation(s)
- A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A M J van Wegberg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands
| | - K Ahring
- Department of PKU, Kennedy Centre, Glostrup, Denmark
| | - S Beblo
- Department of Women and Child Health, Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, University Hospitals, Leipzig, Germany
| | - A Bélanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Hospital Ramon y Cajal Madrid, Madrid, Spain
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - T Coşkun
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Feillet
- Department of Paediatrics, Hôpital d'Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, France
| | - M Giżewska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - V Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185, Rome, Italy
| | - F Maillot
- CHRU de Tours, Université François Rabelais, INSERM U1069, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - J C Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F Trefz
- Department of Paediatrics, University of Heidelberg, Heidelberg, Germany
| | - F J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
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Wood G, Evans S, Pointon-Bell K, Rocha JC, MacDonald A. Special Low Protein Foods in the UK: An Examination of Their Macronutrient Composition in Comparison to Regular Foods. Nutrients 2020; 12:E1893. [PMID: 32630585 PMCID: PMC7353443 DOI: 10.3390/nu12061893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Special low protein foods (SLPFs) are essential in a low phenylalanine diet for treating phenylketonuria (PKU). With little known about their nutritional composition, all SLPFs on UK prescription were studied (n = 146) and compared to equivalent protein-containing foods (n = 190). SLPF nutritional analysis was obtained from suppliers/manufacturers. Comparable information about regular protein-containing foods was obtained from online UK supermarkets. Similar foods were grouped together, with mean nutritional values calculated for each subgroup (n = 40) and percentage differences determined between SLPFs and regular food subgroups. All SLPF subgroups contained 43-100% less protein than regular foods. Sixty-three percent (n = 25/40) of SLPF subgroups contained less total fat with palm oil (25%, n = 36/146) and hydrogenated vegetable oil (23%, n = 33/146) key fat sources. Sixty-eight percent (n = 27/40) of SLPF subgroups contained more carbohydrate, with 72% (n = 105/146) containing added sugar. Key SLPF starch sources were maize/corn (72%; n = 105/146). Seventy-seven percent (n = 113/146) of SLPFs versus 18% (n = 34/190) of regular foods contained added fibre, predominantly hydrocolloids. Nine percent of SLPFs contained phenylalanine > 25 mg/100 g and sources of phenylalanine/protein in their ingredient lists. Stricter nutritional composition regulations for SLPFs are required, identifying maximum upper limits for macronutrients and phenylalanine, and fat and carbohydrate sources that are associated with healthy outcomes.
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Affiliation(s)
- Georgina Wood
- Faculty of Health, Education & Life Sciences, Birmingham City University, City South Campus, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK;
| | - Sharon Evans
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.M.)
| | - Kiri Pointon-Bell
- Faculty of Health, Education & Life Sciences, Birmingham City University, City South Campus, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK;
| | - Júlio César Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal;
- Center for Health Technology and Services Research (CINTESIS), R. Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Anita MacDonald
- Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; (S.E.); (A.M.)
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