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Daly A, Pinto A, Evans S, Almeida M, Assoun M, Belanger-Quintana A, Bernabei S, Bollhalder S, Cassiman D, Champion H, Chan H, Dalmau J, de Boer F, de Laet C, de Meyer A, Desloovere A, Dianin A, Dixon M, Dokoupil K, Dubois S, Eyskens F, Faria A, Fasan I, Favre E, Feillet F, Fekete A, Gallo G, Gingell C, Gribben J, Kaalund Hansen K, Ter Horst N, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs G, Kok I, Kowalik A, Laguerre C, Le Verge S, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Och U, Robert M, Rocha J, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Skeath R, Stolen L, Terry A, Timmer C, Tomlinson L, Tooke A, Vande Kerckhove K, van Dam E, van den Hurk T, van der Ploeg L, van Driessche M, van Rijn M, van Wegberg A, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White F, White L, Zweers H, MacDonald A. Dietary practices in propionic acidemia: A European survey. Mol Genet Metab Rep 2017; 13:83-89. [PMID: 29021961 PMCID: PMC5633157 DOI: 10.1016/j.ymgmr.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background The definitive dietary management of propionic acidaemia (PA) is unknown although natural protein restriction with adequate energy provision is of key importance. Aim To describe European dietary practices in the management of patients with PA prior to the publication of the European PA guidelines. Methods This was a cross-sectional survey consisting of 27 questions about the dietary practices in PA patients circulated to European IMD dietitians and health professionals in 2014. Results Information on protein restricted diets of 186 PA patients from 47 centres, representing 14 European countries was collected. Total protein intake [PA precursor-free L-amino acid supplements (PFAA) and natural protein] met WHO/FAO/UNU (2007) safe protein requirements for age in 36 centres (77%). PFAA were used to supplement natural protein intake in 81% (n = 38) of centres, providing a median of 44% (14–83%) of total protein requirement. Seventy-four per cent of patients were prescribed natural protein intakes below WHO/FAO/UNU (2007) safe levels in one or more of the following age groups: 0–6 m, 7–12 m, 1–10 y, 11–16 y and > 16 y. Sixty-three per cent (n = 117) of patients were tube fed (74% gastrostomy), but only 22% received nocturnal feeds. Conclusions There was high use of PFAA with intakes of natural protein commonly below WHO/FAO/UNU (2007) safe levels. Optimal dietary management can only be determined by longitudinal, multi-centre, prospective case controlled studies. The metabolic instability of PA and small patient cohorts in each centre ensure that this is a challenging undertaking.
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Affiliation(s)
- A. Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A. Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S. Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M.F. Almeida
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal
| | - M. Assoun
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - A. Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S.M. Bernabei
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - D. Cassiman
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | | | - H. Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J. Dalmau
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - F. de Boer
- University of Groningen, University Medical Center Groningen, Netherlands
| | - C. de Laet
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - A. de Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - A. Dianin
- Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, University Hospital of Verona, Italy
| | - M. Dixon
- Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | - K. Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S. Dubois
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - F. Eyskens
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A. Faria
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - I. Fasan
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - E. Favre
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - F. Feillet
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | | | - G. Gallo
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - J. Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K. Kaalund Hansen
- Charles Dent Metabolic Unit National Hospital for Neurology and Surgery, London, UK
| | | | - C. Jankowski
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I. Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - G.E. Kahrs
- Haukeland University Hospital, Bergen, Norway
| | - I.L. Kok
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - A. Kowalik
- Institute of Mother & Child, Warsaw, Poland
| | - C. Laguerre
- Centre de Compétence de L'Hôpital des Enfants de Toulouse, France
| | - S. Le Verge
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - R. Lilje
- Oslo University Hospital, Norway
| | - C. Maddalon
- University Children's Hospital Zurich, Switzerland
| | - D. Mayr
- Ernährungsmedizinische Beratung, Universitätsklinik für Kinder- und Jugendheilkunde, Salzburg, Austria
| | - U. Meyer
- Clinic of Paediatric Kidney, Liver- and Metabolic Diseases, Medical School Hannover, Germany
| | - A. Micciche
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - U. Och
- University Children's Hospital, Munster, Germany
| | - M. Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - J.C. Rocha
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar do Porto - CHP, Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Portugal
| | | | - C. Rohde
- Hospital of Children's & Adolescents, University of Leipzig, Germany
| | - K. Ross
- Royal Aberdeen Children's Hospital, Scotland
| | - I. Saruggia
- Centre de Reference des Maladies Héréditaires du Métabolisme du Pr. B. Chabrol CHU Timone Enfant, Marseille, France
| | - A. Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | | | - E. Sjoqvist
- Children's Hospital, University Hospital, Lund, Sweden
| | - R. Skeath
- Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | | | - A. Terry
- Alder Hey Children's Hospital NHS Foundation Trust Liverpool, UK
| | - C. Timmer
- Academisch Medisch Centrum, Amsterdam, Netherlands
| | - L. Tomlinson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A. Tooke
- Nottingham University Hospitals, UK
| | | | - E. van Dam
- University of Groningen, University Medical Center Groningen, Netherlands
| | - T. van den Hurk
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | | | | | - M. van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | - C. Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | - I. Vitoria
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - D. Webster
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - F.J. White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - L. White
- Sheffield Children's Hospital, UK
| | - H. Zweers
- Radboud University Medical Center Nijmegen, Netherlands
| | - A. MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
- Corresponding author at: Dietetic Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.Dietetic DepartmentBirmingham Children's HospitalSteelhouse LaneBirminghamB4 6NHUK
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Merinero B, Alcaide P, Martín-Hernández E, Morais A, García-Silva MT, Quijada-Fraile P, Pedrón-Giner C, Dulin E, Yahyaoui R, Egea JM, Belanger-Quintana A, Blasco-Alonso J, Fernandez Ruano ML, Besga B, Ferrer-López I, Leal F, Ugarte M, Ruiz-Sala P, Pérez B, Pérez-Cerdá C. Four Years' Experience in the Diagnosis of Very Long-Chain Acyl-CoA Dehydrogenase Deficiency in Infants Detected in Three Spanish Newborn Screening Centers. JIMD Rep 2017; 39:63-74. [PMID: 28755359 DOI: 10.1007/8904_2017_40] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022] Open
Abstract
Identification of very long-chain acyl-CoA dehydrogenase deficiency is possible in the expanded newborn screening (NBS) due to the increase in tetradecenoylcarnitine (C14:1) and in the C14:1/C2, C14:1/C16, C14:1/C12:1 ratios detected in dried blood spots. Nevertheless, different confirmatory tests must be performed to confirm the final diagnosis. We have revised the NBS results and the results of the confirmatory tests (plasma acylcarnitine profiles, molecular findings, and lymphocytes VLCAD activity) for 36 cases detected in three Spanish NBS centers during 4 years, correlating these with the clinical outcome and treatment. Our aim was to distinguish unambiguously true cases from disease carriers in order to obtain useful diagnostic information for clinicians that can be applied in the follow-up of neonates identified by NBS.Increases in C14:1 and of the different ratios, the presence of two pathogenic mutations, and deficient enzyme activity in lymphocytes (<12% of the intra-assay control) identified 12 true-positive cases. These cases were given nutritional therapy and all of them are asymptomatic, except one. Seventeen individuals were considered disease carriers based on the mild increase in plasma C14:1, in conjunction with the presence of only one mutation and/or intermediate residual activity (18-57%). In addition, seven cases were classified as false positives, with normal biochemical parameters and no mutations in the exonic region of ACADVL. All these carriers and the false positive cases remained asymptomatic. The combined evaluation of the acylcarnitine profiles, genetic results, and residual enzyme activities have proven useful to definitively classify individuals with suspected VLCAD deficiency into true-positive cases and carriers, and to decide which cases need treatment.
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Affiliation(s)
- B Merinero
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain.
| | - P Alcaide
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - E Martín-Hernández
- Departamento de Pediatría, Unidad de Enfermedades Mitocondriales-Metabólicas Hereditarias, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, CIBERER, Madrid, Spain
| | - A Morais
- Unidad de Nutrición Infantil y Enfermedades Metabólicas, Hospital Universitario Infantil La Paz, Madrid, Spain
| | - M T García-Silva
- Departamento de Pediatría, Unidad de Enfermedades Mitocondriales-Metabólicas Hereditarias, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, CIBERER, Madrid, Spain
| | - P Quijada-Fraile
- Departamento de Pediatría, Unidad de Enfermedades Mitocondriales-Metabólicas Hereditarias, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, CIBERER, Madrid, Spain
| | - C Pedrón-Giner
- Sección de Gastroenterología y Nutrición, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - E Dulin
- Laboratorio de Cribado Neonatal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Yahyaoui
- Laboratorio de Metabolopatías, Hospital Regional de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - J M Egea
- Centro de Bioquímica y Genética Clínica, Unidad de Metabolopatías, Hospital General Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A Belanger-Quintana
- Unidad de Enfermedades Metabólicas, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Blasco-Alonso
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Regional de Málaga, Málaga, Spain
| | - M L Fernandez Ruano
- Laboratorio de Cribado Neonatal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - B Besga
- Laboratorio de Cribado Neonatal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Ferrer-López
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - F Leal
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - M Ugarte
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - P Ruiz-Sala
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - B Pérez
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
| | - C Pérez-Cerdá
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular-SO UAM-CSIC, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IdiPAZ, Madrid, Spain
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3
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Pinto A, Daly A, Evans S, Almeida MF, Assoun M, Belanger-Quintana A, Bernabei S, Bollhalder S, Cassiman D, Champion H, Chan H, Dalmau J, de Boer F, de Laet C, de Meyer A, Desloovere A, Dianin A, Dixon M, Dokoupil K, Dubois S, Eyskens F, Faria A, Fasan I, Favre E, Feillet F, Fekete A, Gallo G, Gingell C, Gribben J, Kaalund-Hansen K, Horst N, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs GE, Kok IL, Kowalik A, Laguerre C, Le Verge S, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Robert M, Rocha JC, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Stolen LH, Terry A, Timmer C, Tomlinson L, Tooke A, Vande Kerckhove K, van Dam E, van den Hurk T, van der Ploeg L, van Driessche M, van Rijn M, van Teeffelen-Heithoff A, van Wegberg A, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White FJ, White L, Zweers H, MacDonald A. Dietary practices in isovaleric acidemia: A European survey. Mol Genet Metab Rep 2017; 12:16-22. [PMID: 28275552 PMCID: PMC5328917 DOI: 10.1016/j.ymgmr.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background In Europe, dietary management of isovaleric acidemia (IVA) may vary widely. There is limited collective information about dietetic management. Aim To describe European practice regarding the dietary management of IVA, prior to the availability of the E-IMD IVA guidelines (E-IMD 2014). Methods A cross-sectional questionnaire was sent to all European dietitians who were either members of the Society for the Study of Inborn Errors of Metabolism Dietitians Group (SSIEM-DG) or whom had responded to previous questionnaires on dietetic practice (n = 53). The questionnaire comprised 27 questions about the dietary management of IVA. Results Information on 140 patients with IVA from 39 centres was reported. 133 patients (38 centres) were given a protein restricted diet. Leucine-free amino acid supplements (LFAA) were routinely used to supplement protein intake in 58% of centres. The median total protein intake prescribed achieved the WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Centres that prescribed LFAA had lower natural protein intakes in most age groups except 1 to 10 y. In contrast, when centres were not using LFAA, the median natural protein intake met WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Enteral tube feeding was rarely prescribed. Conclusions This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.
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Affiliation(s)
- A Pinto
- Birmingham Children's Hospital, Birmingham, UK
| | - A Daly
- Birmingham Children's Hospital, Birmingham, UK
| | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - M F Almeida
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal
| | - M Assoun
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - A Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S Bernabei
- Children's Hospital Bambino Gesù, Division of Metabolism, Rome, Italy
| | | | - D Cassiman
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | | | - H Chan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Dalmau
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - F de Boer
- University of Groningen, University Medical Center Groningen, Netherlands
| | - C de Laet
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - A de Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - A Dianin
- Pediatric Department, University Hospital of Borgo Roma Verona, Italy
| | - M Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | - S Dubois
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - F Eyskens
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A Faria
- Hospital Pediatrico, Centro Hospitalar e Universitário de Coimbra, EPE, Portugal
| | - I Fasan
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Italy
| | - E Favre
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - F Feillet
- Reference center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - A Fekete
- Metabolic Centre of Vienna, Austria
| | - G Gallo
- Children's Hospital Bambino Gesù, Division of Metabolism, Rome, Italy
| | | | - J Gribben
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Kaalund-Hansen
- Charles Dent Metabolic Unit National Hospital for Neurology and Surgery, London, UK
| | - N Horst
- Emma Children's Hospital, AMC Amsterdam, Netherlands
| | - C Jankowski
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | | | - I Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - G E Kahrs
- Haukeland University Hospital, Bergen, Norway
| | - I L Kok
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - A Kowalik
- Institute of Mother & Child, Warsaw, Poland
| | - C Laguerre
- Centre de Compétence de L'Hôpital des Enfants de Toulouse, France
| | - S Le Verge
- Centre de référence des maladies héréditaires du métabolisme, hôpital Necker enfants Malades, Paris
| | - R Lilje
- Oslo University Hospital, Norway
| | - C Maddalon
- University Children's Hospital Zurich, Switzerland
| | - D Mayr
- Ernährungsmedizinische Beratung, Universitätsklinik für Kinder- und Jugendheilkunde, Salzburg, Austria
| | - U Meyer
- Clinic of Paediatric Kidney, Liver and Metabolic Diseases, Medical School Hannover, Germany
| | - A Micciche
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - J C Rocha
- Centro de Genética Médica, Centro Hospitalar do Porto - CHP, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Portugal; Centre for Health Technology and Services Research (CINTESIS), Portugal
| | - H Rogozinski
- Bradford Teaching Hospital NHS Foundation Trust, UK
| | - C Rohde
- Hospital of Children's & Adolescents, University of Leipzig, Germany
| | - K Ross
- Royal Aberdeen Children's Hospital, Scotland
| | - I Saruggia
- Centre de Reference des Maladies Héréditaires du Métabolisme du Pr. B. Chabrol CHU Timone Enfant, Marseille, France
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | | | - E Sjoqvist
- Children's Hospital, University Hospital, Lund, Sweden
| | | | - A Terry
- Alder Hey Children's Hospital NHS Foundation Trust Liverpool, UK
| | - C Timmer
- Academisch Medisch Centrum, Amsterdam, Netherlands
| | - L Tomlinson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Tooke
- Nottingham University Hospitals, UK
| | - K Vande Kerckhove
- Metabolic Center, University Hospitals Leuven and KU Leuven, Belgium
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Netherlands
| | - T van den Hurk
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Netherlands
| | - L van der Ploeg
- Maastricht University Medical Centre + (MUMC +), Netherlands
| | | | - M van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | - A van Wegberg
- Radboud University Medical Center Nijmegen, The Netherlands
| | - C Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | - I Vitoria
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - D Webster
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - F J White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - L White
- Sheffield Children's Hospital, UK
| | - H Zweers
- Radboud University Medical Center Nijmegen, The Netherlands
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK
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4
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MacDonald A, Ahring K, Almeida MF, Belanger-Quintana A, Blau N, Burlina A, Cleary M, Coskum T, Dokoupil K, Evans S, Feillet F, Giżewska M, Gokmen Ozel H, Lotz-Havla AS, Kamieńska E, Maillot F, Lammardo AM, Muntau AC, Puchwein-Schwepcke A, Robert M, Rocha JC, Santra S, Skeath R, Strączek K, Trefz FK, van Dam E, van Rijn M, van Spronsen F, Vijay S. The challenges of managing coexistent disorders with phenylketonuria: 30 cases. Mol Genet Metab 2015; 116:242-51. [PMID: 26498184 DOI: 10.1016/j.ymgme.2015.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The few published case reports of co-existent disease with phenylketonuria (PKU) are mainly genetic and familial conditions from consanguineous marriages. The clinical and demographic features of 30 subjects with PKU and co-existent conditions were described in this multi-centre, retrospective cohort study. METHODS Diagnostic age of PKU and co-existent condition, treatment regimen, and impact of co-existent condition on blood phenylalanine (Phe) control and PKU management were reported. RESULTS 30 patients (11 males and 19 females), with PKU and a co-existent condition, current median age of 14 years (range 0.4 to 40 years) from 13 treatment centres from Europe and Turkey were described. There were 21 co-existent conditions with PKU; 9 were autoimmune; 6 gastrointestinal, 3 chromosomal abnormalities, and 3 inherited conditions. There were only 5 cases of parental consanguinity. Some patients required conflicting diet therapy (n=5), nutritional support (n=7) and 5 children had feeding problems. There was delayed diagnosis of co-existent conditions (n=3); delayed treatment of PKU (n=1) and amenorrhea associated with Grave's disease that masked a PKU pregnancy for 12 weeks. Co-existent conditions adversely affected blood Phe control in 47% (n=14) of patients. Some co-existent conditions increased the complexity of disease management and increased management burden for patients and caregivers. CONCLUSIONS Occurrence of co-existent disease is not uncommon in patients with PKU and so investigation for co-existent disorders when the clinical history is not completely consistent with PKU is essential. Integrating care of a second condition with PKU management is challenging.
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Affiliation(s)
| | - K Ahring
- Center for PKU, The Kennedy Centre, University Hospital, Glostrup, Copenhagen, Denmark
| | - M F Almeida
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, Porto, Portugal
| | | | - N Blau
- Dietmar-Hopp Metabolic Center, University Children's Hospital, Heidelberg, Germany
| | - A Burlina
- Division of Inherited Metabolic Diseases, University Hospital, Padua, Italy
| | - M Cleary
- Hospital for Sick Children, Great Ormond Street, London, UK
| | - T Coskum
- Department of Inherited Metabolic Disorders, Hacettepe University, Ankara, Turkey
| | - K Dokoupil
- Department of Metabolism and Nutrition, Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - S Evans
- The Children's Hospital, Birmingham, UK
| | - F Feillet
- Hôpital d'enfants Brabois, Vandoeuvre les Nancy, France
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - H Gokmen Ozel
- Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
| | - A S Lotz-Havla
- Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - E Kamieńska
- Department of Paediatrics and Haematology, Pomeranian Medical University, Szczecin, Poland
| | - F Maillot
- CHRU de Tours, service de medicine interne, Université François Rabelais, Tours, France
| | - A M Lammardo
- Depart Ped, San Paolo Hosp Univ Milan, Milan, Italy
| | - A C Muntau
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - M Robert
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - J C Rocha
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - S Santra
- The Children's Hospital, Birmingham, UK
| | - R Skeath
- Hospital for Sick Children, Great Ormond Street, London, UK
| | - K Strączek
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - F K Trefz
- Division of Inborn Metabolic Diseases, University Children's Hospital, Heidelberg, Germany
| | - E van Dam
- Section of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - M van Rijn
- Section of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - F van Spronsen
- Section of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - S Vijay
- The Children's Hospital, Birmingham, UK
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Belanger-Quintana A, Dokoupil K, Gokmen-Ozel H, Lammardo AM, MacDonald A, Motzfeldt K, Nowacka M, Robert M, van Rijn M, Ahring K. Diet in phenylketonuria: a snapshot of special dietary costs and reimbursement systems in 10 international centers. Mol Genet Metab 2012; 105:390-4. [PMID: 22217429 DOI: 10.1016/j.ymgme.2011.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND AIMS To gather exploratory data on the costs and reimbursement of special dietary foods used in the management of phenylketonuria (PKU) from ten international specialist PKU centers. METHODS Experts from each center provided data on retail costs of the three most frequently used phenylalanine-free protein substitutes and low-protein foods at their center; reimbursement of protein substitutes and low-protein foods; and state monetary benefits provided to PKU patients. RESULTS The mean annual cost of protein substitutes across 4 age groups (2 y, 8 y, 15 y and adults) ranged from €4273 to €21,590 per patient. The cost of low-protein products also differed; the mean cost of low-protein bread varied from €0.04 to €1.60 per 100 kcal. All protein substitutes were either fully reimbursed or covered by health insurance. However, reimbursement for low-protein products varied and state benefits differed between centers. CONCLUSIONS The variation in the cost and reimbursement of diet therapy and the level of additional state benefits for PKU patients demonstrates the large difference in expenditure on and access to PKU dietary products. This highlights the inequality between healthcare systems and access to special dietary products for people with PKU, ultimately leading to patients in some countries receiving better care than others.
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Affiliation(s)
- A Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatría, Hospital Ramón y Cajal, Madrid, Spain
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6
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Abstract
Phenylketonuria (PKU) is characterized by persistent hyperphenylalaninemia, due to mutations in the gene coding for phenylalanine hydroxylase (PAH). If untreated, patients develop profound mental retardation. The principal treatment for PKU is lifelong dietary phenylalanine restriction, requiring the administration of special phenylalanine-free protein supplements. Adhering to the diet is burdensome, and poor compliance and control of blood phenylalanine are common, especially in adolescents and adults. A subset of patients, particularly those with milder forms of PKU, shows a clinically significant reduction in blood phenylalanine when treated with pharmacological doses of tetrahydrobiopterin, the cofactor of PAH. A tablet formulation of sapropterin dihydrochloride is approved for therapeutic use in Europe and the USA. Clinical trials have demonstrated durable reductions in blood phenylalanine, and/or increased dietary phenylalanine tolerance, in some patients with hyperphenylalaninemia due to PKU. Although further data are needed, especially with regard to long-term neuropsychological outcomes or possible use in pregnancy, sapropterin appears to represent a useful addition to the management of PKU.
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Affiliation(s)
- F K Trefz
- Klinik fur Kinder und Jugendmedizin Reutlingen, Reutlingen, Germany.
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7
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Merinero B, Pérez-Cerdá C, Ruiz Sala P, Ferrer I, García MJ, Martínez Pardo M, Belanger-Quintana A, de la Mota JL, Martin-Hernández E, Vianey-Saban C, Bischoff C, Gregersen N, Ugarte M. Persistent increase of plasma butyryl/isobutyrylcarnitine concentrations as marker of SCAD defect and ethylmalonic encephalopathy. J Inherit Metab Dis 2006; 29:685. [PMID: 16906473 DOI: 10.1007/s10545-006-0342-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 06/22/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
High concentrations of butyryl/isobutyrylcarnitine (C(4)-carnitine) in plasma with increase of ethylmalonic acid (EMA) in urine point to different genetic entities, and further investigations are required to differentiate the possible underlying defect. Here we report three unrelated cases, two neurologically affected and one asymptomatic, with this abnormal metabolite pattern due either to mutations in the ETHE1 gene or to a short-chain acyl-CoA dehydrogenase (SCAD) defect.
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Affiliation(s)
- B Merinero
- Centro de Diagnóstico de Enfermedades Moleculares, Departamento de Biología Molecular, Facultad Ciencias, Universidad Autónoma de Madrid, 28049, Madrid, Spain.
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