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Wood G, Pinto A, Evans S, Daly A, Adams S, Costelloe S, Gribben J, Ellerton C, Emm A, Firman S, Ford S, French M, Gaff L, Giuliano E, Hill M, Hunjan I, Newby C, Mackenzie A, Pereira R, Prescott C, Robertson L, Seabert H, Skeath R, Tapley S, Terry A, Tooke A, van Wyk K, White FJ, White L, Woodall A, Rocha JC, MacDonald A. Special Low Protein Foods Prescribed in England for PKU Patients: An Analysis of Prescribing Patterns and Cost. Nutrients 2021; 13:nu13113977. [PMID: 34836232 PMCID: PMC8620831 DOI: 10.3390/nu13113977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with phenylketonuria (PKU) are reliant on special low protein foods (SLPFs) as part of their dietary treatment. In England, several issues regarding the accessibility of SLPFs through the national prescribing system have been highlighted. Therefore, prescribing patterns and expenditure on all SLPFs available on prescription in England (n = 142) were examined. Their costs in comparison to regular protein-containing (n = 182) and ‘free-from’ products (n = 135) were also analysed. Similar foods were grouped into subgroups (n = 40). The number of units and costs of SLPFs prescribed in total and per subgroup from January to December 2020 were calculated using National Health Service (NHS) Business Service Authority (NHSBSA) ePACT2 (electronic Prescribing Analysis and Cost Tool) for England. Monthly patient SLPF units prescribed were calculated using patient numbers with PKU and non-PKU inherited metabolic disorders (IMD) consuming SLPFs. This was compared to the National Society for PKU (NSPKU) prescribing guidance. Ninety-eight percent of SLPF subgroups (n = 39/40) were more expensive than regular and ‘free-from’ food subgroups. However, costs to prescribe SLPFs are significantly less than theoretical calculations. From January to December 2020, 208,932 units of SLPFs were prescribed (excluding milk replacers), costing the NHS £2,151,973 (including milk replacers). This equates to £962 per patient annually, and prescribed amounts are well below the upper limits suggested by the NSPKU, indicating under prescribing of SLPFs. It is recommended that a simpler and improved system should be implemented. Ideally, specialist metabolic dietitians should have responsibility for prescribing SLPFs. This would ensure that patients with PKU have the necessary access to their essential dietary treatment, which, in turn, should help promote dietary adherence and improve metabolic control.
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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
- Correspondence:
| | - Alex Pinto
- Dietetic Department, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (S.E.); (A.D.); (A.M.)
| | - Sharon Evans
- Dietetic Department, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (S.E.); (A.D.); (A.M.)
| | - Anne Daly
- Dietetic Department, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (S.E.); (A.D.); (A.M.)
| | - Sandra Adams
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK;
| | - Susie Costelloe
- Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter EX2 5DW, UK;
| | - Joanna Gribben
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EU, UK; (J.G.); (S.F.)
| | - Charlotte Ellerton
- University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UK;
| | - Anita Emm
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK;
| | - Sarah Firman
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EU, UK; (J.G.); (S.F.)
| | - Suzanne Ford
- North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK;
| | - Moira French
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK;
| | - Lisa Gaff
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (L.G.); (C.P.)
| | - Emily Giuliano
- Northamptonshire Healthcare NHS Foundation Trust, St Mary’s Hospital, London Road, Kettering NN15 7PW, UK;
| | - Melanie Hill
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK;
| | - Inderdip Hunjan
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK;
| | - Camille Newby
- Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK;
| | | | - Rachel Pereira
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK;
| | - Celine Prescott
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (L.G.); (C.P.)
| | - Louise Robertson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK;
| | - Heidi Seabert
- Somerset NHS Foundation Trust, Parkfield Drive, Taunton TA1 5DA, UK;
| | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK;
| | - Simon Tapley
- University Hospitals Bristol & Weston NHS Foundation Trust, Marlborough St, Bristol BS1 3NU, UK;
| | - Allyson Terry
- Alder Hey Children’s NHS Foundation Trust, E Prescot Road, Liverpool L12 2AP, UK;
| | - Alison Tooke
- Nottingham University Hospitals NHS Trust, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK;
| | - Karen van Wyk
- Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK; (K.v.W.); (F.J.W.)
| | - Fiona J. White
- Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK; (K.v.W.); (F.J.W.)
| | - Lucy White
- Sheffield Children’s NHS Foundation Trust, Clarkson St, Broomhall, Sheffield S10 2TH, UK;
| | - Alison Woodall
- Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, 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;
- CINTESIS—Center for Health Technology and Services Research, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
| | - Anita MacDonald
- Dietetic Department, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; (A.P.); (S.E.); (A.D.); (A.M.)
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Pinto A, Evans S, Daly A, Almeida MF, Assoun M, Belanger-Quintana A, Bernabei SM, Bollhalder S, Cassiman D, Champion H, Chan H, Corthouts K, Dalmau J, Boer FD, Laet CD, Meyer AD, 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, Hansen KK, Horst NT, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs GE, Kok I, Kowalik A, Laguerre C, Verge SL, Liguori A, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Och U, Robert M, Rocha JC, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Skeath R, Stolen LH, Terry A, Timmer C, Tomlinson L, Tooke A, Kerckhove KV, van Dam E, Hurk DVD, Ploeg LVD, van Driessche M, van Rijn M, Wegberg AV, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White F, White L, Zweers H, MacDonald A. Dietary practices in methylmalonic acidaemia: a European survey. J Pediatr Endocrinol Metab 2020; 33:147-155. [PMID: 31846426 DOI: 10.1515/jpem-2019-0277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/19/2019] [Accepted: 10/23/2019] [Indexed: 11/15/2022]
Abstract
Background The dietary management of methylmalonic acidaemia (MMA) is a low-protein diet providing sufficient energy to avoid catabolism and to limit production of methylmalonic acid. The goal is to achieve normal growth, good nutritional status and the maintenance of metabolic stability. Aim To describe the dietary management of patients with MMA across Europe. Methods A cross-sectional questionnaire was sent to European colleagues managing inherited metabolic disorders (IMDs) (n=53) with 27 questions about the nutritional management of organic acidaemias. Data were analysed by different age ranges (0-6 months; 7-12 months; 1-10 years; 11-16 years; >16 years). Results Questionnaires were returned from 53 centres. Twenty-five centres cared for 80 patients with MMA vitamin B12 responsive (MMAB12r) and 43 centres managed 215 patients with MMA vitamin B12 non-responsive (MMAB12nr). For MMAB12r patients, 44% of centres (n=11/25) prescribed natural protein below the World Health Organization/Food and Agriculture Organization/United Nations University (WHO/FAO/UNU) 2007 safe levels of protein intake in at least one age range. Precursor-free amino acids (PFAA) were prescribed by 40% of centres (10/25) caring for 36% (29/80) of all the patients. For MMAB12nr patients, 72% of centres (n=31/43) prescribed natural protein below the safe levels of protein intake (WHO/FAO/UNU 2007) in at least one age range. PFAA were prescribed by 77% of centres (n=33/43) managing 81% (n=174/215) of patients. In MMAB12nr patients, 90 (42%) required tube feeding: 25 via a nasogastric tube and 65 via a gastrostomy. Conclusions A high percentage of centres used PFAA in MMA patients together with a protein prescription that provided less than the safe levels of natural protein intake. However, there was inconsistent practices across Europe. Long-term efficacy studies are needed to study patient outcome when using PFAA with different severities of natural protein restrictions in patients with MMA to guide future practice.
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Affiliation(s)
- Alex Pinto
- Dietetic Department, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Sharon Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Anne Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Manuela Ferreira Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto - CHUP, 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 Universitário do Porto - CHUP, Porto, Portugal
| | - Murielle Assoun
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - Amaya Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal, Madrid, Spain
| | | | | | - David Cassiman
- Metabolic Center, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | | | - Heidi Chan
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Karen Corthouts
- Metabolic Center, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Jaime Dalmau
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - Foekje de Boer
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corinne De Laet
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - An de Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - Alice Dianin
- Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, University Hospital of Verona, Verona, Italy
| | - Marjorie Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Sandrine Dubois
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - Francois Eyskens
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - Ana Faria
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Ilaria Fasan
- Division of Inherited Metabolic Diseases, Department of Pediatrics, University Hospital of Padova, Padua, Italy
| | - Elisabeth Favre
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | - François Feillet
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Children's University Hospital, Nancy, France
| | | | - Giorgia Gallo
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - Joanna Gribben
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Kit Kaalund Hansen
- Charles Dent Metabolic Unit National Hospital for Neurology and Surgery, London, UK
| | - Nienke Ter Horst
- Emma Children's Hospital, AMC Amsterdam, Amsterdam, The Netherlands
| | - Camille Jankowski
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Ilana Jones
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | | | - Irene Kok
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Catherine Laguerre
- Centre de Compétence de L'Hôpital des Enfants de Toulouse, Toulouse, France
| | - Sandrine Le Verge
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker Enfants Malades, Paris, France
| | - Alessandra Liguori
- Children Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | | | - Doris Mayr
- Ernährungsmedizinische Beratung, Universitätsklinik für Kinder- und Jugendheilkunde, Salzburg, Austria
| | - Uta Meyer
- Clinic of Paediatric Kidney, Liver and Metabolic Diseases, Medical School Hannover, Hannover, Germany
| | - Avril Micciche
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ulrike Och
- University Children's Hospital, Munster, Germany
| | - Martine Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | - Júlio César Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto - CHUP, Porto, Portugal
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHUP, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | | | - Carmen Rohde
- Department of Paediatrics of the University Clinics Leipzig, University of Leipzig, Leipzig, Germany
| | - Kathleen Ross
- Royal Aberdeen Children's Hospital, Aberdeen, Scotland
| | - Isabelle Saruggia
- Centre de Reference des Maladies Héréditaires du Métabolisme du Pr. B. Chabrol CHU Timone Enfant, Marseille, France
| | - Andrea Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | | | | | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Allyson Terry
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Lyndsey Tomlinson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Esther van Dam
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorine van den Hurk
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Margreet van Rijn
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Carla Vasconcelos
- Centro Hospitalar São João - Unidade de Doenças Metabólicas, Porto, Portugal
| | | | - Isidro Vitoria
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | - Diana Webster
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fiona White
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lucy White
- Sheffield Children's Hospital, Sheffield, UK
| | - Heidi Zweers
- Radboud University Medical Center, Nijmegen, The Netherlands
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Evans S, Ford S, Adam S, Adams S, Ash J, Ashmore C, Caine G, Carruthers R, Cawtherley S, Chahal S, Clark A, Cochrane B, Daly A, Dines K, Dixon M, Dunlop C, Ellerton C, French M, Gaff L, Gingell C, Green D, Gribben J, Grimsley A, Hallam P, Hendroff U, Hill M, Hoban R, Howe S, Hunjan I, Kaalund K, Kelleher E, Khan F, Kitchen S, Lang K, Lowry S, Males J, Martin G, McStravick N, Micciche A, Newby C, Nicol C, Pereira R, Robertson L, Ross K, Simpson E, Singleton K, Skeath R, Stafford J, Terry A, Thom R, Tooke A, vanWyk K, White F, White L, MacDonald A. Development of national consensus statements on food labelling interpretation and protein allocation in a low phenylalanine diet for PKU. Orphanet J Rare Dis 2019; 14:2. [PMID: 30606267 PMCID: PMC6318866 DOI: 10.1186/s13023-018-0950-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the treatment of phenylketonuria (PKU), there was disparity between UK dietitians regarding interpretation of how different foods should be allocated in a low phenylalanine diet (allowed without measurement, not allowed, or allowed as part of phenylalanine exchanges). This led to variable advice being given to patients. METHODOLOGY In 2015, British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 70) were sent a multiple-choice questionnaire on the interpretation of protein from food-labels and the allocation of different foods. Based on majority responses, 16 statements were developed. Over 18-months, using Delphi methodology, these statements were systematically reviewed and refined with a facilitator recording discussion until a clear majority was attained for each statement. In Phase 2 and 3 a further 7 statements were added. RESULTS The statements incorporated controversial dietary topics including: a practical 'scale' for guiding calculation of protein from food-labels; a general definition for exchange-free foods; and guidance for specific foods. Responses were divided into paediatric and adult groups. Initially, there was majority consensus (≥86%) by paediatric dietitians (n = 29) for 14 of 16 statements; a further 2 structured discussions were required for 2 statements, with a final majority consensus of 72% (n = 26/36) and 64% (n = 16/25). In adult practice, 75% of dietitians agreed with all initial statements for adult patients and 40% advocated separate maternal-PKU guidelines. In Phase 2, 5 of 6 statements were agreed by ≥76% of respondents with one statement requiring a further round of discussion resulting in 2 agreed statements with a consensus of ≥71% by dietitians in both paediatric and adult practice. In Phase 3 one statement was added to elaborate further on an initial statement, and this received 94% acceptance by respondents. Statements were endorsed by the UK National Society for PKU. CONCLUSIONS The BIMDG dietitians group have developed consensus dietetic statements that aim to harmonise dietary advice given to patients with PKU across the UK, but monitoring of statement adherence by health professionals and patients is required.
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Affiliation(s)
- British Inherited Metabolic Diseases Group (BIMDG) Dietitians Group
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
- The National Society for Phenylketonuria, London, UK
- Queen Elizabeth University Hospital, Glasgow, UK
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
- University Hospital of Wales, Cardiff, UK
- Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Children’s University Hospital Dublin, Dublin, Republic of Ireland
- Belfast Health & Social Care Trust, Belfast, UK
- Royal Hospital for Sick Children Edinburgh, Edinburgh, UK
- Leicester Royal Infirmary, Leicester, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Salford Royal NHS Foundation Trust, Salford, UK
- Evelina London Children’s Healthcare, London, UK
- Mater Misericordiae University Hospital Dublin, Dublin, Ireland
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Ninewells Hospital Dundee, Dundee, Scotland
- Sheffield Children’s NHS Foundation Trust, Sheffield, UK
- Aneurin Bevan University Health Board Wales, Newport, UK
- Bristol Royal Hospital for Children, Bristol, UK
- Norfolk and Norwich University Hospital, Norfolk, UK
- Royal Aberdeen Children’s Hospital, Aberdeen, UK
- Royal Manchester Children’s Hospital, Manchester, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Sharon Evans
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Suzanne Ford
- The National Society for Phenylketonuria, London, UK
| | - Sarah Adam
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Sandra Adams
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jane Ash
- University Hospital of Wales, Cardiff, UK
| | - Catherine Ashmore
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | | | - Rachel Carruthers
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Cawtherley
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Satnam Chahal
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Anne Clark
- Children’s University Hospital Dublin, Dublin, Republic of Ireland
| | | | - Anne Daly
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Karen Dines
- Belfast Health & Social Care Trust, Belfast, UK
| | - Marjorie Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Carolyn Dunlop
- Royal Hospital for Sick Children Edinburgh, Edinburgh, UK
| | | | | | - Lisa Gaff
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cerys Gingell
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Diane Green
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | | | - Paula Hallam
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Una Hendroff
- Mater Misericordiae University Hospital Dublin, Dublin, Ireland
| | - Melanie Hill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Hoban
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Sarah Howe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Inderdip Hunjan
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kit Kaalund
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Eimear Kelleher
- Mater Misericordiae University Hospital Dublin, Dublin, Ireland
| | - Farzana Khan
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Steve Kitchen
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Karen Lang
- Ninewells Hospital Dundee, Dundee, Scotland
| | - Sharan Lowry
- Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Jo Males
- Aneurin Bevan University Health Board Wales, Newport, UK
| | - Georgina Martin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Claire Nicol
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Louise Robertson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Emma Simpson
- Royal Manchester Children’s Hospital, Manchester, UK
| | | | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Allyson Terry
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Ruth Thom
- Belfast Health & Social Care Trust, Belfast, UK
| | - Alison Tooke
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Karen vanWyk
- Royal Manchester Children’s Hospital, Manchester, UK
| | - Fiona White
- Royal Manchester Children’s Hospital, Manchester, UK
| | - Lucy White
- Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Anita MacDonald
- Dietetic Department, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
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Pinto A, Adams S, Ahring K, Allen H, Almeida MF, Garcia-Arenas D, Arslan N, Assoun M, Atik Altınok Y, Barrio-Carreras D, Belanger Quintana A, Bernabei SM, Bontemps C, Boyle F, Bruni G, Bueno-Delgado M, Caine G, Carvalho R, Chrobot A, Chyż K, Cochrane B, Correia C, Corthouts K, Daly A, De Leo S, Desloovere A, De Meyer A, De Theux A, Didycz B, Dijsselhof ME, Dokoupil K, Drabik J, Dunlop C, Eberle-Pelloth W, Eftring K, Ekengren J, Errekalde I, Evans S, Foucart A, Fokkema L, François L, French M, Forssell E, Gingell C, Gonçalves C, Gökmen Özel H, Grimsley A, Gugelmo G, Gyüre E, Heller C, Hensler R, Jardim I, Joost C, Jörg-Streller M, Jouault C, Jung A, Kanthe M, Koç N, Kok IL, Kozanoğlu T, Kumru B, Lang F, Lang K, Liegeois I, Liguori A, Lilje R, Ļubina O, Manta-Vogli P, Mayr D, Meneses C, Newby C, Meyer U, Mexia S, Nicol C, Och U, Olivas SM, Pedrón-Giner C, Pereira R, Plutowska-Hoffmann K, Purves J, Re Dionigi A, Reinson K, Robert M, Robertson L, Rocha JC, Rohde C, Rosenbaum-Fabian S, Rossi A, Ruiz M, Saligova J, Gutiérrez-Sánchez A, Schlune A, Schulpis K, Serrano-Nieto J, Skarpalezou A, Skeath R, Slabbert A, Straczek K, Giżewska M, Terry A, Thom R, Tooke A, Tuokkola J, van Dam E, van den Hurk TAM, van der Ploeg EMC, Vande Kerckhove K, Van Driessche M, van Wegberg AMJ, van Wyk K, Vasconcelos C, Velez García V, Wildgoose J, Winkler T, Żółkowska J, Zuvadelli J, MacDonald A. Weaning practices in phenylketonuria vary between health professionals in Europe. Mol Genet Metab Rep 2018; 18:39-44. [PMID: 30705824 PMCID: PMC6349955 DOI: 10.1016/j.ymgmr.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/12/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe. Methods A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis. Results Weaning started at 17–26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17–26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95). A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods. A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26–36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form. Conclusions Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.
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Affiliation(s)
- A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Adams
- Royal Victoria Infirmary, Newcastle, UK
| | - K Ahring
- Department of PKU, Kennedy Centre, Department of Paediatrics and Adolescents Medicine, Copenhagen University Hospital, Glostrup, Denmark
| | - H Allen
- Sheffield Children's NHS Foundation Trust, UK
| | - M F Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário 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 Universitário do Porto - CHP, Porto, Portugal
| | - D Garcia-Arenas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - N Arslan
- Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmır, Turkey
| | - M Assoun
- Hôpital Necker enfants Malades, Centre de référence des maladies héréditaires du métabolisme, Paris, France
| | - Y Atik Altınok
- Pediatric Metabolism Department, Ege University Medical Faculty, Izmir, Turkey
| | - D Barrio-Carreras
- Servicio de Pediatria, Unidad de Enfermedades Mitocondriales-Metabolicas Hereditarias, Hospital 12 de Octubre, Madrid, Spain
| | - A Belanger Quintana
- Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Unidad de Enfermedades Metabolicas, Spain
| | - S M Bernabei
- Division of Artificial Nutrition, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - F Boyle
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Italy
| | - G Bruni
- Meyer Children's hospital, Florence, Italy
| | | | | | - R Carvalho
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Chrobot
- Children Voievodship Hospital, Bydgoszcz, Poland
| | - K Chyż
- Institute of Mother and Child, Warsaw, Poland
| | - B Cochrane
- Royal Hospital for Children, Glasgow, UK
| | - C Correia
- CHLC- Hospital Dona Estefânia, Lisboa, Portugal
| | | | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S De Leo
- Department of Human Neuroscience, Sapienza University of Rome - Policlinico Umberto I of Rome, Italy
| | | | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A De Theux
- IPG (Institut de Pathologie et de Genetique), Charleroi, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | | | - K Dokoupil
- Dr. von Hauner Children's Hospital of the University of Munich, Germany
| | - J Drabik
- University Clinical Center in Gdansk, Poland
| | - C Dunlop
- Royal Hospital for Children Edinburgh, UK
| | | | - K Eftring
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - J Ekengren
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - I Errekalde
- Hospital Universitario de Cruces, Vizcaya, Spain
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Foucart
- Cliniques universitaires Saint-Luc, Belgium
| | - L Fokkema
- UMC Utrecht Wilhelmina Children's Hospital, Netherlands
| | - L François
- centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Robert-Debré, Paris, France
| | - M French
- University Hospitals of Leicester NHS Trust, UK
| | - E Forssell
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - H Gökmen Özel
- İhsan Doğramacı Children's Hospital, Hacettepe University, Turkey
| | - A Grimsley
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - G Gugelmo
- Department of Pediatrics, Inherited Metabolic Diseases Unit, University Hospital of Verona, Italy
| | - E Gyüre
- Albert Szent-Györgyi Clinical Centre, Hungary
| | - C Heller
- Kinder- und Jugendklinik Erlangen, Germany
| | - R Hensler
- Klinikum Stuttgart Olgahospital, Germany
| | - I Jardim
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Joost
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - M Jörg-Streller
- Universitätsklinik Innsbruck department für Kinder- und Jugendheilkunde, Austria
| | | | - A Jung
- Charite, Virchow Klinikum Berlin, Germany
| | - M Kanthe
- Skane University Hospital, Sweden
| | - N Koç
- Child's Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - I L Kok
- UMC Utrecht Wilhelmina Children's Hospital, Netherlands
| | - T Kozanoğlu
- İstanbul University İstanbul Faculty of Medicine, Turkey
| | - B Kumru
- Cengiz Gökçek Maternity and Children's Hospital, Gaziantep, Turkey
| | - F Lang
- University Hospital Mainz, Villa metabolica, Germany
| | - K Lang
- Ninewells Hospital, Dundee, Scotland, UK
| | | | - A Liguori
- Division of Artificial Nutrition, Children's Hospital Bambino Gesù, Rome, Italy
| | - R Lilje
- Oslo University Hospital, Norway
| | - O Ļubina
- Children's Clinical University Hospital, Riga, Latvia
| | | | - D Mayr
- Universitätsklinik für Jugend und Kinderheilkunde, Müllner Hauptstr, Salzburg, Austria
| | - C Meneses
- Hospital de Santo Espírito da Ilha Terceira, EPER, Portugal
| | - C Newby
- Bristol Royal Hospital for Children, UK
| | - U Meyer
- Clinic for Paediatric Kidney-, Liver and Metabolic Diseases, Medical School Hannover, Germany
| | - S Mexia
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Nicol
- Royal Victoria Infirmary, Newcastle, UK
| | - U Och
- Metabolic Department, University Hospital Muenster, Center for Pediatrics, Germany
| | - S M Olivas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - C Pedrón-Giner
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - K Plutowska-Hoffmann
- The Independent Public Clinical Hospital, Medical University of Silesia in Katowice John Paul II Upper Silesian Child Health Centre, Poland
| | - J Purves
- Royal Hospital for Children Edinburgh, UK
| | - A Re Dionigi
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - K Reinson
- Tartu University Hospital, United Laboratories, Department of Genetics, Italy
| | - M Robert
- Hôpital Universitaire des Enfants, Reine Fabiola, Bruxelles, Belgium
| | | | - J C Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHP), Porto, Portugal.,Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHP, Porto, Portugal.,Centre for Health Technology and Services Research (CINTESIS), Portugal
| | - C Rohde
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Germany
| | - S Rosenbaum-Fabian
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - A Rossi
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - M Ruiz
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - J Saligova
- Children's Faculty Hospital, Kosice, Slovakia
| | - A Gutiérrez-Sánchez
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Duesseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - K Schulpis
- Agia Sophia Childrens' Hospital, Athens, Greece
| | | | - A Skarpalezou
- Institute of Child Health, "A. Sophia" Children's Hospital, Athens
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Slabbert
- Evelina Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Straczek
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - A Terry
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Thom
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - A Tooke
- Nottingham Children's Hospital, UK
| | - J Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation and Pediatric Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Dietetics, Groningen, the Netherlands
| | | | | | | | | | - A M J van Wegberg
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - K van Wyk
- Manchester University NHS Foundation Trust, UK
| | | | - V Velez García
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | | | - T Winkler
- Klinik für Kinder- und Jugendmedizin, Carl-Thiem-Klinikum gGmbH Cottbus, Germany
| | - J Żółkowska
- Institute of Mother and Child, Warsaw, Poland
| | - J Zuvadelli
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
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5
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Pinto A, Adams S, Ahring K, Allen H, Almeida MF, Garcia-Arenas D, Arslan N, Assoun M, Atik Altınok Y, Barrio-Carreras D, Belanger Quintana A, Bernabei SM, Bontemps C, Boyle F, Bruni G, Bueno-Delgado M, Caine G, Carvalho R, Chrobot A, Chyż K, Cochrane B, Correia C, Corthouts K, Daly A, De Leo S, Desloovere A, De Meyer A, De Theux A, Didycz B, Dijsselhof ME, Dokoupil K, Drabik J, Dunlop C, Eberle-Pelloth W, Eftring K, Ekengren J, Errekalde I, Evans S, Foucart A, Fokkema L, François L, French M, Forssell E, Gingell C, Gonçalves C, Gökmen Özel H, Grimsley A, Gugelmo G, Gyüre E, Heller C, Hensler R, Jardim I, Joost C, Jörg-Streller M, Jouault C, Jung A, Kanthe M, Koç N, Kok IL, Kozanoğlu T, Kumru B, Lang F, Lang K, Liegeois I, Liguori A, Lilje R, Ļubina O, Manta-Vogli P, Mayr D, Meneses C, Newby C, Meyer U, Mexia S, Nicol C, Och U, Olivas SM, Pedrón-Giner C, Pereira R, Plutowska-Hoffmann K, Purves J, Re Dionigi A, Reinson K, Robert M, Robertson L, Rocha JC, Rohde C, Rosenbaum-Fabian S, Rossi A, Ruiz M, Saligova J, Gutiérrez-Sánchez A, Schlune A, Schulpis K, Serrano-Nieto J, Skarpalezou A, Skeath R, Slabbert A, Straczek K, Giżewska M, Terry A, Thom R, Tooke A, Tuokkola J, van Dam E, van den Hurk TAM, van der Ploeg EMC, Vande Kerckhove K, Van Driessche M, van Wegberg AMJ, van Wyk K, Vasconcelos C, Velez García V, Wildgoose J, Winkler T, Żółkowska J, Zuvadelli J, MacDonald A. Early feeding practices in infants with phenylketonuria across Europe. Mol Genet Metab Rep 2018; 16:82-89. [PMID: 30101073 PMCID: PMC6082991 DOI: 10.1016/j.ymgmr.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/07/2018] [Accepted: 07/27/2018] [Indexed: 01/15/2023] Open
Abstract
Background In infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe. Methods We sent a cross sectional, survey monkey® questionnaire to European health professionals working in IMD. It contained 31 open and multiple-choice questions. The results were analysed according to different geographical regions. Results Ninety-five centres from 21 countries responded. Over 60% of centres commenced diet in infants by age 10 days, with 58% of centres implementing newborn screening by day 3 post birth. At diagnosis, infant hospital admission occurred in 61% of metabolic centres, mainly in Eastern, Western and Southern Europe. Breastfeeding fell sharply following diagnosis with only 30% of women still breast feeding at 6 months. 53% of centres gave pre-measured Phe-free infant formula before each breast feed and 23% alternated breast feeds with Phe-free infant formula. With standard infant formula feeds, measured amounts were followed by Phe-free infant formula to satiety in 37% of centres (n = 35/95), whereas 44% (n = 42/95) advised mixing both formulas together. Weaning commenced between 17 and 26 weeks in 85% centres, ≥26 weeks in 12% and < 17 weeks in 3%. Discussion This is the largest European survey completed on PKU infant feeding practices. It is evident that practices varied widely across Europe, and the practicalities of infant feeding in PKU received little focus in the PKU European Guidelines (2017). There are few reports comparing different feeding techniques with blood Phe control, Phe fluctuations and growth. Controlled prospective studies are necessary to assess how different infant feeding practices may influence longer term feeding development.
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Affiliation(s)
- A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Adams
- Royal Victoria Infirmary, Newcastle, UK
| | - K Ahring
- Department of PKU, Kennedy Centre, Copenhagen University Hospital, Glostrup, Denmark
| | - H Allen
- Sheffield Children's NHS Foundation Trust, 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
| | - D Garcia-Arenas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - N Arslan
- Dokuz Eylul University Faculty of Medicine, Division of Pediatric Metabolism and Nutrition, Izmır, Turkey
| | - M Assoun
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Necker enfants Malades, Paris, France
| | - Y Atik Altınok
- Pediatric Metabolism Department, Ege University Medical Faculty, Izmir, Turkey
| | - D Barrio-Carreras
- Unidad de Enfermedades Mitocondriales-Metabolicas Hereditarias. Servicio de Pediatría, Hospital 12 de Octubre, Madrid, Spain
| | - A Belanger Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal Madrid, Spain
| | - S M Bernabei
- Children's Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | | | - F Boyle
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Ireland
| | - G Bruni
- Meyer Children's Hospital, Florence, Italy
| | | | | | - R Carvalho
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Chrobot
- Children Voievodship Hospital, Bydgoszcz, Poland
| | - K Chyż
- Institute of Mother and Child, Warsaw, Poland
| | - B Cochrane
- Royal Hospital for Children, Glasgow, UK
| | - C Correia
- CHLC- Hospital Dona Estefânia, Lisboa, Portugal
| | | | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S De Leo
- Department of Human Neuroscience, Sapienza University of Rome - Policlinico Umberto I of Rome, Italy
| | | | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A De Theux
- IPG (Institut de Pathologie et de Genetique), Charleroi, Belgium
| | - B Didycz
- University Children's Hospital, Cracow, Poland
| | | | - K Dokoupil
- Dr. von Hauner Children's Hospital of the University of Munich, Germany
| | - J Drabik
- University Clinical Center in Gdansk, Poland
| | - C Dunlop
- Royal Hospital for Children Edinburgh, UK
| | | | - K Eftring
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - J Ekengren
- Queen Silivia's Children's Hospital Gothenburg, Sweden
| | - I Errekalde
- Hospital Universitario de Cruces, Vizcaya, Spain
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Foucart
- Cliniques universitaires Saint-Luc, Belgium
| | - L Fokkema
- UMC Utrecht, Wilhelmina Children's Hospital, Netherlands
| | - L François
- Hôpital Universitaire Robert-Debré, Centre de référence des maladies héréditaires du métabolisme, Paris, France
| | - M French
- University Hospitals of Leicester NHS Trust, UK
| | - E Forssell
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - H Gökmen Özel
- Hacettepe University, İhsan Doğramacı Children's Hospital, Turkey
| | - A Grimsley
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - G Gugelmo
- Department of Pediatrics, Inherited Metabolic Diseases Unit, University Hospital of Verona, Italy
| | - E Gyüre
- Albert Szent-Györgyi Clinical Centre, Hungary
| | - C Heller
- Kinder- und Jugendklinik Erlangen, Germany
| | - R Hensler
- Klinikum Stuttgart Olgahospital, Germany
| | - I Jardim
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Joost
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - M Jörg-Streller
- Universitätsklinik Innsbruck department für Kinder- und Jugendheilkunde, Austria
| | | | - A Jung
- Charite, Virchow Klinikum Berlin, Germany
| | - M Kanthe
- Skane University Hospital, Sweden
| | - N Koç
- University of Health Sciences, Ankara Child's Health and Diseases Hematology Oncology Training and Research Hospital, Turkey
| | - I L Kok
- UMC Utrecht, Wilhelmina Children's Hospital, Netherlands
| | - T Kozanoğlu
- İstanbul University İstanbul Faculty of Medicine, Turkey
| | - B Kumru
- Gaziantep Cengiz Gökçek Maternity and Children's Hospital, Turkey
| | - F Lang
- University Hospital Mainz, Villa metabolica, Germany
| | - K Lang
- Ninewells Hospital, Dundee, UK
| | | | - A Liguori
- Children's Hospital Bambino Gesù, Division of Artificial Nutrition, Rome, Italy
| | - R Lilje
- Oslo University Hospital, Norway
| | - O Ļubina
- Children's Clinical University Hospital, Riga, Latvia
| | - P Manta-Vogli
- Inborn Errors of Metabolism Department, Institute of Child Health, Athens, Greece
| | - D Mayr
- Universitätsklinik für Jugend und Kinderheilkunde, Müllner Hauptstr, Salzburg, Austria
| | - C Meneses
- Hospital de Santo Espírito da Ilha Terceira, EPER, Portugal
| | - C Newby
- Bristol Royal Hospital for Children, UK
| | - U Meyer
- Medical School Hannover, Clinic for Paediatric Kidney- Liver and Metabolic Diseases, Germany
| | - S Mexia
- Centro Hospitalar Lisboa Norte - H. Sta Maria - Unidade de Doenças Metabólicas, Portugal
| | - C Nicol
- Royal Victoria Infirmary, Newcastle, UK
| | - U Och
- University Hospital Muenster, Center for Pediatrics, Metabolic Department, Germany
| | - S M Olivas
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - C Pedrón-Giner
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - K Plutowska-Hoffmann
- The Independent Public Clinical Hospital, No. 6 of the Medical University of Silesia in Katowice John Paul II Upper Silesian Child Health Centre, Poland
| | - J Purves
- Royal Hospital for Children Edinburgh, UK
| | - A Re Dionigi
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | | | - 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 for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Germany
| | - S Rosenbaum-Fabian
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - A Rossi
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - M Ruiz
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - J Saligova
- Children's Faculty Hospital, Kosice, Slovakia
| | - A Gutiérrez-Sánchez
- Congenital and Metabolic Disease Unit, Gastroenterology, Hepatology and Pediatric Nutrition Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - A Schlune
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Duesseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - K Schulpis
- Inborn Errors of Metabolism Department, Institute of Child Health, Athens, Greece
| | | | - A Skarpalezou
- Institute of Child Health, "A. Sophia" Children's Hospital, Athens, Greece
| | - R Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Slabbert
- Evelina Children's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Straczek
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - M Giżewska
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age Pomeranian Medica University, Poland
| | - A Terry
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Thom
- Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - A Tooke
- Nottingham Children's Hospital, UK
| | - J Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation and Pediatric Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E van Dam
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Dietetics, Groningen, Netherlands
| | | | | | | | | | - A M J van Wegberg
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - K van Wyk
- Manchester University NHS Foundation Trust, UK
| | | | - V Velez García
- Unit of Nutrition and Metabolopathies, Hospital La Fe, Valencia, Spain
| | | | - T Winkler
- Klinik für Kinder- und Jugendmedizin, Carl-Thiem-Klinikum gGmbH Cottbus, Germany
| | - J Żółkowska
- Institute of Mother and Child, Warsaw, Poland
| | - J Zuvadelli
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy
| | - A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
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6
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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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7
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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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Stewart E, Prayle AP, Tooke A, Pasalodos S, Suri M, Bush A, Bhatt JM. Growth and nutrition in children with ataxia telangiectasia. Arch Dis Child 2016; 101:1137-1141. [PMID: 27573920 DOI: 10.1136/archdischild-2015-310373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/22/2015] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Ataxia telangiectasia (A-T) is a rare multisystem disease with high early mortality from lung disease and cancer. Nutritional failure adversely impacts outcomes in many respiratory diseases. Several factors influence nutrition in children with A-T. We hypothesised that children with A-T have progressive growth failure and that early gastrostomy tube feeding (percutaneous endoscopic gastrostomy, PEG) is a favourable management option with good nutritional outcomes. METHODS Data were collected prospectively on weight, height and body mass index (BMI) at the national paediatric A-T clinic. Adequacy and safety of oral intake was assessed. Nutritional advice was given at each multidisciplinary review. RESULTS 101 children (51 girls) had 222 measurements (32 once, 32 twice, 24 thrice) between 2009 and 2016. Median (IQR) age was 9.3 (6.4 to 13.1) years. Mean (SD) weight, height and BMI Z-scores were respectively -1 (1.6), -1.2 (1.2) and -0.4 (1.4). 35/101 children had weight Z-scores below -2 on at least one occasion. Weight, height and BMI Z-scores declined over time. Decline was most obvious after 8 years of age. 14/101 (14%) children had a PEG, with longitudinal data available for 12. In a nested case control study, there was a trend for improvement in weight in those with a PEG (p=0.10). CONCLUSIONS Patients with A-T decline in growth over time. There is an urgent need for new strategies, including an understanding of why growth falters. We suggest early proactive consideration of PEG from age 8 years onwards to prevent progressive growth failure.
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Affiliation(s)
- Emma Stewart
- Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, QMC, Nottingham, UK
| | - Andrew P Prayle
- University of Nottingham, School of Clinical Science, Queens Medical Centre, Child Health, Nottingham, UK
| | - Alison Tooke
- Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, QMC, Nottingham, UK
| | - Sara Pasalodos
- Nottingham Clinical Genetics Service, National Paediatric Ataxia Telangiectasia Clinic, Clinical Genetics Service, City Hospital Campus, Nottingham, UK
| | - Mohnish Suri
- Nottingham Clinical Genetics Service, National Paediatric Ataxia Telangiectasia Clinic, Clinical Genetics Service, City Hospital Campus, Nottingham, UK
| | - Andy Bush
- Imperial College, London, UK.,National Heart and Lung Institute, London, UK.,Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Jayesh M Bhatt
- Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, QMC, Nottingham, UK
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Stewart EL, Tooke A, Pasalodos S, Suri M, Bush A, Bhatt J. P95 Growth and Nutrition in Ataxia Telangiectasia. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schwartz E, Meltzer E, Mendelson M, Tooke A, Steiner F, Gautret P, Friedrich-Jaenicke B, Libman M, Bin H, Wilder-Smith A, Gubler DJ, Freedman DO, Parola P. Detection on four continents of dengue fever cases related to an ongoing outbreak in Luanda, Angola, March to May 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.21.20488-en] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In April 2013, ten cases of dengue fever in travellers returning from Luanda, Angola, to five countries on four continents, were reported to the globally distributed GeoSentinel Surveillance network. Dengue virus serotype 1 was identified in two cases. The findings indicate that a major dengue outbreak is currently ongoing in Luanda. This report illustrates how cases from an emerging arboviral epidemic focus can spread internationally and highlights the risk of dissemination of a vector-borne disease into receptive areas
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Affiliation(s)
- E Schwartz
- Center for Geographic Medicine and Department of Medicine C the Sheba medical center, Tel Hashomer & Sackler School of Medicine, Tel Aviv, Israel
| | - E Meltzer
- Center for Geographic Medicine and Department of Medicine C the Sheba medical center, Tel Hashomer & Sackler School of Medicine, Tel Aviv, Israel
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A Tooke
- Department of Medicine, 2 Military Hospital, Wynberg, Cape Town, South Africa
| | - F Steiner
- Institut für Tropenmedizin und Internationale Gesundheit Charité - Universitätsmedizin Berlin, Germany
| | - P Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
| | - B Friedrich-Jaenicke
- Institut für Tropenmedizin und Internationale Gesundheit Charité - Universitätsmedizin Berlin, Germany
| | - M Libman
- J.D. MacLean Centre for Tropical Medicine, McGill University Health Centre Montreal, Quebec Canada
| | - H Bin
- The Central Virology Laboratory, Ministry of Health, Tel Hashomer Israel
| | - A Wilder-Smith
- Institute of Public Health, University of Heidelberg, Germany
| | - D J Gubler
- Program on Emerging Infectious Diseases- Duke-NUS Graduate Medical School, Singapore
| | - D O Freedman
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - P Parola
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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Schwartz E, Meltzer E, Mendelson M, Tooke A, Steiner F, Gautret P, Friedrich-Jaenicke B, Libman M, Bin H, Wilder-Smith A, Gubler D, Freedman DO, Parola P. Detection on four continents of dengue fever cases related to an ongoing outbreak in Luanda, Angola, March to May 2013. Euro Surveill 2013; 18:20488. [PMID: 23725977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- E Schwartz
- Center for Geographic Medicine and Department of Medicine C the Sheba medical center, Tel Hashomer & Sackler School of Medicine, Tel Aviv, Israel
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12
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O'Neill TW, Mahmoud A, Tooke A, Thomas RD, Maddison PJ. Is there a relationship between subclinical myocardial abnormalities, conduction defects and Ro/La antibodies in adults with systemic lupus erythematosus? Clin Exp Rheumatol 1993; 11:409-12. [PMID: 8403587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Thirty-three adult patients with systemic lupus erythematosus (SLE) were studied to determine whether there was an association between subclinical abnormalities of left ventricular function, conduction defects, and the presence of antibodies to Ro and/or La. Twelve patients had one or both of these antibodies. Conduction defects were present in 2, neither being currently positive for Ro or La antibody. There was no difference in abnormalities of left ventricular function between those with or without antibody. Valvular abnormalities were present in 11, 6 of whom had focal or diffuse thickening of one or more valves. Adults with SLE and anti-Ro and/or La antibody do not appear to be at particular risk of conduction defects. Subclinical left ventricular functional abnormalities were not associated with the presence of these antibodies.
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Affiliation(s)
- T W O'Neill
- ARC Epidemiology Research Unit, Manchester University, U.K
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