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Kalkan Uçar S, Altınok YA, Mansuroglu Y, Canda E, Yazıcı H, Çelik MY, Erdem F, Yanbolu AY, Ülger Z, Çoker M. Long-term personalized high-protein, high-fat diet in pediatric patients with glycogen storage disease type IIIa: Evaluation of myopathy, metabolic control, physical activity, growth, and dietary compliance. J Inherit Metab Dis 2024. [PMID: 38623712 DOI: 10.1002/jimd.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
Dietary lipid manipulation has recently been proposed for managing glycogen storage disease (GSD) type IIIa. This study aimed to evaluate the myopathic, cardiac, and metabolic status, physical activity, growth, and dietary compliance of a personalized diet high in protein and fat for 24 months. Of 31 patients with type IIIa GSD, 12 met the inclusion criteria. Of these, 10 patients (mean age 11.2 ± 7.4 years) completed the study. Patients were prescribed a personalized high-protein, high-fat diet, comprising 3.0-3.5 g/kg/day of protein and 3.0-4.5 g/kg/day of fat, constituting 18.5%-28% and 70.5%-75.7% of daily energy, respectively. Dietary compliance was ensured and assessed via the regular administration of questionnaires. Our results revealed consistent and significant decreases of 22%, 54%, and 30% in the creatinine kinase, creatine kinase-myocardial band, and lactate dehydrogenase levels, respectively. Echocardiography revealed improvements in the Z-scores of the left ventricular mass and interventricular septum thickness. A significant increase in body muscle mass was observed, and a higher score was achieved using the Daily Activity Questionnaire. Growth monitoring revealed an arrest in the height-SDS at the 6th and 12th months, followed by subsequent improvement at the end of the second year. A gradual and persistent decline in the periods of hypo- and hyperglycemia has been reported. Biotinidase activity decreased, whereas hepatosteatosis increased and then decreased by the end of the study. Implementing a high-protein, high-fat diet and monitoring key parameters in patients with type IIIa GSD can lead to myopathic and cardiac improvements and increased physical activity.
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Affiliation(s)
- Sema Kalkan Uçar
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Yasemin Atik Altınok
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Yelda Mansuroglu
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Ebru Canda
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Havva Yazıcı
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Merve Yoldaş Çelik
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Fehime Erdem
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Ayşe Yüksel Yanbolu
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Zülal Ülger
- Department of Pediatrics, Division of Pediatric Cardiology, Ege University Medical Faculty, Izmir, Turkey
| | - Mahmut Çoker
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
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