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Daly A, Adam S, Allen H, Ash J, Dale C, Dixon M, Dunlop C, Ellerton C, Evans S, Firman S, Ford S, Freedman F, Gribben J, Howe S, Khan F, McDonald J, McStravick N, Nguyen P, Oxley N, Skeath R, Simpson E, Terry A, Woodall A, White L, MacDonald A. UK Dietary Practices for Tyrosinaemias: Time for Change. Nutrients 2022; 14:nu14245202. [PMID: 36558364 PMCID: PMC9787818 DOI: 10.3390/nu14245202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
In the UK, different dietary systems are used to calculate protein or tyrosine/phenylalanine intake in the dietary management of hereditary tyrosinaemia, HTI, II and III (HT), with no systematic evidence comparing the merits and inadequacies of each. This study aimed to examine the current UK dietary practices in all HTs and, using Delphi methodology, to reach consensus agreement about the best dietary management system. Over 12 months, five meetings were held with UK paediatric and adult dietitians working in inherited metabolic disorders (IMDs) managing HTs. Eleven statements on the dietary system for calculating protein or tyrosine/phenylalanine intake were discussed. Dietitians from 12 of 14 IMD centres caring for HT patients participated, and 7/11 statements were agreed with one Delphi round. Nine centres (three abstentions) supported a 1 g protein exchange system for all foods except fruit and vegetables. The same definitions used in the UK for phenylketonuria (PKU) were adopted to define when to calculate foods as part of a protein exchange system or permit them without measurement. Fruit and vegetables contain a lower amount of tyrosine/phenylalanine per 1 g of protein than animal and cereal foods. The correlation of tyrosine vs. phenylalanine (mg/100 g) for vegetables and fruits was high (r = 0.9). In Delphi round 2, agreement was reached to use the tyrosine/phenylalanine analyses of fruits/vegetables, for their allocation within the HT diet. This allowed larger portion sizes of measured fruits and vegetables and increased the variety of fruit and vegetables that could be eaten without measurement. In HTs, a combined dietary management system will be used: 1 g protein exchanges for cereal and milk protein sources and tyrosine/phenylalanine exchanges for fruit and vegetables. Intensive, systematic communication with IMD dietitians and reappraisal of the evidence has redefined and harmonised HT dietary practice across the UK.
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Affiliation(s)
- Anne Daly
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
- Correspondence:
| | - Sarah Adam
- Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Heather Allen
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Jane Ash
- University Hospital of Wales, Cardiff CF4 4XW, UK
| | - Clare Dale
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Marjorie Dixon
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | | | - Charlotte Ellerton
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Sarah Firman
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EU, UK
| | - Suzanne Ford
- Southmead Hospital North Bristol Trust, Bristol BS10 5NB, UK
| | - Francine Freedman
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Joanna Gribben
- Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Sara Howe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Farzana Khan
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford BD5 0NA, UK
| | - Joy McDonald
- Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | | | - Patty Nguyen
- University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Natalia Oxley
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford BD5 0NA, UK
| | - Rachel Skeath
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Emma Simpson
- Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
| | - Allyson Terry
- Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Alison Woodall
- Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Lucy White
- Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
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