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van Wegberg AMJ, van der Weerd JC, Engelke UFH, Coene KLM, Jahja R, Bakker SJL, Huijbregts SCJ, Wevers RA, Heiner-Fokkema MR, van Spronsen FJ. The clinical relevance of novel biomarkers as outcome parameter in adults with phenylketonuria. J Inherit Metab Dis 2024. [PMID: 38556470 DOI: 10.1002/jimd.12732] [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: 11/17/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
Recent studies in PKU patients identified alternative biomarkers in blood using untargeted metabolomics. To test the added clinical value of these novel biomarkers, targeted metabolomics of 11 PKU biomarkers (phenylalanine, glutamyl-phenylalanine, glutamyl-glutamyl-phenylalanine, N-lactoyl-phenylalanine, N-acetyl-phenylalanine, the dipeptides phenylalanyl-phenylalanine and phenylalanyl-leucine, phenylalanine-hexose conjugate, phenyllactate, phenylpyruvate, and phenylacetate) was performed in stored serum samples of the well-defined PKU patient-COBESO cohort and a healthy control group. Serum samples of 35 PKU adults and 20 healthy age- and sex-matched controls were analyzed using ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Group differences were tested using the Mann-Whitney U test. Multiple linear regression analyses were performed with these biomarkers as predictors of (neuro-)cognitive functions working memory, sustained attention, inhibitory control, and mental health. Compared to healthy controls, phenylalanine, glutamyl-phenylalanine, N-lactoyl-phenylalanine, N-acetyl-phenylalanine, phenylalanine-hexose conjugate, phenyllactate, phenylpyruvate, and phenylacetate were significant elevated in PKU adults (p < 0.001). The remaining three were below limit of detection in PKU and controls. Both phenylalanine and N-lactoyl-phenylalanine were associated with DSM-VI Attention deficit/hyperactivity (R2 = 0.195, p = 0.039 and R2 = 0.335, p = 0.002, respectively) of the ASR questionnaire. In addition, N-lactoyl-phenylalanine showed significant associations with ASR DSM-VI avoidant personality (R2 = 0.265, p = 0.010), internalizing (R2 = 0.192, p = 0.046) and externalizing problems (R2 = 0.217, p = 0.029) of the ASR questionnaire and multiple aspects of the MS2D and FI tests, reflecting working memory with R2 between 0.178 (p = 0.048) and 0.204 (p = 0.033). Even though the strength of the models was not considered strong, N-lactoyl-phenylalanine outperformed phenylalanine in its association with working memory and mental health outcomes.
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Affiliation(s)
- A M J van Wegberg
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
| | - J C van der Weerd
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - U F H Engelke
- Department of Human Genetics, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K L M Coene
- Laboratory of Clinical Chemistry and Hematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - R Jahja
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
| | - S J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - R A Wevers
- Department of Human Genetics, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M R Heiner-Fokkema
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
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Evers RAF, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Bosch AM, Burlina A, Campistol J, Coskun T, Feillet F, Giżewska M, Huijbregts SCJ, Kearney S, Langeveld M, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz FK, MacDonald A, van Spronsen FJ. Defining tetrahydrobiopterin responsiveness in phenylketonuria: Survey results from 38 countries. Mol Genet Metab 2021; 132:215-219. [PMID: 33610470 DOI: 10.1016/j.ymgme.2021.01.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A subset of patients with phenylketonuria benefit from treatment with tetrahydrobiopterin (BH4), although there is no consensus on the definition of BH4 responsiveness. The aim of this study therefore was to gain insight into the definitions of long-term BH4 responsiveness being used around the world. METHODS We performed a web-based survey targeting healthcare professionals involved in the treatment of PKU patients. Data were analysed according to geographical region (Europe, USA/Canada, other). RESULTS We analysed 166 responses. Long-term BH4 responsiveness was commonly defined using natural protein tolerance (95.6%), improvement of metabolic control (73.5%) and increase in quality of life (48.2%). When a specific value for a reduction in phenylalanine concentrations was reported (n = 89), 30% and 20% were most frequently used as cut-off values (76% and 19% of respondents, respectively). When a specific relative increase in natural protein tolerance was used to define long-term BH4 responsiveness (n = 71), respondents most commonly reported cut-off values of 30% and 100% (28% of respondents in both cases). Respondents from USA/Canada (n = 50) generally used less strict cut-off values compared to Europe (n = 96). Furthermore, respondents working within the same center answered differently. CONCLUSION The results of this study suggest a very heterogeneous situation on the topic of defining long-term BH4 responsiveness, not only at a worldwide level but also within centers. Developing a strong evidence- and consensus-based definition would improve the quality of BH4 treatment.
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Affiliation(s)
- R A F Evers
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - A M J van Wegberg
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - K Ahring
- Department of PKU, Copenhagen University Hospital, Denmark
| | - S Beblo
- Center for Pediatric Research Leipzig, Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, Germany
| | - A Bélanger-Quintana
- Metabolic Diseases Unit, Department of Pediatrics, Hospital Ramon y Cajal, Madrid, Spain
| | - A M Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Integrated Diagnostics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - T Coskun
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nutrition & Metabolism, Hacettepe, Ankara, Turkey
| | - F Feillet
- Inborn Errors of Metabolism, Pediatric unit, University Hospital of Nancy, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Nancy, France
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - S Kearney
- Clinical Psychology Department, Birmingham Children's Hospital, Birmingham, UK
| | - M Langeveld
- Department of Endocrinology and Metabolism, Amterdam UMC, University of Amsterdam, AZ, Amsterdam, the Netherlands
| | - V Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - F Maillot
- Department of Internal Medicine, CHRU de Tours, Université de Tours, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J C Rocha
- 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), Portugal; Nutrition & Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F K Trefz
- University Children's Hospital, Dietmar-Hoppe Metabolic Centre, Heidelberg, Germany
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - F J van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands.
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van Wegberg AMJ, MacDonald A, Abeln D, Hagedorn TS, Lange E, Trefz F, van Vliet D, van Spronsen FJ. Patient's thoughts and expectations about centres of expertise for PKU. Orphanet J Rare Dis 2021; 16:2. [PMID: 33407655 PMCID: PMC7789756 DOI: 10.1186/s13023-020-01647-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the Netherlands (NL) the government assigned 2 hospitals as centres of expertise (CE) for Phenylketonuria (PKU), while in the United Kingdom (UK) and Germany no centres are assigned specifically as PKU CE's. METHODS To identify expectations of patients/caregivers with PKU of CEs, a web-based survey was distributed through the national Phenylketonuria societies of Germany, NL and UK. RESULTS In total, 105 responded (43 patients, 56 parents, 4 grandparents, 2 other) of whom 59 were from NL, 33 from UK and 13 from Germany. All participants (n = 105) agreed that patients and/or practitioners would benefit from CEs. The frequency patients would want to visit a CE, when not treated in a CE (n = 83) varied: every hospital visit (24%, n = 20), annual or bi-annual (45%, n = 37), at defined patient ages (6%, n = 5), one visit only (22%, n = 18), or never (4%, n = 3). Distance was reported as a major barrier (42%, n = 35). 78% (n = 65) expected CE physicians and dieticians to have a higher level of knowledge than in non-CE centres. For participants already treated in a CE (n = 68), 66% requested a more extensive annual or bi-annual review. In general, psychology review and neuropsychologist assessment were identified as necessary by approximately half of the 105 participants. In addition, 66% (n = 68) expected a strong collaboration with patient associations. CONCLUSION In this small study, most participants expected that assigning CEs will change the structure of and delivery of Phenylketonuria care.
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Affiliation(s)
- A M J van Wegberg
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, 9713 GZ, Groningen, The Netherlands
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - D Abeln
- Dutch Society for PKU, Tiel, The Netherlands
| | - T S Hagedorn
- Deutsche Interessengemeinschaft Phenylketonurie, Fürth, Germany
| | - E Lange
- National Society for Phenylketonuria United Kingdom, Preston, UK
| | - F Trefz
- University Children's Hospital, Dietmar Hopp Metabolic Centre, 69120, Heidelberg, Germany
| | - D van Vliet
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, 9713 GZ, Groningen, The Netherlands
| | - F J van Spronsen
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, 9713 GZ, Groningen, The Netherlands.
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MacDonald A, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts SC, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz F, van Spronsen FJ. Correction to: PKU dietary handbook to accompany PKU guidelines. Orphanet J Rare Dis 2020; 15:230. [PMID: 32873338 PMCID: PMC7465324 DOI: 10.1186/s13023-020-01486-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A M J van Wegberg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - K Ahring
- Department of PKU, Kennedy Centre, Glostrup, Denmark
| | - S Beblo
- Department of Women and Child Health, Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, University Hospitals, Leipzig, Germany
| | - A Bélanger-Quintana
- Department of Paediatrics, Hospital Ramon y Cajal Madrid, Metabolic Diseases Unit, Madrid, Spain
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - T Coşkun
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Feillet
- Department of Paediatrics, Hôpital d'Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, France
| | - M Giżewska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - V Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185, Rome, Italy
| | - F Maillot
- CHRU de Tours, Université François Rabelais, INSERM U1069, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - J C Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F Trefz
- Department of Paediatrics, University of Heidelberg, Heidelberg, Germany
| | - F J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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MacDonald A, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts SC, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz F, van Spronsen FJ. PKU dietary handbook to accompany PKU guidelines. Orphanet J Rare Dis 2020; 15:171. [PMID: 32605583 PMCID: PMC7329487 DOI: 10.1186/s13023-020-01391-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [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: 09/09/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism caused by deficiency in the enzyme phenylalanine hydroxylase that converts phenylalanine into tyrosine. Main body In 2017 the first European PKU Guidelines were published. These guidelines contained evidence based and/or expert opinion recommendations regarding diagnosis, treatment and care for patients with PKU of all ages. This manuscript is a supplement containing the practical application of the dietary treatment. Conclusion This handbook can support dietitians, nutritionists and physicians in starting, adjusting and maintaining dietary treatment.
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Affiliation(s)
- A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A M J van Wegberg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands
| | - K Ahring
- Department of PKU, Kennedy Centre, Glostrup, Denmark
| | - S Beblo
- Department of Women and Child Health, Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, University Hospitals, Leipzig, Germany
| | - A Bélanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Hospital Ramon y Cajal Madrid, Madrid, Spain
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - T Coşkun
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Feillet
- Department of Paediatrics, Hôpital d'Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, France
| | - M Giżewska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - V Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185, Rome, Italy
| | - F Maillot
- CHRU de Tours, Université François Rabelais, INSERM U1069, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - J C Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F Trefz
- Department of Paediatrics, University of Heidelberg, Heidelberg, Germany
| | - F J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
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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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7
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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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8
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van Wegberg AMJ, MacDonald A, Ahring K, Bélanger-Quintana A, Blau N, Bosch AM, Burlina A, Campistol J, Feillet F, Giżewska M, Huijbregts SC, Kearney S, Leuzzi V, Maillot F, Muntau AC, van Rijn M, Trefz F, Walter JH, van Spronsen FJ. The complete European guidelines on phenylketonuria: diagnosis and treatment. Orphanet J Rare Dis 2017; 12:162. [PMID: 29025426 PMCID: PMC5639803 DOI: 10.1186/s13023-017-0685-2] [Citation(s) in RCA: 381] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022] Open
Abstract
Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine metabolism caused by deficiency in the enzyme phenylalanine hydroxylase that converts phenylalanine into tyrosine. If left untreated, PKU results in increased phenylalanine concentrations in blood and brain, which cause severe intellectual disability, epilepsy and behavioural problems. PKU management differs widely across Europe and therefore these guidelines have been developed aiming to optimize and standardize PKU care. Professionals from 10 different European countries developed the guidelines according to the AGREE (Appraisal of Guidelines for Research and Evaluation) method. Literature search, critical appraisal and evidence grading were conducted according to the SIGN (Scottish Intercollegiate Guidelines Network) method. The Delphi-method was used when there was no or little evidence available. External consultants reviewed the guidelines. Using these methods 70 statements were formulated based on the highest quality evidence available. The level of evidence of most recommendations is C or D. Although study designs and patient numbers are sub-optimal, many statements are convincing, important and relevant. In addition, knowledge gaps are identified which require further research in order to direct better care for the future.
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Affiliation(s)
- A. M. J. van Wegberg
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, PO BOX 30.001, 9700 RB Groningen, The Netherlands
| | - A. MacDonald
- Dietetic Department, Birmingham Children’s Hospital, Birmingham, UK
| | - K. Ahring
- Department of PKU, Kennedy Centre, Glostrup, Denmark
| | - A. Bélanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Hospital Ramon y Cajal Madrid, Madrid, Spain
| | - N. Blau
- University Children’s Hospital, Dietmar-Hoppe Metabolic Centre, Heidelberg, Germany
- University Children’s Hospital Zürich, Zürich, Switzerland
| | - A. M. Bosch
- Department of Paediatrics, Division of Metabolic Disorders, Academic Medical Centre, University Hospital of Amsterdam, Amsterdam, The Netherlands
| | - A. Burlina
- Division of Inherited Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Padova, Italy
| | - J. Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - F. Feillet
- Department of Paediatrics, Hôpital d’Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, France
| | - M. Giżewska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S. C. Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - S. Kearney
- Clinical Psychology Department, Birmingham Children’s Hospital, Birmingham, UK
| | - V. Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy
| | - F. Maillot
- CHRU de Tours, Université François Rabelais, INSERM U1069, Tours, France
| | - A. C. Muntau
- University Children’s Hospital, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - M. van Rijn
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, PO BOX 30.001, 9700 RB Groningen, The Netherlands
| | - F. Trefz
- Department of Paediatrics, University of Heidelberg, Heidelberg, Germany
| | - J. H. Walter
- Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - F. J. van Spronsen
- Division of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, PO BOX 30.001, 9700 RB Groningen, The Netherlands
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