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9. Protein substitutes for phenylketonuria in Europe: access and nutritional composition

Author

Pena, M.J., de Almeida, M.F., van Dam, E., Ahring, K., Belanger-Quintana, A., Dokoupil, K., Gokmen-Ozel, H., Lammardo, A.M., MacDonald, A., Robert, M., and Rocha, J.C.

Subjects
Phenylketonuria -- Physiological aspects, Food/cooking/nutrition, Health
Abstract

BACKGROUND/OBJECTIVES: Protein substitutes (PS) are an essential component in the dietary management of phenylketonuria (PKU). PS are available as phenylalanine-free amino-acid mixtures (AAM), glycomacropeptide-based PS (GMP) and large neutral amino acids (LNAA). There is a lack of information regarding their availability in different countries and comparison of their nutritional composition is limited. The objectives of this study were to identify the number of PS available in different European countries and Turkey and to compare their nutritional composition. SUBJECTS/METHODS: Members of the European Nutritionist Expert Panel on PKU (ENEP) (Portugal, Spain, Belgium, Italy, Germany, Netherlands, United Kingdom, Denmark and Turkey) provided data on PS available in each country. The nutritional composition of PS available in Portugal was analyzed. RESULTS: The number of PS available in each country varied from 30 (Turkey) to 105 (Germany), with a median of 64. GMP was available only in Portugal, whereas LNAA was an option in Portugal, Italy, Turkey and Denmark. Some PS were designed for weaning. Many PS did not contain added fat and fiber. GMP contained the highest carbohydrate (CHO) and energy content as well as higher LNAA content compared with AAM. Only one AAM contained added fructo-oligosaccharides and galacto-oligosaccharides. AAM designed for the first year of life had the highest CHO, fat and LNAA contribution. Liquid AAM had lower CHO and fat contents compared with powdered AAM, but contained higher LNAA. CONCLUSIONS: There was widely dissimilar numbers of PS available in different countries. Nutritional composition of different PS was variable and should be considered before prescription. European Journal of Clinical Nutrition (2016) 70, 785-789; doi: 10.1038/ejcn.2016.54; published online 27 April 2016, INTRODUCTION Nutritional treatment of patients with phenylketonuria (PKU) involves the restriction of phenylalanine (Phe), found in natural protein-containing foods, in combination with a protein replacement/substitute without Phe. Protein substitutes (PS) [...]

Published
2016
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14. Dietary practices in methylmalonic acidaemia: a European survey

Author

Pinto, A., Evans, S., Daly, A., Almeida, M.F., Assoun, M., Belanger-Quintana, A., Bernabei, S.M., Bollhalder, S., Cassiman, D., Champion, H., Chan, H., Corthouts, K., Dalmau, J., 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., Hansen, K.K., Horst, N.T., Jankowski, C., Janssen-Regelink, R.G., Jones, I., Jouault, C., Kahrs, G.E., Kok, I., Kowalik, A., Laguerre, C., Verge, S.L., Liguori, A., Lilje, R., Maddalon, C., Mayr, D., Meyer, U., Micciche, A., Och, U., Robert, M., Rocha, J.C., Rogozinski, H., Rohde, C., Ross, K., Saruggia, I., Schlune, A., Singleton, K., Sjoqvist, E., Skeath, R., Stolen, L.H., Terry, A., Timmer, C., Tomlinson, L., Tooke, A., Kerckhove, K.V., Dam, E. van, Hurk, D.V.D., Ploeg, L.V., Driessche, M. Van, Rijn, M. van de, Wegberg, A.M. van, Vasconcelos, C., Vestergaard, H., Vitoria, I., Webster, D., White, F., White, L., Zweers, H.E., MacDonald, A., Pinto, A., Evans, S., Daly, A., Almeida, M.F., Assoun, M., Belanger-Quintana, A., Bernabei, S.M., Bollhalder, S., Cassiman, D., Champion, H., Chan, H., Corthouts, K., Dalmau, J., 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., Hansen, K.K., Horst, N.T., Jankowski, C., Janssen-Regelink, R.G., Jones, I., Jouault, C., Kahrs, G.E., Kok, I., Kowalik, A., Laguerre, C., Verge, S.L., Liguori, A., Lilje, R., Maddalon, C., Mayr, D., Meyer, U., Micciche, A., Och, U., Robert, M., Rocha, J.C., Rogozinski, H., Rohde, C., Ross, K., Saruggia, I., Schlune, A., Singleton, K., Sjoqvist, E., Skeath, R., Stolen, L.H., Terry, A., Timmer, C., Tomlinson, L., Tooke, A., Kerckhove, K.V., Dam, E. van, Hurk, D.V.D., Ploeg, L.V., Driessche, M. Van, Rijn, M. van de, Wegberg, A.M. van, Vasconcelos, C., Vestergaard, H., Vitoria, I., Webster, D., White, F., White, L., Zweers, H.E., and MacDonald, A.

Abstract

Contains fulltext : 220058.pdf (Publisher’s version ) (Open Access), 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

Published
2020

15. Impact of pregnancy planning and preconceptual dietary training on metabolic control and offspring's outcome in phenylketonuria.

Author

Grohmann-Held K, Burgard P, Baerwald CGO, Beblo S, Vom Dahl S, Das A, Dokoupil K, Fleissner S, Freisinger P, Heddrich-Ellerbrok M, Jung A, Korpel V, Krämer J, Lier D, Maier EM, Meyer U, Mühlhausen C, Newger M, Och U, Plöckinger U, Rosenbaum-Fabian S, Rutsch F, Santer R, Schick P, Schwarz M, Spiekerkötter U, Strittmatter U, Thiele AG, Ziagaki A, Mütze U, Gleich F, Garbade SF, and Kölker S

Subjects
Pregnancy, Child, Female, Humans, Retrospective Studies, Phenylalanine, Diet, Child Behavior, Syndrome, Pregnancy Outcome, Phenylketonuria, Maternal therapy, Phenylketonurias
Abstract

To prevent maternal phenylketonuria (PKU) syndrome low phenylalanine concentrations (target range, 120-360 μmol/L) during pregnancy are recommended for women with PKU. We evaluated the feasibility and effectiveness of current recommendations and identified factors influencing maternal metabolic control and children's outcome. Retrospective study of first successfully completed pregnancies of 85 women with PKU from 12 German centers using historical data and interviews with the women. Children's outcome was evaluated by standardized IQ tests and parental rating of child behavior. Seventy-four percent (63/85) of women started treatment before conception, 64% (54/85) reached the phenylalanine target range before conception. Pregnancy planning resulted in earlier achievement of the phenylalanine target (18 weeks before conception planned vs. 11 weeks of gestation unplanned, p < 0.001) and lower plasma phenylalanine concentrations during pregnancy, particularly in the first trimester (0-7 weeks of gestation: 247 μmol/L planned vs. 467 μmol/L unplanned, p < 0.0001; 8-12 weeks of gestation: 235 μmol/L planned vs. 414 μmol/L unplanned, p < 0.001). Preconceptual dietary training increased the success rate of achieving the phenylalanine target before conception compared to women without training (19 weeks before conception vs. 9 weeks of gestation, p < 0.001). The majority (93%) of children had normal IQ (mean 103, median age 7.3 years); however, IQ decreased with increasing phenylalanine concentration during pregnancy. Good metabolic control during pregnancy is the prerequisite to prevent maternal PKU syndrome in the offspring. This can be achieved by timely provision of detailed information, preconceptual dietary training, and careful planning of pregnancy., (© 2022 The Authors. Journal of Inherited Metabolic Disease published by John Wiley & Sons Ltd on behalf of SSIEM.)

Published
2022
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19. Weaning practices in phenylketonuria vary between health professionals in Europe

Author

Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M.F., Garcia-Arenas, D., Arslan, N., Assoun, M., Altinok, Y. Atik, Barrio-Carreras, D., Quintana, A. Belanger, Bernabei, S.M., Bontemps, C., Boyle, F., Bruni, G., Bueno-Delgado, M., Caine, G., Carvalho, R., Chrobot, A., Chyz, K., Cochrane, B., Correia, C., Corthouts, K., Daly, A., Leo, S. De, Desloovere, A., Meyer, A, Theux, A. De, Didycz, B., Dijsselhof, M.E., Dokoupil, K., Drabik, J., Dunlop, C., Eberle-Pelloth, W., Eftring, K., Ekengren, J., Errekalde, I., Evans, S., Foucart, A., Fokkema, L., Francois, L., French, M., Forssell, E., Gingell, C., Goncalves, C., Ozel, H. Gokmen, Grimsley, A., Gugelmo, G., Gyure, E., Heller, C., Hensler, R., Jardim, I., Joost, C., Jorg-Streller, M., Jouault, C., Jung, A., Kanthe, M., Koc, N., Kok, I.L., Kozanoglu, T., Kumru, B., Lang, F., Lang, K., Liegeois, I., Liguori, A., Lilje, R., Lubina, O., Manta-Vogli, P., Mayr, D., Meneses, C., Newby, C., Meyer, U., Mexia, S., Nicol, C., Och, U., Olivas, S.M., Pedron-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Dionigi, A. Re, Reinson, K., Robert, M., Robertson, L., Rocha, J.C., Rohde, C., Rosenbaum-Fabian, S., Rossi, A, Ruiz, M., Saligova, J., Gutierrez-Sanchez, A., Schlune, A., Schulpis, K., Serrano-Nieto, J., Skarpalezou, A., Skeath, R., Slabbert, A., Straczek, K., Gizewska, M., Terry, A., Wegberg, A.M.J. van, Zuvadelli, J., MacDonald, A., Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M.F., Garcia-Arenas, D., Arslan, N., Assoun, M., Altinok, Y. Atik, Barrio-Carreras, D., Quintana, A. Belanger, Bernabei, S.M., Bontemps, C., Boyle, F., Bruni, G., Bueno-Delgado, M., Caine, G., Carvalho, R., Chrobot, A., Chyz, K., Cochrane, B., Correia, C., Corthouts, K., Daly, A., Leo, S. De, Desloovere, A., Meyer, A, Theux, A. De, Didycz, B., Dijsselhof, M.E., Dokoupil, K., Drabik, J., Dunlop, C., Eberle-Pelloth, W., Eftring, K., Ekengren, J., Errekalde, I., Evans, S., Foucart, A., Fokkema, L., Francois, L., French, M., Forssell, E., Gingell, C., Goncalves, C., Ozel, H. Gokmen, Grimsley, A., Gugelmo, G., Gyure, E., Heller, C., Hensler, R., Jardim, I., Joost, C., Jorg-Streller, M., Jouault, C., Jung, A., Kanthe, M., Koc, N., Kok, I.L., Kozanoglu, T., Kumru, B., Lang, F., Lang, K., Liegeois, I., Liguori, A., Lilje, R., Lubina, O., Manta-Vogli, P., Mayr, D., Meneses, C., Newby, C., Meyer, U., Mexia, S., Nicol, C., Och, U., Olivas, S.M., Pedron-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Dionigi, A. Re, Reinson, K., Robert, M., Robertson, L., Rocha, J.C., Rohde, C., Rosenbaum-Fabian, S., Rossi, A, Ruiz, M., Saligova, J., Gutierrez-Sanchez, A., Schlune, A., Schulpis, K., Serrano-Nieto, J., Skarpalezou, A., Skeath, R., Slabbert, A., Straczek, K., Gizewska, M., Terry, A., Wegberg, A.M.J. van, Zuvadelli, J., and MacDonald, A.

Abstract

Contains fulltext : 205374.pdf (publisher's version ) (Open Access), 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 6months 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(R)) 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 17-26weeks in 85% (n=81/95) of centres, >26weeks in 12% (n=11/95) and<17weeks 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 17-26weeks and 48% (n=46/95) at >26weeks. 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 26-36weeks (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

Published
2019

20. Weaning practices in phenylketonuria vary between health professionals in Europe.

Author

UCL - (SLuc) Service d'endocrinologie et de nutrition, Pinto, A, Adams, S, Ahring, K, Allen, H, Almeida, M F, Garcia-Arenas, D, Arslan, N, Assoun, M, Atik Altınok, Y, Barrio-Carreras, D, Belanger Quintana, A, Bernabei, S M, 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, M E, Dokoupil, K, Drabik, J, Dunlop, C, Eberle-Pelloth, W, Eftring, K, Ekengren, J, Errekalde, I, Evans, S, Foucart, Audrey, 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, I L, 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, S M, Pedrón-Giner, C, Pereira, R, Plutowska-Hoffmann, K, Purves, J, Re Dionigi, A, Reinson, K, Robert, M, Robertson, L, Rocha, J C, 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, T A M, van der Ploeg, E M C, Vande Kerckhove, K, Van Driessche, M, van Wegberg, A M J, van Wyk, K, Vasconcelos, C, Velez García, V, Wildgoose, J, Winkler, T, Żółkowska, J, Zuvadelli, J, MacDonald, A, UCL - (SLuc) Service d'endocrinologie et de nutrition, Pinto, A, Adams, S, Ahring, K, Allen, H, Almeida, M F, Garcia-Arenas, D, Arslan, N, Assoun, M, Atik Altınok, Y, Barrio-Carreras, D, Belanger Quintana, A, Bernabei, S M, 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, M E, Dokoupil, K, Drabik, J, Dunlop, C, Eberle-Pelloth, W, Eftring, K, Ekengren, J, Errekalde, I, Evans, S, Foucart, Audrey, 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, I L, 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, S M, Pedrón-Giner, C, Pereira, R, Plutowska-Hoffmann, K, Purves, J, Re Dionigi, A, Reinson, K, Robert, M, Robertson, L, Rocha, J C, 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, T A M, van der Ploeg, E M C, Vande Kerckhove, K, Van Driessche, M, van Wegberg, A M J, van Wyk, K, Vasconcelos, C, Velez García, V, Wildgoose, J, Winkler, T, Żółkowska, J, Zuvadelli, J, and MacDonald, A

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 throu

Published
2019

23. Weaning practices in phenylketonuria vary between health professionals in Europe

Author

Pinto, A., primary, Adams, S., additional, Ahring, K., additional, Allen, H., additional, Almeida, M.F., additional, Garcia-Arenas, D., additional, Arslan, N., additional, Assoun, M., additional, Atik Altınok, Y., additional, Barrio-Carreras, D., additional, Belanger Quintana, A., additional, Bernabei, S.M., additional, Bontemps, C., additional, Boyle, F., additional, Bruni, G., additional, Bueno-Delgado, M., additional, Caine, G., additional, Carvalho, R., additional, Chrobot, A., additional, Chyż, K., additional, Cochrane, B., additional, Correia, Carla, additional, Corthouts, K., additional, Daly, A., additional, De Leo, S., additional, Desloovere, A., additional, De Meyer, A., additional, De Theux, A., additional, Didycz, B., additional, Dijsselhof, M.E., additional, Dokoupil, K., additional, Drabik, J., additional, Dunlop, C., additional, Eberle-Pelloth, W., additional, Eftring, K., additional, Ekengren, J., additional, Errekalde, I., additional, Evans, S., additional, Foucart, A., additional, Fokkema, L., additional, François, L., additional, French, M., additional, Forssell, E., additional, Gingell, C., additional, Gonçalves, C., additional, Gökmen Özel, H., additional, Grimsley, A., additional, Gugelmo, G., additional, Gyüre, E., additional, Heller, C., additional, Hensler, R., additional, Jardim, I., additional, Joost, C., additional, Jörg-Streller, M., additional, Jouault, C., additional, Jung, A., additional, Kanthe, M., additional, Koç, N., additional, Kok, I.L., additional, Kozanoğlu, T., additional, Kumru, B., additional, Lang, F., additional, Lang, K., additional, Liegeois, I., additional, Liguori, A., additional, Lilje, R., additional, Ļubina, O., additional, Manta-Vogli, P., additional, Mayr, D., additional, Meneses, C., additional, Newby, C., additional, Meyer, U., additional, Mexia, S., additional, Nicol, C., additional, Och, U., additional, Olivas, S.M., additional, Pedrón-Giner, C., additional, Pereira, R., additional, Plutowska-Hoffmann, K., additional, Purves, J., additional, Re Dionigi, A., additional, Reinson, K., additional, Robert, M., additional, Robertson, L., additional, Rocha, J.C., additional, Rohde, C., additional, Rosenbaum-Fabian, S., additional, Rossi, A., additional, Ruiz, M., additional, Saligova, J., additional, Gutiérrez-Sánchez, A., additional, Schlune, A., additional, Schulpis, K., additional, Serrano-Nieto, J., additional, Skarpalezou, A., additional, Skeath, R., additional, Slabbert, A., additional, Straczek, K., additional, Giżewska, M., additional, Terry, A., additional, Thom, R., additional, Tooke, A., additional, Tuokkola, J., additional, van Dam, E., additional, van den Hurk, T.A.M., additional, van der Ploeg, E.M.C., additional, Vande Kerckhove, K., additional, Van Driessche, M., additional, van Wegberg, A.M.J., additional, van Wyk, K., additional, Vasconcelos, C., additional, Velez García, V., additional, Wildgoose, J., additional, Winkler, T., additional, Żółkowska, J., additional, Zuvadelli, J., additional, and MacDonald, A., additional

Published
2019
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28. Early feeding practices in infants with phenylketonuria across Europe

Author

Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M. F., Garcia-Arenas, D., Arslan, N., Assoun, M., Atik Altınok, Y., Barrio-Carreras, D., Belanger Quintana, A., Bernabei, S. M., 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, M. E., 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, I. L., 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, S. M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., Robertson, L., Rocha, J. C., 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, T. A.M., van der Ploeg, E. M.C., Vande Kerckhove, K., Van Driessche, M., van Wegberg, A. M.J., van Wyk, K., Vasconcelos, C., Velez García, V., Wildgoose, J., Winkler, T., Żółkowska, J., Zuvadelli, J., MacDonald, A., Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M. F., Garcia-Arenas, D., Arslan, N., Assoun, M., Atik Altınok, Y., Barrio-Carreras, D., Belanger Quintana, A., Bernabei, S. M., 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, M. E., 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, I. L., 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, S. M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., Robertson, L., Rocha, J. C., 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, T. A.M., van der Ploeg, E. M.C., Vande Kerckhove, K., Van Driessche, M., van Wegberg, A. M.J., van Wyk, K., Vasconcelos, C., Velez García, V., Wildgoose, J., Winkler, T., Żółkowska, J., Zuvadelli, J., and MacDonald, A.

Published
2018

29. Early feeding practices in infants with phenylketonuria across Europe

Author

UCL - (SLuc) Unité d'endocrinologie pédiatrique, Thom, R., De Theux, A., Dijsselhof, M.E., Dokoupil, K., Drabik, J., Dunlop, C., Eberle-Pelloth, W., Eftring, K., Ekengren, J., Errekalde, I., Evans, S., Foucart, Audrey, 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., Meyer, U., Olivas, S.M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., Robertson, L., UCL - (SLuc) Unité d'endocrinologie pédiatrique, Thom, R., De Theux, A., Dijsselhof, M.E., Dokoupil, K., Drabik, J., Dunlop, C., Eberle-Pelloth, W., Eftring, K., Ekengren, J., Errekalde, I., Evans, S., Foucart, Audrey, 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., Meyer, U., Olivas, S.M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., and Robertson, L.

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 dev

Published
2018

30. Early feeding practices in infants with phenylketonuria across Europe

Author

Afdeling Dietetiek, Other research (not in main researchprogram), Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M. F., Garcia-Arenas, D., Arslan, N., Assoun, M., Atik Altınok, Y., Barrio-Carreras, D., Belanger Quintana, A., Bernabei, S. M., 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, M. E., 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, I. L., 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, S. M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., Robertson, L., Rocha, J. C., 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, T. A.M., van der Ploeg, E. M.C., Vande Kerckhove, K., Van Driessche, M., van Wegberg, A. M.J., van Wyk, K., Vasconcelos, C., Velez García, V., Wildgoose, J., Winkler, T., Żółkowska, J., Zuvadelli, J., MacDonald, A., Afdeling Dietetiek, Other research (not in main researchprogram), Pinto, A., Adams, S., Ahring, K., Allen, H., Almeida, M. F., Garcia-Arenas, D., Arslan, N., Assoun, M., Atik Altınok, Y., Barrio-Carreras, D., Belanger Quintana, A., Bernabei, S. M., 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, M. E., 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, I. L., 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, S. M., Pedrón-Giner, C., Pereira, R., Plutowska-Hoffmann, K., Purves, J., Re Dionigi, A., Reinson, K., Robert, M., Robertson, L., Rocha, J. C., 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, T. A.M., van der Ploeg, E. M.C., Vande Kerckhove, K., Van Driessche, M., van Wegberg, A. M.J., van Wyk, K., Vasconcelos, C., Velez García, V., Wildgoose, J., Winkler, T., Żółkowska, J., Zuvadelli, J., and MacDonald, A.

Published
2018

31. Early feeding practices in infants with phenylketonuria across Europe

Author

Pinto, A., primary, Adams, S., additional, Ahring, K., additional, Allen, H., additional, Almeida, M.F., additional, Garcia-Arenas, D., additional, Arslan, N., additional, Assoun, M., additional, Atik Altınok, Y., additional, Barrio-Carreras, D., additional, Belanger Quintana, A., additional, Bernabei, S.M., additional, Bontemps, C., additional, Boyle, F., additional, Bruni, G., additional, Bueno-Delgado, M., additional, Caine, G., additional, Carvalho, R., additional, Chrobot, A., additional, Chyż, K., additional, Cochrane, B., additional, Correia, C., additional, Corthouts, K., additional, Daly, A., additional, De Leo, S., additional, Desloovere, A., additional, De Meyer, A., additional, De Theux, A., additional, Didycz, B., additional, Dijsselhof, M.E., additional, Dokoupil, K., additional, Drabik, J., additional, Dunlop, C., additional, Eberle-Pelloth, W., additional, Eftring, K., additional, Ekengren, J., additional, Errekalde, I., additional, Evans, S., additional, Foucart, A., additional, Fokkema, L., additional, François, L., additional, French, M., additional, Forssell, E., additional, Gingell, C., additional, Gonçalves, C., additional, Gökmen Özel, H., additional, Grimsley, A., additional, Gugelmo, G., additional, Gyüre, E., additional, Heller, C., additional, Hensler, R., additional, Jardim, I., additional, Joost, C., additional, Jörg-Streller, M., additional, Jouault, C., additional, Jung, A., additional, Kanthe, M., additional, Koç, N., additional, Kok, I.L., additional, Kozanoğlu, T., additional, Kumru, B., additional, Lang, F., additional, Lang, K., additional, Liegeois, I., additional, Liguori, A., additional, Lilje, R., additional, Ļubina, O., additional, Manta-Vogli, P., additional, Mayr, D., additional, Meneses, C., additional, Newby, C., additional, Meyer, U., additional, Mexia, S., additional, Nicol, C., additional, Och, U., additional, Olivas, S.M., additional, Pedrón-Giner, C., additional, Pereira, R., additional, Plutowska-Hoffmann, K., additional, Purves, J., additional, Re Dionigi, A., additional, Reinson, K., additional, Robert, M., additional, Robertson, L., additional, Rocha, J.C., additional, Rohde, C., additional, Rosenbaum-Fabian, S., additional, Rossi, A., additional, Ruiz, M., additional, Saligova, J., additional, Gutiérrez-Sánchez, A., additional, Schlune, A., additional, Schulpis, K., additional, Serrano-Nieto, J., additional, Skarpalezou, A., additional, Skeath, R., additional, Slabbert, A., additional, Straczek, K., additional, Giżewska, M., additional, Terry, A., additional, Thom, R., additional, Tooke, A., additional, Tuokkola, J., additional, van Dam, E., additional, van den Hurk, T.A.M., additional, van der Ploeg, E.M.C., additional, Vande Kerckhove, K., additional, Van Driessche, M., additional, van Wegberg, A.M.J., additional, van Wyk, K., additional, Vasconcelos, C., additional, Velez García, V., additional, Wildgoose, J., additional, Winkler, T., additional, Żółkowska, J., additional, Zuvadelli, J., additional, and MacDonald, A., additional

Published
2018
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32. Dietary practices in propionic acidemia: A European survey

Author

Daly, A., primary, Pinto, A., additional, Evans, S., additional, Almeida, M.F., additional, Assoun, M., additional, Belanger-Quintana, A., additional, Bernabei, S.M., additional, Bollhalder, S., additional, Cassiman, D., additional, Champion, H., additional, Chan, H., additional, Dalmau, J., additional, de Boer, F., additional, de Laet, C., additional, de Meyer, A., additional, Desloovere, A., additional, Dianin, A., additional, Dixon, M., additional, Dokoupil, K., additional, Dubois, S., additional, Eyskens, F., additional, Faria, A., additional, Fasan, I., additional, Favre, E., additional, Feillet, F., additional, Fekete, A., additional, Gallo, G., additional, Gingell, C., additional, Gribben, J., additional, Kaalund Hansen, K., additional, Ter Horst, N.M., additional, Jankowski, C., additional, Janssen-Regelink, R., additional, Jones, I., additional, Jouault, C., additional, Kahrs, G.E., additional, Kok, I.L., additional, Kowalik, A., additional, Laguerre, C., additional, Le Verge, S., additional, Lilje, R., additional, Maddalon, C., additional, Mayr, D., additional, Meyer, U., additional, Micciche, A., additional, Och, U., additional, Robert, M., additional, Rocha, J.C., additional, Rogozinski, H., additional, Rohde, C., additional, Ross, K., additional, Saruggia, I., additional, Schlune, A., additional, Singleton, K., additional, Sjoqvist, E., additional, Skeath, R., additional, Stolen, L.H., additional, Terry, A., additional, Timmer, C., additional, Tomlinson, L., additional, Tooke, A., additional, Vande Kerckhove, K., additional, van Dam, E., additional, van den Hurk, T., additional, van der Ploeg, L., additional, van Driessche, M., additional, van Rijn, M., additional, van Wegberg, A., additional, Vasconcelos, C., additional, Vestergaard, H., additional, Vitoria, I., additional, Webster, D., additional, White, F.J., additional, White, L., additional, Zweers, H., additional, and MacDonald, A., additional

Published
2017
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33. Dietary practices in isovaleric acidemia: A European survey

Author

Pinto, A., Daly, A., Evans, S., Almeida, M.F., Assoun, M., Belanger-Quintana, A., Bernabei, S., Bollhalder, S., Cassiman, D., Champion, H., Chan, H., Dalmau, J., 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.G., Jones, I., Jouault, C., Kahrs, G.E., Kok, I.L., Kowalik, A., Laguerre, C., Verge, S. Le, Lilje, R., Maddalon, C., Mayr, D., Meyer, U., Micciche, A., Robert, M., Rocha, J.C., Rogozinski, H., Rohde, C., Ross, K., Saruggia, I., Schlune, A., Singleton, K., Sjoqvist, E., Stolen, L.H., Terry, A., Timmer, C., Tomlinson, L., Tooke, A., Kerckhove, K. Vande, Dam, E. van, Hurk, T. van den, Ploeg, L. van der, Driessche, M. Van, Rijn, M. van de, Teeffelen-Heithoff, A. van, Wegberg, A.M. van, Vasconcelos, C., Vestergaard, H., Vitoria, I., Webster, D., White, F.J., White, L., Zweers, H.E., Macdonald, A., Pinto, A., Daly, A., Evans, S., Almeida, M.F., Assoun, M., Belanger-Quintana, A., Bernabei, S., Bollhalder, S., Cassiman, D., Champion, H., Chan, H., Dalmau, J., 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.G., Jones, I., Jouault, C., Kahrs, G.E., Kok, I.L., Kowalik, A., Laguerre, C., Verge, S. Le, Lilje, R., Maddalon, C., Mayr, D., Meyer, U., Micciche, A., Robert, M., Rocha, J.C., Rogozinski, H., Rohde, C., Ross, K., Saruggia, I., Schlune, A., Singleton, K., Sjoqvist, E., Stolen, L.H., Terry, A., Timmer, C., Tomlinson, L., Tooke, A., Kerckhove, K. Vande, Dam, E. van, Hurk, T. van den, Ploeg, L. van der, Driessche, M. Van, Rijn, M. van de, Teeffelen-Heithoff, A. van, Wegberg, A.M. van, Vasconcelos, C., Vestergaard, H., Vitoria, I., Webster, D., White, F.J., White, L., Zweers, H.E., and Macdonald, A.

Abstract

Contains fulltext : 169955.pdf (publisher's version ) (Open Access), 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.

Published
2017

34. Dietary practices in isovaleric acidemia: A European survey

Author

Pinto, A., primary, Daly, A., additional, Evans, S., additional, Almeida, M.F., additional, Assoun, M., additional, Belanger-Quintana, A., additional, Bernabei, S., additional, Bollhalder, S., additional, Cassiman, D., additional, Champion, H., additional, Chan, H., additional, Dalmau, J., additional, de Boer, F., additional, de Laet, C., additional, de Meyer, A., additional, Desloovere, A., additional, Dianin, A., additional, Dixon, M., additional, Dokoupil, K., additional, Dubois, S., additional, Eyskens, F., additional, Faria, A., additional, Fasan, I., additional, Favre, E., additional, Feillet, F., additional, Fekete, A., additional, Gallo, G., additional, Gingell, C., additional, Gribben, J., additional, Kaalund-Hansen, K., additional, Horst, N., additional, Jankowski, C., additional, Janssen-Regelink, R., additional, Jones, I., additional, Jouault, C., additional, Kahrs, G.E., additional, Kok, I.L., additional, Kowalik, A., additional, Laguerre, C., additional, Le Verge, S., additional, Lilje, R., additional, Maddalon, C., additional, Mayr, D., additional, Meyer, U., additional, Micciche, A., additional, Robert, M., additional, Rocha, J.C., additional, Rogozinski, H., additional, Rohde, C., additional, Ross, K., additional, Saruggia, I., additional, Schlune, A., additional, Singleton, K., additional, Sjoqvist, E., additional, Stolen, L.H., additional, Terry, A., additional, Timmer, C., additional, Tomlinson, L., additional, Tooke, A., additional, Vande Kerckhove, K., additional, van Dam, E., additional, van den Hurk, T., additional, van der Ploeg, L., additional, van Driessche, M., additional, van Rijn, M., additional, van Teeffelen-Heithoff, A., additional, van Wegberg, A., additional, Vasconcelos, C., additional, Vestergaard, H., additional, Vitoria, I., additional, Webster, D., additional, White, F.J., additional, White, L., additional, Zweers, H., additional, and MacDonald, A., additional

Published
2017
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35. Hepatorenal Tyrosinaemia: Impact of a Simplified Diet on Metabolic Control and Clinical Outcome.

Author

Bärhold F, Meyer U, Neugebauer AK, Thimm EM, Lier D, Rosenbaum-Fabian S, Och U, Fekete A, Möslinger D, Rohde C, Beblo S, Hochuli M, Bogovic N, Korpel V, Dahl SV, Mayorandan S, Fischer A, Freisinger P, Dokoupil K, Heddrich-Ellerbrok M, Jörg-Streller M, van Teeffelen-Heithoff A, Lahl J, and Das AM

Subjects
Adolescent, Austria, Child, Child, Preschool, Combined Modality Therapy methods, Combined Modality Therapy standards, Diet, Protein-Restricted standards, Female, Germany, Humans, Male, Patient Compliance statistics & numerical data, Phenylalanine blood, Practice Guidelines as Topic, Prospective Studies, Retrospective Studies, Surveys and Questionnaires statistics & numerical data, Switzerland, Treatment Outcome, Tyrosine blood, Tyrosinemias blood, Tyrosinemias diagnosis, Tyrosinemias metabolism, Young Adult, Cyclohexanones administration & dosage, Diet, Protein-Restricted methods, Dietary Proteins administration & dosage, Enzyme Inhibitors administration & dosage, Nitrobenzoates administration & dosage, Tyrosinemias therapy
Abstract

Background : Tyrosinaemia type 1 is a rare inherited metabolic disease caused by an enzyme defect in the tyrosine degradation pathway. It is treated using nitisinone and a low-protein diet. In a workshop in 2013, a group of nutritional specialists from Germany, Switzerland and Austria agreed to advocate a simplified low-protein diet and to allow more natural protein intake in patients with tyrosinaemia type 1. This retrospective study evaluates the recommendations made at different treatment centers and their impact on clinical symptoms and metabolic control. Methods : For this multicenter study, questionnaires were sent to nine participating treatment centers to collect data on the general therapeutic approach and data of 47 individual patients treated by those centers. Results : Dietary simplification allocating food to 3 categories led to increased tyrosine and phenylalanine blood concentrations without weighing food. Phenylalanine levels were significantly higher in comparison to a strict dietary regimen whereas tyrosine levels in plasma did not change. Non-inferiority was shown for the simplification and liberalization of the diet. Compliance with dietary recommendations was higher using the simplified diet in comparison to the stricter approach. Age correlates negatively with compliance. Conclusions : Simplification of the diet with increased natural protein intake based on three categories of food may be implemented in the diet of patients with tyrosinaemia type 1 without significantly altering metabolic control. Patient compliance is strongly influencing tyrosine blood concentrations. A subsequent prospective study with a larger sample size is necessary to get a better insight into the effect of dietary recommendations on metabolic control.

Published
2020
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36. [Dietary treatment of inborn errors of metabolism-a balancing act between indulgence and therapy].

Author

Schiergens KA, Weiß KJ, Dokoupil K, Fleissner S, and Maier EM

Subjects
Adolescent, Child, Diet, Germany, Humans, Phenylketonurias, Quality of Life, Metabolism, Inborn Errors
Abstract

For many inborn metabolic diseases, a lifelong diet is a crucial part of the therapy since pharmacological therapy is available for only a few conditions and patients. The implementation of a low natural protein diet with a reduced intake of natural protein and the complementary use of synthetic amino acid mixtures is described using the examples of phenylketonuria and urea cycle disorders focusing on children and adolescents. For phenylketonuria, the amino acid supplement is free of phenylalanine whereas for urea cycle disorders, it exclusively consists of essential amino acids. The dietary treatment aims to maintain metabolic stability and to prevent accumulation of toxic metabolites. At the same time, the nutritional requirements to ensure growth and development must be met. Therefore, patients need to follow strict rules regarding the choice of food products. This restrictive therapy interferes with the desire for autonomy and the joy of eating and often results in a reduced quality of life.Following the diet is crucial for a favorable outcome. To meet its requirements, patients and their families are provided with training. It is a great challenge not only to support the patients and their families in all practical aspects of dietary management, but also to motivate them to lifelong adherence in order to ensure the best possible outcome.

Published
2020
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37. Management of three preterm infants with phenylketonuria.

Author

Weiss K, Lotz-Havla A, Dokoupil K, and Maier EM

Subjects
Amino Acids administration & dosage, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases blood, Infant, Very Low Birth Weight blood, Male, Phenylalanine administration & dosage, Phenylalanine blood, Phenylketonurias blood, Dietary Proteins administration & dosage, Enteral Nutrition methods, Infant, Premature, Diseases therapy, Parenteral Nutrition methods, Phenylketonurias therapy
Abstract

Providing adequate amounts of protein in preterm infants suffering from a metabolic disease that requires a reduced intake of natural protein is challenging. Phenylketonuria (PKU) is an inborn error of metabolism affecting the enzymatic conversion of phenylalanine to tyrosine. The dietary treatment of PKU aims to lower phenylalanine concentrations in the blood by implementing a low-phenylalanine diet restrictive in natural protein. We describe the nutritional management of three preterm infants, two with very low birth weight, with PKU detected by newborn screening. All three infants tolerated high amounts of phenylalanine; two were breastfed unrestrictedly during late prematurity. We show that nutrition of preterm infants with PKU according to recommendations of early and intensive nutrition with a high intake of protein is feasible even in infants with impaired enteral feeding. Due to a high phenylalanine tolerance of PKU infants during prematurity, there is no need for a phenylalanine-free parenteral amino acid mixture. During the catabolic state of prematurity preterm infants with PKU have phenylalanine requirements comparable to healthy preterm infants., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2020
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38. Dietary practices in methylmalonic acidaemia: a European survey.

Author

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 F, Laet C, 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, 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 LV, van Driessche M, van Rijn M, Wegberg AV, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White F, White L, Zweers H, and MacDonald A

Subjects
Adolescent, Amino Acid Metabolism, Inborn Errors epidemiology, Child, Child, Preschool, Cross-Sectional Studies, Europe epidemiology, Female, Humans, Infant, Infant, Newborn, Male, Nutritional Support, Amino Acid Metabolism, Inborn Errors diet therapy, Dietary Proteins administration & dosage, Surveys and Questionnaires standards
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.

Published
2020
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39. How strict is galactose restriction in adults with galactosaemia? International practice

Author

Adam, Siddig Momin, Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, Judith, Dawson, S., Defourny, S., Meyer, A., Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grünert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C.F., Lefebure, K., Luyten, K., MacDonald, A., Meyer, U., Micciche, A., Müller, E., Portnoi, P., Ripley, S., Robert, C.M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, Erica S, Singleton, K., Sjöqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Vande Kerckhove, K., van den Ploeg, L., Van Driessche, M., van Rijn, M., van Teeffelen-Heithoff, A., Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., Zweers, H., Adam, Siddig Momin, Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, Judith, Dawson, S., Defourny, S., Meyer, A., Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grünert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C.F., Lefebure, K., Luyten, K., MacDonald, A., Meyer, U., Micciche, A., Müller, E., Portnoi, P., Ripley, S., Robert, C.M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, Erica S, Singleton, K., Sjöqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Vande Kerckhove, K., van den Ploeg, L., Van Driessche, M., van Rijn, M., van Teeffelen-Heithoff, A., Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., and Zweers, H.

Published
2015

40. How strict is galactose restriction in adults with galactosaemia? International practice

Author

Adam, S., Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, J., Dawson, S., Defourny, S., Meijer, A, Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grunert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C., Lefebure, K., Luyten, K., Macdonald, A., Meyer, U., Micciche, A., Muller, E., Portnoi, P., Ripley, S., Robert, M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, S., Singleton, K., Sjoqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Kerckhove, K. Vande, Ploeg, L. van der, Driessche, M. Van, Rijn, M. van de, Teeffelen-Heithoff, A. van, Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., Zweers, H.E., Adam, S., Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, J., Dawson, S., Defourny, S., Meijer, A, Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grunert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C., Lefebure, K., Luyten, K., Macdonald, A., Meyer, U., Micciche, A., Muller, E., Portnoi, P., Ripley, S., Robert, M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, S., Singleton, K., Sjoqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Kerckhove, K. Vande, Ploeg, L. van der, Driessche, M. Van, Rijn, M. van de, Teeffelen-Heithoff, A. van, Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., and Zweers, H.E.

Abstract

Item does not contain fulltext, Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides +/- fruits and vegetables and 12 offal. 38% (n=15) relaxed diet by: 1) allowing traces of lactose in manufactured foods (n=13) or 2) giving fruits, vegetables and galactosides (n=2). Only 15% (n=6) calculated dietary galactose. 32% of patients were lost to dietetic follow-up. In adult galactosaemia, there is limited diet relaxation.

Published
2015

41. How strict is galactose restriction in adults with galactosaemia? International practice

Author

Afdeling Dietetiek, Other research (not in main researchprogram), Adam, Siddig Momin, Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, Judith, Dawson, S., Defourny, S., Meyer, A., Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grünert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C.F., Lefebure, K., Luyten, K., MacDonald, A., Meyer, U., Micciche, A., Müller, E., Portnoi, P., Ripley, S., Robert, C.M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, Erica S, Singleton, K., Sjöqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Vande Kerckhove, K., van den Ploeg, L., Van Driessche, M., van Rijn, M., van Teeffelen-Heithoff, A., Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., Zweers, H., Afdeling Dietetiek, Other research (not in main researchprogram), Adam, Siddig Momin, Akroyd, R., Bernabei, S., Bollhalder, S., Boocock, S., Burlina, A., Coote, T., Corthouts, K., Dalmau, Judith, Dawson, S., Defourny, S., Meyer, A., Desloovere, A., Devlin, Y., Diels, M., Dokoupil, K., Donald, S., Evans, S., Fasan, I., Ferguson, C., Ford, S., Forga, M., Gallo, G., Grünert, S.C., Heddrich-Ellerbrok, M., Heidenborg, C., Jonkers, C.F., Lefebure, K., Luyten, K., MacDonald, A., Meyer, U., Micciche, A., Müller, E., Portnoi, P., Ripley, S., Robert, C.M., Robertson, L.V., Rosenbaum-Fabian, S., Sahm, K., Schultz, Erica S, Singleton, K., Sjöqvist, E., Stoelen, L., Terry, A., Thompson, S., Timmer, C., Vande Kerckhove, K., van den Ploeg, L., Van Driessche, M., van Rijn, M., van Teeffelen-Heithoff, A., Vitoria, I., Voillot, C., Wenz, J., Westbrook, M., Wildgoose, J., and Zweers, H.

Published
2015

42. The challenges of managing coexistent disorders with phenylketonuria: 30 cases

Author

MacDonald, A., primary, Ahring, K., additional, Almeida, M.F., additional, Belanger-Quintana, A., additional, Blau, N., additional, Burlina, A., additional, Cleary, M., additional, Coskum, T., additional, Dokoupil, K., additional, Evans, S., additional, Feillet, F., additional, Giżewska, M., additional, Gokmen Ozel, H., additional, Lotz-Havla, A.S., additional, Kamieńska, E., additional, Maillot, F., additional, Lammardo, A.M., additional, Muntau, A.C., additional, Puchwein-Schwepcke, A., additional, Robert, M., additional, Rocha, J.C., additional, Santra, S., additional, Skeath, R., additional, Strączek, K., additional, Trefz, F.K., additional, van Dam, E., additional, van Rijn, M., additional, van Spronsen, F., additional, and Vijay, S., additional

Published
2015
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44. How strict is galactose restriction in adults with galactosaemia? International practice

Author

Adam, S., primary, Akroyd, R., additional, Bernabei, S., additional, Bollhalder, S., additional, Boocock, S., additional, Burlina, A., additional, Coote, T., additional, Corthouts, K., additional, Dalmau, J., additional, Dawson, S., additional, Defourny, S., additional, De Meyer, A., additional, Desloovere, A., additional, Devlin, Y., additional, Diels, M., additional, Dokoupil, K., additional, Donald, S., additional, Evans, S., additional, Fasan, I., additional, Ferguson, C., additional, Ford, S., additional, Forga, M., additional, Gallo, G., additional, Grünert, S.C., additional, Heddrich-Ellerbrok, M., additional, Heidenborg, C., additional, Jonkers, C., additional, Lefebure, K., additional, Luyten, K., additional, MacDonald, A., additional, Meyer, U., additional, Micciche, A., additional, Müller, E., additional, Portnoi, P., additional, Ripley, S., additional, Robert, M., additional, Robertson, L.V., additional, Rosenbaum-Fabian, S., additional, Sahm, K., additional, Schultz, S., additional, Singleton, K., additional, Sjöqvist, E., additional, Stoelen, L., additional, Terry, A., additional, Thompson, S., additional, Timmer, C., additional, Vande Kerckhove, K., additional, van der Ploeg, L., additional, Van Driessche, M., additional, van Rijn, M., additional, van Teeffelen-Heithoff, A., additional, Vitoria, I., additional, Voillot, C., additional, Wenz, J., additional, Westbrook, M., additional, Wildgoose, J., additional, and Zweers, H., additional

Published
2015
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46. Long-Term Growth in Phenylketonuria: A Systematic Review and Meta-Analysis.

Author

Ilgaz F, Pinto A, Gökmen-Özel H, Rocha JC, van Dam E, Ahring K, Bélanger-Quintana A, Dokoupil K, Karabulut E, and MacDonald A

Subjects
Body Height, Body Weight, Child, Preschool, Female, Humans, Infant, Male, Child Development, Phenylketonurias
Abstract

There is an ongoing debate regarding the impact of phenylketonuria (PKU) and its treatment on growth. To date, evidence from studies is inconsistent, and data on the whole developmental period is limited. The primary aim of this systematic review was to investigate the effects of a phenylalanine (Phe)-restricted diet on long-term growth in patients with PKU. Four electronic databases were searched for articles published until September 2018. A total of 887 results were found, but only 13 articles met eligibility criteria. Only three studies had an adequate methodology for meta-analysis. Although the results indicate normal growth at birth and during infancy, children with PKU were significantly shorter and had lower weight for age than reference populations during the first four years of life. Impaired linear growth was observed until the end of adolescence in PKU. In contrast, growth impairment was not reported in patients with mild hyperphenylalaninemia, not requiring dietary restriction. Current evidence indicates that even with advances in dietary treatments, "optimal" growth outcomes are not attained in PKU. The majority of studies include children born before 1990s, so further research is needed to show the effects of recent dietary practices on growth in PKU.

Published
2019
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47. A series of three case reports in patients with phenylketonuria performing regular exercise: first steps in dietary adjustment.

Author

Rocha JC, van Dam E, Ahring K, Almeida MF, Bélanger-Quintana A, Dokoupil K, Gökmen-Özel H, Robert M, Heidenborg C, Harbage E, and MacDonald A

Subjects
Adolescent, Adult, Female, Humans, Male, Phenylalanine blood, Phenylketonurias blood, Prognosis, Young Adult, Biomarkers analysis, Dietary Supplements, Exercise Therapy, Phenylketonurias therapy
Abstract

Background Phenylketonuria (PKU), a rare, inherited metabolic condition, is treated with a strict low-phenylalanine (Phe) diet, supplemented with Phe-free protein substitute. The optimal nutritional management of a sporting individual with PKU has not been described. Therefore, guidelines for the general athlete have to be adapted. Case presentation Three clinical scenarios of sporting patients with PKU are given, illustrating dietary adaptations to usual management and challenges to attain optimal sporting performance. Therefore, the main objectives of sports nutrition in PKU are to (1) maintain a high carbohydrate diet; (2) carefully monitor hydration status; and (3) give attention to the timing of protein substitute intake in the immediate post-exercise recovery phase. Optimal energy intake should be given prior to, during and post exercise training sessions or competition. Fortunately, a usual low-Phe diet is rich in carbohydrate, but attention is required on the types of special low-protein foods chosen. Acute exercise does not seem to influence blood Phe concentrations, but further evidence is needed. Summary Well-treated PKU patients should be able to participate in sports activities, but this is associated with increased nutritional requirements and dietary adjustments. Conclusions It should be the goal of all sporting patients with PKU to maintain good metabolic Phe control and attain maximal athletic performance.

Published
2019
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48. Weaning practices in phenylketonuria vary between health professionals in Europe.

Author

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, and MacDonald A

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.

Published
2018
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