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Adjusting Diet With Sapropterin In Phenylketonuria: What Factors Should Be Considered?

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Date
2011
Author
MacDonald, Anita
Ahring, Kirsten
Dokoupil, Katharina
Gokmen-Ozel, Hulya
Lammardo, Anna Maria
Motzfeldt, Kristina
Robert, Martine
Rocha, Julio Cesar
van Rijn, Margreet
Belanger-Quintana, Amaya
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Abstract
The usual treatment for phenylketonuria (PKU) is a phenylalanine-restricted diet. Following this diet is challenging, and long-term adherence (and hence metabolic control) is commonly poor. Patients with PKU (usually, but not exclusively, with a relatively mild form of the disorder) who are responsive to treatment with pharmacological doses of tetrahydrobiopterin (BH4) have either lower concentrations of blood phenylalanine or improved dietary phenylalanine tolerance. The availability of a registered formulation of BH4 (sapropterin dihydrochloride, Kuvan (R)) has raised many practical issues and new questions in the dietary management of these patients. Initially, patients and carers must understand clearly the likely benefits (and limitations) of sapropterin therapy. A minority of patients who respond to sapropterin are able to discontinue the phenylalanine-restricted diet completely, while others are able to relax the diet to some extent. Care is required when altering the phenylalanine-restricted diet, as this may have unintended nutritional consequences and must be undertaken with caution. New clinical protocols are required for managing any dietary change while maintaining control of blood phenylalanine, ensuring adequate nutrition and preventing nutritional deficiencies, overweight or obesity. An accurate initial evaluation of pre-sapropterin phenylalanine tolerance is essential, and the desired outcome from treatment with sapropterin (e. g. reduction in blood phenylalanine or relaxation in diet) must also be understood by the patient and carers from the outset. Continuing education and support will be required thereafter, with further adjustment of diet and sapropterin dosage as a young patient grows.
URI
https://doi.org/10.1017/S0007114511000298
http://hdl.handle.net/11655/20732
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  • Beslenme ve Diyetetik Bölümü Makale Koleksiyonu [72]
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