Background: Adult phenylketonuria (PKU) patients often reduce their intake of amino acid mixture (AAM) to less than the prescribed amounts. Effects of reduced AAM intake on nutrient supply were evaluated. Methods: Nutrient intake was calculated in 20 adult PKU patients based on a structured food record and complemented by laboratory assessment of nutritional status. Patients were classified into 2 groups, (A) regular AAM intake, or (B) AAM intake below calculated requirements. Results: Group B consumed a higher proportion of natural protein (60 ± 23 vs. 33 ± 12%, p = 0.002); however, the total protein intake was below the recommended amounts in 60% of patients in group B versus 7% in group A (p = 0.03). Fat intake was higher in group B (39 ± 9% of energy vs. 31 ± 6%, p = 0.03), mainly from saturated fats. Selenium, folate, and vitamin B12 intake was below the recommended intake in group B. However, serum concentrations of these analytes remained within the normal range in both groups, although vitamin B12 levels were lower in group B. Plasma tyrosine correlated with AAM intake, and hydroxyproline correlated with the amount of natural protein consumed. Conclusion: Relaxed AAM intake resulted in insufficient nutrient supply, despite a compensatory increase in consumption of natural protein. Care needs to be taken to ensure adequate nutrition in adults with PKU.

1.
Blau N, van Spronsen FJ, Levy HL: Phenylketonuria. Lancet 2010;376:1417-1427.
2.
Donlon J, Sarkissian C, Levy H, Scriver CR: Hyperphenylalaninemia: phenylalanine hydroxylase deficiency; in Beaudet AL, Vogelstein B, Kinzler KW, Antonarakis SE, Ballabio A, Gibson KM, Mitchell G (eds): The Online Metabolic and Molecular Bases of Inherited Disease. New York, The McGraw-Hill Companies, Inc., 2014.
3.
MacDonald A, Rocha JC, van Rijn M, Feillet F: Nutrition in phenylketonuria. Mol Genet Metab 2011;104(suppl):S10-S18.
4.
Lammardo AM, Robert M, Rocha JC, van Rijn M, Ahring K, Belanger-Quintana A, MacDonald A, Dokoupil K, Ozel HG, Goyens P, Feillet F: Main issues in micronutrient supplementation in phenylketonuria. Mol Genet Metab 2013;110(suppl):S1-S5.
5.
Vockley J, Andersson HC, Antshel KM, Braverman NE, Burton BK, Frazier DM, Mitchell J, Smith WE, Thompson BH, Berry SA; American College of Medical Genetics and Genomics Therapeutics Committee: Phenylalanine hydroxylase deficiency: diagnosis and management guideline. Genet Med 2014;16:188-200.
6.
van Spronsen FJ, van Wegberg AM, Ahring K, Belanger-Quintana A, Blau N, Bosch AM, Burlina A, Campistol J, Feillet F, Gizewska M, Huijbregts SC, Kearney S, Leuzzi V, Maillot F, Muntau AC, Trefz FK, van Rijn M, Walter JH, MacDonald A: Key European guidelines for the diagnosis and management of patients with phenylketonuria. Lancet Diabetes Endocrinol 2017;pii:S2213-8587(16) 30320-5.
7.
Trefz FK, van Spronsen FJ, MacDonald A, Feillet F, Muntau AC, Belanger-Quintana A, Burlina A, Demirkol M, Giovannini M, Gasteyger C: Management of adult patients with phenylketonuria: survey results from 24 countries. Eur J Pediatr 2015;174:119-127.
8.
Das AM, Goedecke K, Meyer U, Kanzelmeyer N, Koch S, Illsinger S, Lucke T, Hartmann H, Lange K, Lanfermann H, Hoy L, Ding XQ: Dietary habits and metabolic control in adolescents and young adults with phenylketonuria: self-imposed protein restriction may be harmful. JIMD Rep 2014;13:149-158.
9.
Walter JH, White FJ, Hall SK, MacDonald A, Rylance G, Boneh A, Francis DE, Shortland GJ, Schmidt M, Vail A: How practical are recommendations for dietary control in phenylketonuria? Lancet 2002;360:55-57.
10.
MacDonald A, Gokmen-Ozel H, van Rijn M, Burgard P: The reality of dietary compliance in the management of phenylketonuria. J Inherit Metab Dis 2010;33:665-670.
11.
Evans S, Daly A, MacDonald J, Preece MA, Santra S, Vijay S, Chakrapani A, MacDonald A: The micronutrient status of patients with phenylketonuria on dietary treatment: an ongoing challenge. Ann Nutr Metab 2014;65:42-48.
12.
Rohde C, von Teeffelen-Heithoff A, Thiele AG, Arelin M, Mutze U, Kiener C, Gerloff J, Baerwald C, Schultz S, Heller C, Muller AS, Kiess W, Beblo S: PKU patients on a relaxed diet may be at risk for micronutrient deficiencies. Eur J Clin Nutr 2014;68:119-124.
13.
Deutsche Gesellschaft für Ernährung ÖGfE, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung (Hrsg.): Referenzwerte für die Nährstoffzufuhr, ed 2. Aufl., 1. Ausgabe 2015. Bonn, Neuer Umschau Buchverl, 2015.
14.
Robert M, Rocha JC, van Rijn M, Ahring K, Belanger-Quintana A, MacDonald A, Dokoupil K, Gokmen Ozel H, Lammardo AM, Goyens P, Feillet F: Micronutrient status in phenylketonuria. Mol Genet Metab 2013;110(suppl):S6-S17.
15.
Crujeiras V, Aldamiz-Echevarria L, Dalmau J, Vitoria I, Andrade F, Roca I, Leis R, Fernandez-Marmiesse A, Couce ML: Vitamin and mineral status in patients with hyperphenylalaninemia. Mol Genet Metab 2015;115:145-150.
16.
Hvas AM, Nexo E, Nielsen JB: Vitamin B12 and vitamin B6 supplementation is needed among adults with phenylketonuria (PKU). J Inherit Metab Dis 2006;29:47-53.
17.
Hanley WB, Lee AW, Hanley AJ, Lehotay DC, Austin VJ, Schoonheyt WE, Platt BA, Clarke JT: “Hypotyrosinemia” in phenylketonuria. Mol Genet Metab 2000;69:286-294.
18.
Schulpis KH, Kalogerakou M, Gioni V, Papastamataki M, Papassotiriou I: Glutamine, ornithine, citrulline and arginine levels in children with phenylketonuria: the diet effect. Clin Biochem 2011;44:821-825.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.