Cardiometabolic and Nutritional Morbidities of a Large, Adult, PKU Cohort from Andalusia

Abstract

The establishment of national neonatal screening systems has resulted in improved quality of life and life expectancy in patients with phenylketonuria (PKU). This has led to the development of multidisciplinary treatment units for adult patients with PKU. We present a retrospective descriptive study of a cohort of 90 adult patients (>16 years) with PKU under active follow-up in two reference centers in Andalusia. We analyzed disease severity, treatment type, demographic variables, cardiovascular risk factors, vitamin and hormone profiles, and bone metabolism. The median (interquartile range)age was 29 (23–38) years, 47 (52.2%) were women and 43 (47.8%) were men. Eighty (88.9%) had classical PKU, five (5.6%) moderate PKU, and five (5.6%) mild PKU. Diagnosis was by neonatal screening in 62 (68.9%) of the patients. The rest had late diagnosis. Treatment with sapropterin was given to 18 (20%) patients and diet and nutrition therapy to 72 (80%). There was adequate metabolic control according to Phe levels in 43 (47.78%) patients. Body mass index was 26.61 (22.7–31.1) kg/m2. Twenty-six (29.2%) patients had obesity, 7 (7.9%) hypertension, 2 (2.2%) type 2 diabetes, 26 (28.89%) dyslipidemia, 14 (15.6%) elevated total cholesterol, 9 (15.8%) decreased high-density lipoprotein cholesterol and 16 (17.8%) hypertriglyceridemia. Seven (10.3%) patients had osteoporosis and 28 (41.17%) osteopenia. Twenty-six (30.6%) had vitamin D (25OH) deficiency and four (4.5%) vitamin B12 deficiency. Although we observed no differences with most vascular risk factors, we found a high prevalence of obesity in relation to the age of the cohort. A continued evaluation of comorbidities in these patients is therefore needed, despite adequate metabolic control.

Overweight and obesity in adult patients with phenylketonuria: a systematic review

“…Our findings are supported also by the recent publication of Dios-Fuentes et al [ 24 ] including an adult cohort of 90 PKU patients in Spain. PKU patients participating in this study had a median BMI of 26.61 kg/m 2 (22.7–31.1 kg/m 2 ) and 29.2% were obese.…”

The BMI Z-Score and Protein Energy Ratio in Early- and Late-Diagnosed PKU Patients from a Single Reference Center in Mexico

“…In Mexico, there are different factors associated with overweight in childhood, such as: high consumption of sugary drinks, sedentary activities and a diet rich in fat and carbohydrates [ 42 ]; a recent systematic review of overweight in PKU children also found a high caloric intake and lack of physical activity as possible causal factors [ 43 ]. Moreover, it is known that obesity represents one of the most frequent comorbidities in HPA/PKU patients [ 44 , 45 , 46 ], which indicates the necessity of a closer nutritional follow-up and new therapeutic approaches. Overweight in this study occurred in spite of the lack of commercial special low-protein foods, although there is still not sufficient evidence of its direct impact.…”