The long-term responses of 5 adolescent phenylketonuric patients to chemically-defined, synthetic diets with normal and low phenylalanine content were determined.
The synthetic preparations were found capable of sustaining good health and rapid growth in this group of profoundly retarded, behaviourally disturbed patients over a 3½-year period without clinical or biochemical evidence of nutritional inadequacy. 4 of these patients who were treated for 6 months on a comparable diet, in which 80% of the phenylalanine was replaced by tyrosine, continued to show weight maintenance and height increases. There was no evidence of poor acceptability of the imbalanced diet, whether the blood phenylalanine concentrations were at phenylketonuric or treatment levels. The phenylalanine intake required to maintain blood phenylalanine concentrations of 3-5 mg/100 ml in these 4 patients was well below normal requirements, and ranged between 6·8 and 20·1 mg/kg per day. Predictably, the phenylalanine requirement varied with individual growth rates.
All 4 treated patients had objective signs of improved central nervous system function during the six-month period on the phenylalanine-restricted diet. These electrophysiological and behavioural improvements were manifest after blood phenylalanine concentrations fell below 12 mg/100 ml in 3 cases and below 5 mg/100 ml in the fourth.
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