VLCAD deficiency: Follow-up and outcome of patients diagnosed through newborn screening in Victoria

被引:28
|
作者
Evans, Maureen [1 ]
Andresen, Brage S. [2 ,3 ]
Nation, Judy [1 ]
Boneh, Avihu [1 ,4 ,5 ]
机构
[1] Royal Childrens Hosp Melbourne, Dept Metab Med, Parkville, Vic, Australia
[2] Skejby Sygehus, Res Unit Mol Med, Aarhus, Denmark
[3] Univ Southern Denmark, Villum Ctr Bioanalyt Sci, Dept Biochem & Mol Biol, Odense, Denmark
[4] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia
[5] Murdoch Childrens Res Inst, Metab Res, Parkville, Vic, Australia
关键词
Fatty acid oxidation; VLCAD deficiency; Body composition; COA DEHYDROGENASE-DEFICIENCY; FATTY-ACID OXIDATION; PROTEIN TFP DEFICIENCY; METABOLIC-CONTROL; BODY-COMPOSITION; MOLECULAR-BASIS; CHAIN; CHILDREN; IDENTIFICATION; DISORDERS;
D O I
10.1016/j.ymgme.2016.05.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is an inherited metabolic disorder of fatty acid oxidation. Treatment practices of the disorder have changed over the past 10-15 years since this disorder was included in newborn screening programs and patients were diagnosed pre-symptomatically. A genotype phenotype correlation has been suggested but the discovery of novel mutations make this knowledge limited. Herein, we describe our experience in treating patients (n = 22) diagnosed through newborn screening and mutational confirmation and followed up over a median period of 104 months. We report five novel mutations. In 2013 we formalised our treatment protocol, which essentially follows a European consensus paper from 2009 and our own experience. The prescribed low natural fat diet is relaxed for patients who are asymptomatic when reaching age 5 years but medium-chain triglyceride oil is recommended before and after physical activity regardless of age. Metabolic stability, growth, development and cardiac function are satisfactory in all patients. There were no episodes of encephalopathy or hypoglycaemia but three patients had episodes of muscle pain with our without rhabdomyolysis. Body composition studies showed a negative association between dietary protein intake and percent body fat. Larger patient cohort and longer follow up time are required for further elucidation of genotype-phenotype correlations and for establishing the role of dietary protein in metabolic stability and long-term healthier body composition in patients with VLCAD deficiency. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:282 / 287
页数:6
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