March 2015, v.1.12
Current version: v.2.5
Updated: August 2016
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- Overview
- Methodology
- Background
- Biochemical Pathway and Nutrition Treatment Rationale
- Nutrition Assessment
- Comparative Standards
- Nutrition Problem Identification
- Nutrition Intervention
- Nutrition Recommendations
- 1. Nutrition intervention for appropriate nutrient intake
- 2. Nutrition intervention to achieve appropriate blood PHE concentration
- 3. Strategies for nutrition intervention
- 4. Monitoring nutrition intervention
- 5. Nutrition intervention with alternative or adjunctive therapies
- 6. Nutrition intervention before, during and after pregnancy
- Monitoring and Evaluation
- Resources
- Benefits and Harms of Implementing the Recommendations
- Barriers to Implementation
- Areas for Future Research
- List of Tables
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Literature Evidence Summary Tables
- T.1 Laboratory and Clinical Findings in PKU
- T.2 Classification of PKU
- T.3 Recommended Intakes of PHE, TYR and Protein for PKU
- T.4 Nutrition Problem Identification for PKU
- T.5 Comparison of Recommendations for Dietary Protein Intake for Infants and Children under 4 Years of Age to the 2015 GMDI/SERC Guideline Recommendation
- T.6 Classification of Medical Foods for PKU
- T.7 Recommendations for Nutrient Intake and Sources in the Dietary Treatment of PKU
- T.8 Monitoring Nutritional Management of PKU
- T.9 Recommendations for Neurocognitive Testing in PKU
PKU Toolkit Tables- T.10 Recommended Intake of PHE, TYR, Protein and Energy for an Infant with PKU
- T.11 Composition of Breast Milk, Infant Formula, and Medical Food for an Infant with PKU
- T.12 Calculation of Formula Mixture Containing Breast Milk and Medical Food for an Infant with PKU
- T.13 Calculation of Formula Mixture Containing Infant Formula and Medical Food for an Infant with PKU
- T.14 Monitoring Nutritional Management for an Infant with PKU
- T.15 Calculation of Modified Formula Mixture Using Breast Milk for an Infant with PKU
- T.16 Current Daily Nutrient Intake for an Older Infant with PKU
- T.17 Composition of Infant Formula and Medical Food for an Older Infant with PKU
- T.18 Calculation of Daily Nutrient Intake Goals for an Older Infant with PKU
- T.19 Sample Menu Introducing Solid Food for an Older Infant with PKU
- T.20 Recommended Intake of PHE, TYR, Protein and Energy for a Child, Adolescent or Adult with PKU
- T.21 DRI Ranges for Recommended Intake of Protein and Energy for Childhood through Adulthood by Gender and Age
- T.22 Composition of Medical Food for a Child with PKU
- T.23 Calculation of Nutrient Intake Goals for a Child with PKU
- T.24 Sample Menu for a Child with PKU Eating Lunch at School
- T.25 Monitoring Nutritional Management of PKU in a Young Child
- T.26 Composition of Medical Food for a Young Adult with PKU
- T.27 Calculation of Dietary Intake for the Young Adult with PKU
- T.28 Sample Menu for a Young Adult with PKU Transitioning to Self Care
- T.29 Monitoring Nutritional Management of PKU in the Older Child, Adolescent and Adult
- T.30 Sample menu for a Young Adult with PKU Transitioning to Self Care with a Simplified Diet
- T.31 Composition of Medical Food for a Child with PKU Before Taking Sapropterin
- T.32 Calculation of Daily Nutrient Intake Goals for a Child with PKU Before Taking Sapropterin
- T.33 Baseline Blood PHE and PHE Intake for a Child with PKU Before Taking Sapropterin
- T.34 Blood PHE and Dietary PHE Intake for a Child with PKU During a Trial of Sapropterin
- T.35 Calculation of Daily Nutrient Intake Goals for a Child with PKU While Taking Sapropterin
- T.36 Sample Menu Liberalized for a child with PKU While Taking Sapropterin
- T.37 Recommended Intakes of PHE, TYR, Protein and Energy in Pregnancy for a Woman with PKU
- T.38 Composition of Medical Food in Pregnancy for a Woman with PKU
- T.39 Calculation of Daily Nutrient Intake Goals in Early Pregnancy for a Woman with PKU
- T.40 Sample Menu for a Woman with PKU in Early Pregnancy
- T.41 Recommendations for Healthy Weight Gain During Pregnancy
- T.42 Monitoring Nutritional Management of PKU During Pregnancy and Lactation
- T.43 Sample Menu for a Woman with PKU in Late Pregnancy
- References
- Contributors
- Appendix A: Recommendation Rating Definitions
- Appendix B: Terms
- Disclaimer
The PKU Nutrition Management Guideline is part of a larger project undertaken by the Southeast Newborn Screening and Genetics Collaboration – HRSA Region 3 (SERC) and the Genetic Metabolic Dietitians International (GMDI) to develop nutrition management guidelines for inherited metabolic disorders (IMD).
The purpose of this guideline is to foster optimal nutrition management of individuals with PKU and reduce the uncertainty and variability in the management of this disorder to allow for best outcomes.
The target population includes individuals with PKU at all life stages from the newborn period, through childhood and adolescence, to ongoing management in adult years, and during pregnancy. It also includes guidance for individuals who were late-diagnosed or are returning to treatment and those pairing dietary treatment with other treatment modalities.
The guideline is intended for use by all who provide care and advice for individuals with PKU, including: metabolic dietitians, physicians, and other health-care professionals, researchers, industry partners, public health personnel, third party health care payers, and PKU advocacy groups.
The development of nutrition guidelines is a joint effort between the Southeast Regional Newborn Screening Collaborative (SERC) and Genetic Metabolic Dietitians International (GMDI).
Funding for this project has been provided to SERC by the Health Resources and Services Administration (HRSA): grant # H46MC24090. GMDI received an unrestricted education grant from National PKU Alliance for partial funding of a dietitian consultant and the Nominal Group meeting.
Contents of the guideline include:
- Methodology used for development of the evidence- and consensus-based guideline
- Background about PKU: diagnosis, biochemical pathway, nutrition treatment rationale
- Description of nutrition care in management of PKU including: assessment, nutrition problem identification, nutrition intervention using evidence- and consensus-based recommendations, and monitoring and evaluation of outcome
- Rating of all recommendations based on the strength of the evidence
- Suggested implementation of the guideline recommendations
- Areas needing further research through collaborative studies