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. 2020 Sep 16:2020:8489707.
doi: 10.1155/2020/8489707. eCollection 2020.

Clinical Course and Nutritional Management of Propionic and Methylmalonic Acidemias

Amira Mobarak  1 , Heba Dawoud  1 , Hanaa Nofal  2 , Amr Zoair  1
Affiliations

Clinical Course and Nutritional Management of Propionic and Methylmalonic Acidemias

Amira Mobarak et al. J Nutr Metab. .

Abstract

Propionic and methylmalonic acidemias result in multiple health problems including increased risk for neurological and intellectual disabilities. Knowledge regarding factors that correlate to poor prognosis and long-term outcomes is still limited. In this study, we aim to provide insight concerning clinical course and long-term complications by identifying possible correlating factors to complications. Results. This is a retrospective review of 20 Egyptian patients diagnosed with PA (n = 10) and MMA (n = 10) in the years 2014-2018. PA patients had lower DQ/IQ and were more liable to hypotonia and developmental delay. The DQ/IQ had a strong negative correlation with length of hospital stay, frequency of PICU admissions, time delay until diagnosis, and the mode ammonia level. However, DQ/IQ did not correlate with age of onset of symptoms or the peak ammonia level at presentation. Both the growth percentiles and albumin levels had a positive correlation with natural protein intake and did not correlate with the total protein intake. Additionally, patients on higher amounts of medical formula did not necessarily show an improvement in the frequency of decompensation episodes. Conclusion. Our findings indicate that implementation of NBS, vigilant and proactive management of decompensation episodes, and pursuing normal ammonia levels during monitoring can help patients achieve a better neurological prognosis. Furthermore, patients can have a better outcome on mainly natural protein; medical formula should only be used in cases where patients do not meet 100-120% of their DRI from natural protein.

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Conflict of interest statement

All the authors declare no conflicts of interest. The corresponding author A. Mobarak received a joint supervision scholarship from the Missions Sector, Ministry of Higher Education, Egypt.

Figures

Figure 1
Figure 1
Daily protein intake (gm/kg/day), both intact and synthetic in each individual patient. Patients are categorized by age and diagnosis. The percentage of natural protein intake in all patients was lower than the protein provided through the amino acid formula, 35.23 ± 5.7%, with a range of 24%–45%.
Figure 2
Figure 2
(a) The different growth parameters of the study group, and (b) the age of the study group.
Figure 3
Figure 3
(a) There was a significant positive correlation between the amount of natural protein intake and the albumin level, r = 0.87 and p < 0.001. (c) There was also a positive correlation between the ratio of natural protein/synthetic protein in diet and the albumin level, r = 0.80 and p < 0.0001. On the other hand, (b) there was a negative correlation between the synthetic protein intake and the albumin level, r = −0.48 and p=0.031, and (d) no correlation between the total protein and the albumin level, r = −0.08 and p=0.73.
Figure 4
Figure 4
The most frequent neurological complication (n).
See this image and copyright information in PMC

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