Weaning practices in phenylketonuria vary between health professionals in Europe

A Pinto, S Adams, K Ahring, H Allen, M F Almeida, D Garcia-Arenas, N Arslan, M Assoun, Y Atik Altınok, D Barrio-Carreras, A Belanger Quintana, S M Bernabei, C Bontemps, F Boyle, G Bruni, M Bueno-Delgado, G Caine, R Carvalho, A Chrobot, K ChyżB Cochrane, C Correia, K Corthouts, A Daly, S De Leo, A Desloovere, A De Meyer, A De Theux, B Didycz, M E Dijsselhof, K Dokoupil, J Drabik, C Dunlop, W Eberle-Pelloth, K Eftring, J Ekengren, I Errekalde, S Evans, A Foucart, L Fokkema, L François, M French, E Forssell, C Gingell, C Gonçalves, H Gökmen Özel, A Grimsley, G Gugelmo, E Gyüre, C Heller, R Hensler, I Jardim, C Joost, M Jörg-Streller, C Jouault, A Jung, M Kanthe, N Koç, I L Kok, T Kozanoğlu, B Kumru, F Lang, K Lang, I Liegeois, A Liguori, R Lilje, O Ļubina, P Manta-Vogli, D Mayr, C Meneses, C Newby, U Meyer, S Mexia, C Nicol, U Och, S M Olivas, C Pedrón-Giner, R Pereira, K Plutowska-Hoffmann, J Purves, A Re Dionigi, K Reinson, M Robert, L Robertson, J C Rocha, C Rohde, S Rosenbaum-Fabian, A Rossi, M Ruiz, J Saligova, A Gutiérrez-Sánchez, A Schlune, K Schulpis, J Serrano-Nieto, A Skarpalezou, R Skeath, A Slabbert, K Straczek, M Giżewska, A Terry, R Thom, A Tooke, J Tuokkola, E van Dam, T A M van den Hurk, E M C van der Ploeg, K Vande Kerckhove, M Van Driessche, A M J van Wegberg, K van Wyk, C Vasconcelos, V Velez García, J Wildgoose, T Winkler, J Żółkowska, J Zuvadelli, A MacDonald

Research output: Contribution to journalArticle

Abstract

Background: In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe.

Methods: A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis.

Results: Weaning started at 17-26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17-26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95).A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods.A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26-36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form.

Conclusions: Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.

Original languageEnglish
Pages (from-to)39-44
Number of pages6
JournalMolecular Genetics and Metabolism Reports
Volume18
DOIs
Publication statusPublished - Mar 2019

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Phenylketonurias
Weaning
Phenylalanine
Health
Amino Acids
Eastern Europe
Infant Formula
Austria
Germany
Human Milk
Child Development
Vegetables
Caregivers
Haplorhini
Fruit
Proteins
Cross-Sectional Studies
Diet
Food

Cite this

Weaning practices in phenylketonuria vary between health professionals in Europe. / Pinto, A; Adams, S; Ahring, K; Allen, H; Almeida, M F; Garcia-Arenas, D; Arslan, N; Assoun, M; Atik Altınok, Y; Barrio-Carreras, D; Belanger Quintana, A; Bernabei, S M; Bontemps, C; Boyle, F; Bruni, G; Bueno-Delgado, M; Caine, G; Carvalho, R; Chrobot, A; Chyż, K; Cochrane, B; Correia, C; Corthouts, K; Daly, A; De Leo, S; Desloovere, A; De Meyer, A; De Theux, A; Didycz, B; Dijsselhof, M E; Dokoupil, K; Drabik, J; Dunlop, C; Eberle-Pelloth, W; Eftring, K; Ekengren, J; Errekalde, I; Evans, S; Foucart, A; Fokkema, L; François, L; French, M; Forssell, E; Gingell, C; Gonçalves, C; Gökmen Özel, H; Grimsley, A; Gugelmo, G; Gyüre, E; Heller, C; Hensler, R; Jardim, I; Joost, C; Jörg-Streller, M; Jouault, C; Jung, A; Kanthe, M; Koç, N; Kok, I L; Kozanoğlu, T; Kumru, B; Lang, F; Lang, K; Liegeois, I; Liguori, A; Lilje, R; Ļubina, O; Manta-Vogli, P; Mayr, D; Meneses, C; Newby, C; Meyer, U; Mexia, S; Nicol, C; Och, U; Olivas, S M; Pedrón-Giner, C; Pereira, R; Plutowska-Hoffmann, K; Purves, J; Re Dionigi, A; Reinson, K; Robert, M; Robertson, L; Rocha, J C; Rohde, C; Rosenbaum-Fabian, S; Rossi, A; Ruiz, M; Saligova, J; Gutiérrez-Sánchez, A; Schlune, A; Schulpis, K; Serrano-Nieto, J; Skarpalezou, A; Skeath, R; Slabbert, A; Straczek, K; Giżewska, M; Terry, A; Thom, R; Tooke, A; Tuokkola, J; van Dam, E; van den Hurk, T A M; van der Ploeg, E M C; Vande Kerckhove, K; Van Driessche, M; van Wegberg, A M J; van Wyk, K; Vasconcelos, C; Velez García, V; Wildgoose, J; Winkler, T; Żółkowska, J; Zuvadelli, J; MacDonald, A.

In: Molecular Genetics and Metabolism Reports, Vol. 18, 03.2019, p. 39-44.

Research output: Contribution to journalArticle

Pinto, A, Adams, S, Ahring, K, Allen, H, Almeida, MF, Garcia-Arenas, D, Arslan, N, Assoun, M, Atik Altınok, Y, Barrio-Carreras, D, Belanger Quintana, A, Bernabei, SM, Bontemps, C, Boyle, F, Bruni, G, Bueno-Delgado, M, Caine, G, Carvalho, R, Chrobot, A, Chyż, K, Cochrane, B, Correia, C, Corthouts, K, Daly, A, De Leo, S, Desloovere, A, De Meyer, A, De Theux, A, Didycz, B, Dijsselhof, ME, Dokoupil, K, Drabik, J, Dunlop, C, Eberle-Pelloth, W, Eftring, K, Ekengren, J, Errekalde, I, Evans, S, Foucart, A, Fokkema, L, François, L, French, M, Forssell, E, Gingell, C, Gonçalves, C, Gökmen Özel, H, Grimsley, A, Gugelmo, G, Gyüre, E, Heller, C, Hensler, R, Jardim, I, Joost, C, Jörg-Streller, M, Jouault, C, Jung, A, Kanthe, M, Koç, N, Kok, IL, Kozanoğlu, T, Kumru, B, Lang, F, Lang, K, Liegeois, I, Liguori, A, Lilje, R, Ļubina, O, Manta-Vogli, P, Mayr, D, Meneses, C, Newby, C, Meyer, U, Mexia, S, Nicol, C, Och, U, Olivas, SM, Pedrón-Giner, C, Pereira, R, Plutowska-Hoffmann, K, Purves, J, Re Dionigi, A, Reinson, K, Robert, M, Robertson, L, Rocha, JC, Rohde, C, Rosenbaum-Fabian, S, Rossi, A, Ruiz, M, Saligova, J, Gutiérrez-Sánchez, A, Schlune, A, Schulpis, K, Serrano-Nieto, J, Skarpalezou, A, Skeath, R, Slabbert, A, Straczek, K, Giżewska, M, Terry, A, Thom, R, Tooke, A, Tuokkola, J, van Dam, E, van den Hurk, TAM, van der Ploeg, EMC, Vande Kerckhove, K, Van Driessche, M, van Wegberg, AMJ, van Wyk, K, Vasconcelos, C, Velez García, V, Wildgoose, J, Winkler, T, Żółkowska, J, Zuvadelli, J & MacDonald, A 2019, 'Weaning practices in phenylketonuria vary between health professionals in Europe', Molecular Genetics and Metabolism Reports, vol. 18, pp. 39-44. https://doi.org/10.1016/j.ymgmr.2018.11.003
Pinto, A ; Adams, S ; Ahring, K ; Allen, H ; Almeida, M F ; Garcia-Arenas, D ; Arslan, N ; Assoun, M ; Atik Altınok, Y ; Barrio-Carreras, D ; Belanger Quintana, A ; Bernabei, S M ; Bontemps, C ; Boyle, F ; Bruni, G ; Bueno-Delgado, M ; Caine, G ; Carvalho, R ; Chrobot, A ; Chyż, K ; Cochrane, B ; Correia, C ; Corthouts, K ; Daly, A ; De Leo, S ; Desloovere, A ; De Meyer, A ; De Theux, A ; Didycz, B ; Dijsselhof, M E ; Dokoupil, K ; Drabik, J ; Dunlop, C ; Eberle-Pelloth, W ; Eftring, K ; Ekengren, J ; Errekalde, I ; Evans, S ; Foucart, A ; Fokkema, L ; François, L ; French, M ; Forssell, E ; Gingell, C ; Gonçalves, C ; Gökmen Özel, H ; Grimsley, A ; Gugelmo, G ; Gyüre, E ; Heller, C ; Hensler, R ; Jardim, I ; Joost, C ; Jörg-Streller, M ; Jouault, C ; Jung, A ; Kanthe, M ; Koç, N ; Kok, I L ; Kozanoğlu, T ; Kumru, B ; Lang, F ; Lang, K ; Liegeois, I ; Liguori, A ; Lilje, R ; Ļubina, O ; Manta-Vogli, P ; Mayr, D ; Meneses, C ; Newby, C ; Meyer, U ; Mexia, S ; Nicol, C ; Och, U ; Olivas, S M ; Pedrón-Giner, C ; Pereira, R ; Plutowska-Hoffmann, K ; Purves, J ; Re Dionigi, A ; Reinson, K ; Robert, M ; Robertson, L ; Rocha, J C ; Rohde, C ; Rosenbaum-Fabian, S ; Rossi, A ; Ruiz, M ; Saligova, J ; Gutiérrez-Sánchez, A ; Schlune, A ; Schulpis, K ; Serrano-Nieto, J ; Skarpalezou, A ; Skeath, R ; Slabbert, A ; Straczek, K ; Giżewska, M ; Terry, A ; Thom, R ; Tooke, A ; Tuokkola, J ; van Dam, E ; van den Hurk, T A M ; van der Ploeg, E M C ; Vande Kerckhove, K ; Van Driessche, M ; van Wegberg, A M J ; van Wyk, K ; Vasconcelos, C ; Velez García, V ; Wildgoose, J ; Winkler, T ; Żółkowska, J ; Zuvadelli, J ; MacDonald, A. / Weaning practices in phenylketonuria vary between health professionals in Europe. In: Molecular Genetics and Metabolism Reports. 2019 ; Vol. 18. pp. 39-44.
@article{6e5ec59eb41f485cae9c168c1d57b795,
title = "Weaning practices in phenylketonuria vary between health professionals in Europe",
abstract = "Background: In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe.Methods: A cross sectional questionnaire (survey monkey{\circledR}) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis.Results: Weaning started at 17-26 weeks in 85{\%} (n = 81/95) of centres, >26 weeks in 12{\%} (n = 11/95) and < 17 weeks in 3{\%} (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51{\%} (n = 48/95) of centres introduced Phe containing foods at 17-26 weeks and 48{\%} (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59{\%}, n = 56/95) and fruit (34{\%}, n = 32/95).A Phe exchange system to allocate dietary Phe was used by 52{\%} (n = 49/95) of centres predominantly from Northern and Southern Europe and 48{\%} (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods.A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41{\%} (n = 39/95) of centres at infant age 26-36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37{\%} (n = 35/95) at infant age > 1y mainly from Southern Europe. 53{\%} (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form.Conclusions: Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.",
author = "A Pinto and S Adams and K Ahring and H Allen and Almeida, {M F} and D Garcia-Arenas and N Arslan and M Assoun and {Atik Altınok}, Y and D Barrio-Carreras and {Belanger Quintana}, A and Bernabei, {S M} and C Bontemps and F Boyle and G Bruni and M Bueno-Delgado and G Caine and R Carvalho and A Chrobot and K Chyż and B Cochrane and C Correia and K Corthouts and A Daly and {De Leo}, S and A Desloovere and {De Meyer}, A and {De Theux}, A and B Didycz and Dijsselhof, {M E} and K Dokoupil and J Drabik and C Dunlop and W Eberle-Pelloth and K Eftring and J Ekengren and I Errekalde and S Evans and A Foucart and L Fokkema and L Fran{\cc}ois and M French and E Forssell and C Gingell and C Gon{\cc}alves and {G{\"o}kmen {\"O}zel}, H and A Grimsley and G Gugelmo and E Gy{\"u}re and C Heller and R Hensler and I Jardim and C Joost and M J{\"o}rg-Streller and C Jouault and A Jung and M Kanthe and N Ko{\cc} and Kok, {I L} and T Kozanoğlu and B Kumru and F Lang and K Lang and I Liegeois and A Liguori and R Lilje and O Ļubina and P Manta-Vogli and D Mayr and C Meneses and C Newby and U Meyer and S Mexia and C Nicol and U Och and Olivas, {S M} and C Pedr{\'o}n-Giner and R Pereira and K Plutowska-Hoffmann and J Purves and {Re Dionigi}, A and K Reinson and M Robert and L Robertson and Rocha, {J C} and C Rohde and S Rosenbaum-Fabian and A Rossi and M Ruiz and J Saligova and A Guti{\'e}rrez-S{\'a}nchez and A Schlune and K Schulpis and J Serrano-Nieto and A Skarpalezou and R Skeath and A Slabbert and K Straczek and M Giżewska and A Terry and R Thom and A Tooke and J Tuokkola and {van Dam}, E and {van den Hurk}, {T A M} and {van der Ploeg}, {E M C} and {Vande Kerckhove}, K and {Van Driessche}, M and {van Wegberg}, {A M J} and {van Wyk}, K and C Vasconcelos and {Velez Garc{\'i}a}, V and J Wildgoose and T Winkler and J Ż{\'o}łkowska and J Zuvadelli and A MacDonald",
year = "2019",
month = "3",
doi = "10.1016/j.ymgmr.2018.11.003",
language = "English",
volume = "18",
pages = "39--44",
journal = "Molecular Genetics and Metabolism Reports",
issn = "2214-4269",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Weaning practices in phenylketonuria vary between health professionals in Europe

AU - Pinto, A

AU - Adams, S

AU - Ahring, K

AU - Allen, H

AU - Almeida, M F

AU - Garcia-Arenas, D

AU - Arslan, N

AU - Assoun, M

AU - Atik Altınok, Y

AU - Barrio-Carreras, D

AU - Belanger Quintana, A

AU - Bernabei, S M

AU - Bontemps, C

AU - Boyle, F

AU - Bruni, G

AU - Bueno-Delgado, M

AU - Caine, G

AU - Carvalho, R

AU - Chrobot, A

AU - Chyż, K

AU - Cochrane, B

AU - Correia, C

AU - Corthouts, K

AU - Daly, A

AU - De Leo, S

AU - Desloovere, A

AU - De Meyer, A

AU - De Theux, A

AU - Didycz, B

AU - Dijsselhof, M E

AU - Dokoupil, K

AU - Drabik, J

AU - Dunlop, C

AU - Eberle-Pelloth, W

AU - Eftring, K

AU - Ekengren, J

AU - Errekalde, I

AU - Evans, S

AU - Foucart, A

AU - Fokkema, L

AU - François, L

AU - French, M

AU - Forssell, E

AU - Gingell, C

AU - Gonçalves, C

AU - Gökmen Özel, H

AU - Grimsley, A

AU - Gugelmo, G

AU - Gyüre, E

AU - Heller, C

AU - Hensler, R

AU - Jardim, I

AU - Joost, C

AU - Jörg-Streller, M

AU - Jouault, C

AU - Jung, A

AU - Kanthe, M

AU - Koç, N

AU - Kok, I L

AU - Kozanoğlu, T

AU - Kumru, B

AU - Lang, F

AU - Lang, K

AU - Liegeois, I

AU - Liguori, A

AU - Lilje, R

AU - Ļubina, O

AU - Manta-Vogli, P

AU - Mayr, D

AU - Meneses, C

AU - Newby, C

AU - Meyer, U

AU - Mexia, S

AU - Nicol, C

AU - Och, U

AU - Olivas, S M

AU - Pedrón-Giner, C

AU - Pereira, R

AU - Plutowska-Hoffmann, K

AU - Purves, J

AU - Re Dionigi, A

AU - Reinson, K

AU - Robert, M

AU - Robertson, L

AU - Rocha, J C

AU - Rohde, C

AU - Rosenbaum-Fabian, S

AU - Rossi, A

AU - Ruiz, M

AU - Saligova, J

AU - Gutiérrez-Sánchez, A

AU - Schlune, A

AU - Schulpis, K

AU - Serrano-Nieto, J

AU - Skarpalezou, A

AU - Skeath, R

AU - Slabbert, A

AU - Straczek, K

AU - Giżewska, M

AU - Terry, A

AU - Thom, R

AU - Tooke, A

AU - Tuokkola, J

AU - van Dam, E

AU - van den Hurk, T A M

AU - van der Ploeg, E M C

AU - Vande Kerckhove, K

AU - Van Driessche, M

AU - van Wegberg, A M J

AU - van Wyk, K

AU - Vasconcelos, C

AU - Velez García, V

AU - Wildgoose, J

AU - Winkler, T

AU - Żółkowska, J

AU - Zuvadelli, J

AU - MacDonald, A

PY - 2019/3

Y1 - 2019/3

N2 - Background: In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe.Methods: A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis.Results: Weaning started at 17-26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17-26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95).A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods.A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26-36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form.Conclusions: Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.

AB - Background: In phenylketonuria (PKU), weaning is considered more challenging when compared to feeding healthy infants. The primary aim of weaning is to gradually replace natural protein from breast milk or standard infant formula with solids containing equivalent phenylalanine (Phe). In addition, a Phe-free second stage L-amino acid supplement is usually recommended from around 6 months to replace Phe-free infant formula. Our aim was to assess different weaning approaches used by health professionals across Europe.Methods: A cross sectional questionnaire (survey monkey®) composed of 31 multiple and single choice questions was sent to European colleagues caring for inherited metabolic disorders (IMD). Centres were grouped into geographical regions for analysis.Results: Weaning started at 17-26 weeks in 85% (n = 81/95) of centres, >26 weeks in 12% (n = 11/95) and < 17 weeks in 3% (n = 3/95). Infant's showing an interest in solid foods, and their age, were important determinant factors influencing weaning commencement. 51% (n = 48/95) of centres introduced Phe containing foods at 17-26 weeks and 48% (n = 46/95) at >26 weeks. First solids were mainly low Phe vegetables (59%, n = 56/95) and fruit (34%, n = 32/95).A Phe exchange system to allocate dietary Phe was used by 52% (n = 49/95) of centres predominantly from Northern and Southern Europe and 48% (n = 46/95) calculated most Phe containing food sources (all centres in Eastern Europe and the majority from Germany and Austria). Some centres used a combination of both methods.A second stage Phe-free L-amino acid supplement containing a higher protein equivalent was introduced by 41% (n = 39/95) of centres at infant age 26-36 weeks (mainly from Germany, Austria, Northern and Eastern Europe) and 37% (n = 35/95) at infant age > 1y mainly from Southern Europe. 53% (n = 50/95) of centres recommended a second stage Phe-free L-amino acid supplement in a spoonable or semi-solid form.Conclusions: Weaning strategies vary throughout European PKU centres. There is evidence to suggest that different infant weaning strategies may influence longer term adherence to the PKU diet or acceptance of Phe-free L-amino acid supplements; rendering prospective long-term studies important. It is essential to identify an effective weaning strategy that reduces caregiver burden but is associated with acceptable dietary adherence and optimal infant feeding development.

U2 - 10.1016/j.ymgmr.2018.11.003

DO - 10.1016/j.ymgmr.2018.11.003

M3 - Article

C2 - 30705824

VL - 18

SP - 39

EP - 44

JO - Molecular Genetics and Metabolism Reports

JF - Molecular Genetics and Metabolism Reports

SN - 2214-4269

ER -