Medium-Chain Triglyceride Oil and Dietary Intervention Improved Body Composition and Metabolic Parameters in Children with Glycogen Storage Disease Type 1 in Jordan: A Clinical Trial
Abstract
:1. Introduction
- Biochemical blood tests, including blood glucose levels, triglycerides, cholesterol, lactic acid and uric acid, are carried out to determine to what extent a patient sticks to the prescribed diet.
- Abdominal ultrasound to measure the volume of the liver and kidneys to assess whether or not there is an enlargement.
- Dual-energy X-ray absorptiometry (DEXA) to assess bone mineral content and vitamin D status.
- Growth parameters, including body weight and height.
2. Materials and Methods
2.1. Study Design
2.2. Patient Recruitment
2.3. Inclusion and Exclusion Criteria
- Positive family history of the condition as long as GSD has an autosomal recessive inheritance pattern.
- Biochemical findings, including hypoglycaemia, hyperlipidaemia, lactic acidosis, hyperuricemia and neutropenia, which are consistent with 1b only can be used as a tool to distinguish between the two subtypes, 1a and 1b.
- Physical considerations such as a rounded doll face, distended abdomen and short stature.
- Liver biopsy findings that show huge amounts of glycogen within the hepatocytes.
- Genetic testing that rules out the glycogen storage disease panel so that either mutated gene can be obtained: G6PC gene for 1a or SLC37A4 gene for 1b.
2.4. Questionnaire
2.5. Anthropometry and Body Composition Analysis
2.6. Dietary Intervention
- First, energy needs should be distributed throughout the day according to height, body weight and physical activity (complex carbohydrates 60–70%, proteins 15–20% and fats less than 30%).
- Second, milk formulas used must not contain sucrose, lactose or fructose.
- Third, infants who are breastfed are allowed to continue unless they are metabolically uncontrolled. Their feeding intervals must be every two to three hours, day and night, to keep blood glucose levels stable.
- Fourth, the diet should be lactose-, fructose- and sucrose-free or intake is to be severely restricted.
- Fifth, measured amounts of UCCS, according to the patient’s age and body weight. Between 1.75 and 2.5 g/kg of body weight every 4–6 h for children over two years and 1.6 g/kg of body weight every 3–4 h for young children from six months up to two years old, to be administered with water or non-acidic fluids. Acidity will break down the glycosidic bonds by which starch loses its performance at a ratio of 1:2, which gives a slow release of glucose to maintain euglycemia (≥70 mg/dL or 4 mmol/L).
- Sixth, MCT oil (0.16–0.44 g/kg and day for 32–40 months) is prescribed starting from the day of diagnosis based on the physician’s prescription.
- Finally, sucrose and lactose-free vitamin and mineral supplementations are prescribed by the metabolic physician to ensure optimal nutrition intake. (This diet is not nutritionally well-balanced regarding the amounts of certain vitamins and minerals. Therefore, patients are recommended to consume multivitamins and minerals, especially calcium and vitamin D2.).
2.7. Clinical Assessment Sheet
2.8. Blood Samples Collection
2.9. Statistical Analyses
3. Results
3.1. Socio-Demographic Characteristics of the Study Population
3.2. Laboratory Results Analysis and Abdominal Ultrasound
3.3. Nutritional Behaviours of the Study Population
3.4. Medical Information and Other GSD-Related Issues
3.5. Anthropometric Measurements and Body Composition Analysis
3.5.1. Anthropometric Measurements
3.5.2. Body Composition Analysis
4. Discussion
- First, as a substrate for the pentose phosphate pathway (PPP), which, in turn, increases the catabolic process of ribose-5-phosphate to produce uric acid, causing hyperuricemia, which may predispose, if left untreated, to gout.
- Second, this greater flux of G6P enters the glycolytic pathway to produce huge amounts of pyruvate, leading to an alternative route that produces lactate under the action of lactate dehydrogenase (LDH), which results in lactic acidosis (hyperlactatemia).
- Third, pyruvate enters the Krebs cycle and produces acetyl CoA. Then, the latter starts lipogenesis, i.e., forming cholesterol and fatty acids. These fatty acids bind to glycerol (from glycolysis) to synthesise triglycerides, thus leading to hyperlipidaemia [42], as well as the production of malonyl CoA, which inhibits the key enzyme in β oxidation, carnitine palmitoyl transferase I (CPT I) [14,43].
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | N | % |
---|---|---|
Multivitamins intake | ||
Yes | 34 | 89.5 |
No | 4 | 10.5 |
Vitamin D deficiency | ||
Yes | 23 | 60.5 |
No | 15 | 39.5 |
Frequency and dose of vitamin D intake | ||
None | 2 | 5.3 |
Daily (2000 IU *) | 10 | 26.3 |
Every other day (5000 IU) | 6 | 15.8 |
Weekly (50,000 IU) | 20 | 52.6 |
Calcium supplement intake | ||
Yes | 22 | 57.9 |
No | 16 | 42.1 |
GSD subtype | ||
Type 1a | 11 | 28.9 |
Type 1b | 27 | 71.1 |
Initial clinical symptoms | ||
Hypoglycaemia | 26 | 68.4 |
Hepatomegaly | 9 | 23.7 |
Both | 3 | 7.9 |
Method of diagnosis | ||
Clinical presentation | 15 | 39.5 |
Liver biopsy and clinical presentation | 9 | 23.7 |
Clinical presentation and positive family history | 7 | 18.4 |
Genetic testing and positive family history | 4 | 10.5 |
Genetic testing and clinical presentation | 3 | 7.9 |
MCT Intervention | Mean | Normal Range | SD | Minimum | Maximum | Median | p-Value | |
---|---|---|---|---|---|---|---|---|
Glucose (mg/dL) | Before After | 53.03 90.47 | 70–110 | 16.619 18.569 | 13 58 | 93 142 | 55.50 88.00 | ≤0.001 b |
TG (mg/dL) | Before After | 657.16 368.35 | 50–200 | 660.812 255.958 | 202.6 126.9 | 2895.0 1136.8 | 351.85 284.60 | ≤0.001 a |
Cholesterol (mg/dL) | Before After | 251.16 170.21 | 70–200 | 73.486 65.876 | 122 103 | 405 383 | 249.50 143 | ≤0.001 a |
Uric Acid (mg/dL) | Before After | 7.70 5.94 | 2.4–7.0 | 1.917 1.660 | 5.56 2.7 | 13.3 12.70 | 7.10 5.85 | ≤0.001 a |
Lactate (mg/dL) | Before After | 53.17 19.51 | 0–25.2 | 27.030 6.533 | 13.9 10.11 | 129.00 40.40 | 41.00 18.05 | ≤0.001 a |
Neutrophils Count (103/µL) | Before After | 1.93 1.82 | 1.5–7.0 | 1.802 1.145 | 0.10 0.22 | 6.19 4.42 | 1.06 1.5 | 0.331 a |
HCT (%) | Before After | 31.73 32.62 | 31–54 | 4.580 4.748 | 22.1 17.2 | 42.1 47.6 | 31.25 32.15 | 0.020 a |
Laboratories Tests | Abnormal Levels before MCT Oil (%) | Abnormal Levels after MCT Oil (%) | p-Value |
---|---|---|---|
Glucose (mg/dL) | 94 | 7.9 | 0.001 |
Lactic Acid (mg/dL) | 94.7 | 18.4 | 0.001 |
Triglycerides (mg/dL) | 100 | 71.1 | 0.001 |
Cholesterol (mg/dL) | 73.7 | 21.1 | 0.001 |
Uric Acid (mg/dL) | 97.4 | 52.6 | 0.001 |
Neutrophils (103/µL) | 60.5 | 55.3 | 0.001 |
Variable | Baseline | Follow-Up | ||||
---|---|---|---|---|---|---|
Age Group | Mean | SD | Mean | SD | p-Value | |
Weight-for-age | <2 years ≥2 years | 36.67 25.68 | 41.826 29.014 | 39.17 26.14 | 48.008 30.101 | 0.593 a 0.940 a |
Height-for-age | <2 years ≥2 years | 33.27 4.13 | 46.708 8.351 | 33.13 5.25 | 36.258 10.328 | 1.00 a 0.034 a |
BMI-for-age | <2 years ≥2 years | 45.53 75.34 | 27.632 20.487 | 62.90 71.63 | 42.062 23.503 | 0.593 a 0.074 a |
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Subih, H.S.; Qudah, R.A.; Janakat, S.; Rimawi, H.; Elsahoryi, N.A.; Alyahya, L. Medium-Chain Triglyceride Oil and Dietary Intervention Improved Body Composition and Metabolic Parameters in Children with Glycogen Storage Disease Type 1 in Jordan: A Clinical Trial. Foods 2024, 13, 1091. https://doi.org/10.3390/foods13071091
Subih HS, Qudah RA, Janakat S, Rimawi H, Elsahoryi NA, Alyahya L. Medium-Chain Triglyceride Oil and Dietary Intervention Improved Body Composition and Metabolic Parameters in Children with Glycogen Storage Disease Type 1 in Jordan: A Clinical Trial. Foods. 2024; 13(7):1091. https://doi.org/10.3390/foods13071091
Chicago/Turabian StyleSubih, Hadil S., Reem A. Qudah, Sana Janakat, Hanadi Rimawi, Nour Amin Elsahoryi, and Linda Alyahya. 2024. "Medium-Chain Triglyceride Oil and Dietary Intervention Improved Body Composition and Metabolic Parameters in Children with Glycogen Storage Disease Type 1 in Jordan: A Clinical Trial" Foods 13, no. 7: 1091. https://doi.org/10.3390/foods13071091