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Nutritional management of patients with urea cycle disorders

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Journal of Inherited Metabolic Disease

Summary

The nutritional management of patients with urea cycle disorders (UCDs) involves restriction of dietary protein along with provision of adequate protein-free energy, essential amino acid supplements, and vitamins and minerals in combination with nitrogen-scavenging drugs. The present paper discusses nutrition therapy for a range of circumstances: during an acute hyperammonaemic episode and at hospital discharge; before, during, and after surgery; and for lifelong chronic management of UCDs.

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References

  • Acosta PB, Yannicelli S (2001) Protocol 24—Urea cycle disorders. The Ross Metabolic Formula System Nutrition Support Protocols, 4th edn. Columbus: Ross Products Division, 429.

    Google Scholar 

  • Acosta PB, Yannicelli S, Ryan AS, et al (2005) Nutritional therapy improves growth and protein status of children with a urea cycle enzyme defect. Mol Genet Metab 86(4): 448-55.

    Article  CAS  PubMed  Google Scholar 

  • Anonymous (2006) Newborn screening: toward a uniform screening panel and system. Genet Med 8(Supplement 1): 1S-52S.

    Google Scholar 

  • Batshaw ML, MacArthur RB, Tuchman M (2001) Alternative pathway therapy for urea cycle disorders: twenty years later. J Pediatr 138(1 Supplement):S46–S54.

    CAS  PubMed  Google Scholar 

  • Berry GT, Steiner RD (2001) Long-term management of patients with urea cycle disorders. J Pediatr 138(1 Supplement): S56–S60.

    CAS  PubMed  Google Scholar 

  • Brusilow SW, Horwich AL (2001) Urea cycle enzymes. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds; Childs B, Kinzler KW, Vogelstein B, assoc, eds. The Metabolic and Molecular Bases of Inherited Disease, 8th edn. New York: McGraw-Hill, 1909–1963.

    Google Scholar 

  • Buse MG, Reid SS (1975) Leucine. A possible regulator of protein turnover in muscle. J Clin Invest 56(5): 1250-261.

    Article  CAS  PubMed  Google Scholar 

  • Fomon SJ, Haschke F, Ziegler EE, Nelson SE (1982) Body composition of reference children from birth to age 10 years. Am J Clin Nutr 35(5 Supplement): 1169-175.

    CAS  PubMed  Google Scholar 

  • Fryburg DA, Jahn LA, Hill SA, Oliveras DM, Barrett EJ (1995) Insulin and insulin-like growth factor-I enhance human skeletal muscle protein anabolism during hyperaminoacidemia by different mechanisms. J Clin Invest 96(4): 1722-729.

    Article  CAS  PubMed  Google Scholar 

  • Ikizler TA, Pupim LB, Brouillette JR, et al (2002) Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab 282(1): E107–E116.

    CAS  PubMed  Google Scholar 

  • Jouvet P, Jugie M, Rabier D, et al (2001) Combined nutritional support and continuous extracorporeal removal therapy in the severe acute phase of maple syrup urine disease. Intensive Care Med 27(11): 1798-806.

    Article  CAS  PubMed  Google Scholar 

  • Laffel L (1999) Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev 15(6): 412-26.

    Article  CAS  PubMed  Google Scholar 

  • Lee B, Singh RH, Rhead WJ, et al (2005) Considerations in the difficult-to-manage urea cycle disorder patient. Crit Care Clin 21(4 Supplement): S19–S25.

    Article  PubMed  Google Scholar 

  • Leonard JV (2001) The nutritional management of urea cycle disorders. J Pediatr 138(1): S40–S44.

    Article  CAS  PubMed  Google Scholar 

  • Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS (1979) Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr 3(6): 452-56.

    Article  CAS  PubMed  Google Scholar 

  • Lynch CJ, Halle B, Fujii H, et al (2003) Potential role of leucine metabolism in the leucine-signaling pathway involving mTOR. Am J Physiol Endocrinol Metab 285(4): E854–E863.

    CAS  PubMed  Google Scholar 

  • Nicolaides P, Liebsch D, Dale N, Leonard J, Surtees R (2002) Neurological outcome of patients with ornithine carbamoyltransferase deficiency. Arch Dis Child 86(1): 54-6.

    Article  CAS  PubMed  Google Scholar 

  • Norenberg MD, Rao KV, Jayakumar AR (2005) Mechanisms of ammonia-induced astrocyte swelling. Metab Brain Dis 20(4): 303-18.

    Article  CAS  PubMed  Google Scholar 

  • Pupim LB, Flakoll PJ, Ikizler TA (2004) Protein homeostasis in chronic hemodialysis patients. Curr Opin Clin Nutr Metab Care 7(1): 89-5.

    Article  CAS  PubMed  Google Scholar 

  • Scaglia F, Carter S, O’Brien WE, Lee B (2004) Effect of alternative pathway therapy on branched chain amino acid metabolism in urea cycle disorder patients. Mol Genet Metab 81(Supplement 1): S79–S85.

    Article  CAS  PubMed  Google Scholar 

  • Singh RH, Rhead WJ, Smith W, Lee B, King LS, Summar M (2005) Nutritional management of urea cycle disorders. Crit Care Clin 21(4 Supplement): S27–S35.

    Article  PubMed  Google Scholar 

  • Singh RH, Acosta PB, Kennedy MJ, Longo N, Elsas LJ (2006) Potassium retention in patients treated for argininosuccinate lyase deficiency. 10th International Congress of Inborn Errors of Metabolism, Chiba, Japan.

  • Summar M (2001) Current strategies for the management of neonatal urea cycle disorders. J Pediatr 138(1 Supplement): S30–S39.

    CAS  PubMed  Google Scholar 

  • Wagenmakers AJ (1998) Protein and amino acid metabolism in human muscle. Adv Exp Med Biol 441: 307-19.

    CAS  PubMed  Google Scholar 

  • Wolfe RR (2005) Regulation of skeletal muscle protein metabolism in catabolic states. Curr Opin Clin Nutr Metab Care 8(1): 61-5.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to R. H. Singh.

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Communicating editor: Michael Gibson

Competing interests: None declared

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Singh, R.H. Nutritional management of patients with urea cycle disorders. J Inherit Metab Dis 30, 880–887 (2007). https://doi.org/10.1007/s10545-007-0718-4

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  • DOI: https://doi.org/10.1007/s10545-007-0718-4

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