Can patients with phenylketonuria eat fish and shrimp?

Written by Zeng Hai Jiang
Pediatrics
Updated on January 22, 2025
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Children with phenylketonuria cannot eat fish and shrimp because phenylketonuria is caused by a deficiency of phenylalanine hydroxylase in the phenylalanine metabolic pathway, leading to metabolic disorder of phenylalanine in the liver. Phenylketonuria is the first hereditary metabolic disease that can be controlled by diet, as natural foods contain certain amounts of phenylalanine. Therefore, once diagnosed, children with phenylketonuria should stop consuming a natural diet and should be treated with a low phenylalanine diet. Fish and shrimp contain rich protein and high levels of phenylalanine, hence children with phenylketonuria cannot eat fish and shrimp.

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Written by Zeng Hai Jiang
Pediatrics
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Does phenylketonuria definitely cause intellectual disabilities when one grows up?

Phenylketonuria is a common amino acid metabolic disorder that is due to a deficiency of phenylalanine hydroxylase in the phenylalanine metabolic pathway, leading to metabolic disorder of phenylalanine in the liver. Phenylketonuria is the first genetic metabolic disorder that can be controlled and treated through diet. Once diagnosed, natural diet should be discontinued for the patient, and a low-phenylalanine diet should be administered. If phenylketonuria is diagnosed and treated early, intelligence can be normal. However, if not controlled, it can lead to delayed growth and development, especially in terms of intellectual development.

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Written by Tong Peng
Pediatrics
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Does phenylketonuria have a distinctive facial appearance?

Phenylketonuria is characterized by a specific facial appearance, primarily presenting with pale skin and yellow hair. Some affected children may develop eczema due to a disruption in melanin synthesis, which results in a distinctive skin color. Additionally, there are neuropsychiatric abnormalities, such as intellectual disability, increased excitability, and heightened muscle tone. The urine of patients has a plastic-like smell, largely because phenylketonuria is a hereditary metabolic disease. Newborns exhibit hyperphenylalaninemia, but as harmful metabolites of phenylalanine are not present in high concentrations before feeding begins, initial conditions at birth are often normal. However, as diet is introduced and metabolite concentrations increase, specific clinical symptoms, including severe cases of epileptic seizures manifested as infantile spasms, nodding seizures, or other forms, become evident. Therefore, dietary management is essential in treatment.

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Written by Yan Xin Liang
Pediatrics
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The causes of phenylketonuria

Phenylketonuria is a common autosomal recessive genetic disorder, the most frequent primary clinical manifestation among congenital amino acid metabolic disorders. It is characterized by intellectual disability, pale skin and hair pigmentation, and a mouse urine-like odor. The main cause is that phenylalanine is an essential amino acid for the human body. The phenylalanine ingested is partly used for protein synthesis and partly converted to tyrosine by the action of phenylalanine hydroxylase, which is necessary for the synthesis of substances like adrenaline, melanin, and thyroxine. The disease is mainly due to a deficiency of phenylalanine hydroxylase, which inhibits the conversion of phenylalanine to tyrosine, resulting in increased concentrations of phenylalanine in the blood, cerebrospinal fluid, and various tissues. At the same time, due to the predominance of the main pathway, the enhancement of the secondary metabolic pathway leads to the deamination of phenylalanine by transaminase, producing a large amount of phenylpyruvic acid, which through oxidation produces a large amount of phenylacetic acid, phenyllactic acid, and p-hydroxyphenylpyruvic acid. These metabolic by-products are excreted in large quantities in the urine, and the high concentrations of phenylalanine and its by-products accumulate extensively in brain tissue, thereby causing damage to brain cells.

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Written by Zeng Hai Jiang
Pediatrics
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Does phenylketonuria require lifelong dietary control?

Theoretically, phenylketonuria requires lifelong dietary control. Phenylketonuria is caused by a deficiency in phenylalanine hydroxylase in the metabolic pathway of phenylalanine, leading to disordered metabolism of phenylalanine in the liver. Phenylketonuria is the first genetic metabolic disease that can be managed through diet. Since natural foods all contain certain amounts of phenylalanine, once diagnosed, affected children should cease consuming natural diets and should be treated with a low-phenylalanine diet. Treatment with a low-phenylalanine formula should continue at least until the age of 12. When the concentration of phenylalanine in the blood is controlled at an ideal level, natural foods can gradually be reintroduced in small amounts. The reintroduction of food should still follow the principles of low protein and low phenylalanine. The types and amounts of food that each child can add vary individually and are related to the severity of the enzyme deficiency.

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Written by Zeng Hai Jiang
Pediatrics
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Can patients with phenylketonuria eat fish and shrimp?

Children with phenylketonuria cannot eat fish and shrimp because phenylketonuria is caused by a deficiency of phenylalanine hydroxylase in the phenylalanine metabolic pathway, leading to metabolic disorder of phenylalanine in the liver. Phenylketonuria is the first hereditary metabolic disease that can be controlled by diet, as natural foods contain certain amounts of phenylalanine. Therefore, once diagnosed, children with phenylketonuria should stop consuming a natural diet and should be treated with a low phenylalanine diet. Fish and shrimp contain rich protein and high levels of phenylalanine, hence children with phenylketonuria cannot eat fish and shrimp.