title: Dietary modifications in patients receiving miglustat.
abstract: Weight loss and gastrointestinal disturbances are often seen during miglustat therapy for lysosomal storage diseases. A retrospective analysis of data from a mixed group of patients treated with miglustat at two UK centres was performed to evaluate the effect of two different dietary interventions on body weight and gastrointestinal tolerability during the initial 6 months of miglustat therapy. Neurological outcomes in these patients are not discussed herein. Data were analysed from a total of 29 patients with varied neurolipidoses (21 children/adolescents; 8 adults). Negative mean changes in body weight were seen in children/adolescents on an unmodified diet (-8.1%), and in adults (-4.1%) and children/adolescents (-5.2%) on a low-lactose diet. Patients on the low-disaccharide diet showed a positive mean change in body weight (+2.0%), although there was high variability in this group. Non-parametric sub-analysis of median body-weight change in children/adolescents also showed high variability both within and between diet groups, with no statistically significant difference between the effects of different diets on body weight (p = 0.062). The low-lactose diet reduced gastrointestinal disturbances; single small doses of loperamide were required in some patients. Patients on the low-disaccharide diet showed the lowest frequency of gastrointestinal effects. In conclusion, simple dietary modifications allowed the maintenance of body-weight gain in line with normal growth potential during miglustat therapy in young patients with lysosomal storage diseases, and reduced gastrointestinal disturbances.
authors.affiliation: Paediatric Metabolic Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK. helena.champion@addenbrookes.nhs.uk
authors.forename: H
authors.initials: H
authors.lastname: Champion
authors.forename: U
authors.initials: U
authors.lastname: Ramaswami
authors.forename: J
authors.initials: J
authors.lastname: Imrie
authors.forename: R H
authors.initials: RH
authors.lastname: Lachmann
authors.forename: J
authors.initials: J
authors.lastname: Gallagher
authors.forename: T M
authors.initials: TM
authors.lastname: Cox
authors.forename: J E
authors.initials: JE
authors.lastname: Wraith
mesh_terms: D017485:1-Deoxynojirimycin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D041923:Adolescent Development / Q000187:drug effects; D000328:Adult; D000367:Age Factors; D002648:Child; D002657:Child Development / Q000187:drug effects; D050528:Diet, Carbohydrate-Restricted; D004739:England; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D005964:Glucosyltransferases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006801:Humans; D007785:Lactose / Q000008:administration & dosage*; D020140:Lysosomal Storage Diseases, Nervous System / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects; D055815:Young Adult
chemical_list: D004791:Enzyme Inhibitors; D017485:1-Deoxynojirimycin; C059896:miglustat; D005964:Glucosyltransferases; C023246:ceramide glucosyltransferase; D007785:Lactose