Phenylalanine And Tryptophan Intake Of Hyperactive Children With Autism

Article Info History: Received : 11 Nov 2017 Accepted : 22 Dec 2017 Available : 31 Dec 2017 Abstract Background: Hyperactive is behavior which demonstrates the attitude of more energy than normal behavior. Level of neurotransmitter dopamine and serotonin in the body may be the factor of this disorder behavior. Level of phenylalanine and serotonin were found high in hyperactive children with autism. Level phenylalanine in the brain shows that it is not changed into tyrosine so dopamine can not be form. Serotonin derived from an amino acid tryptophan. Objective : To understand the association between phenylalanine and tryptophan intake to hyperactivity of children with autism. Methods: A survey analytic research with cross sectional approach involving 20 subjects. Phenylalanine and tryptophan intake data was collected by Semi Quantitative-Food Frequency Questionnaire (SQ-FFQ), and hyperactivity disorder of child ren with autism was measured based on DSM-IV guidelines. Results: Eight (40%) children had low hyperactivity, 9 (45%) children had moderate hyperactivity, 2 (10%) children had severe hyperactivity, and 1 (5%) child had very severe hyperactivity. Mean phenylalanine intake was 4899.74mg (±1543.42) with maximum and minimum intake respectively 7735.42mg and 1843.88mg. Tryptophan intake was 1153.91mg (±384.99) with ma ximum and minimum intake respectively 1953.89mg and 367.69mg. There was significant association between phenylalanine intake (p=0,034; r=0,477) and tryptophan intake and hyperactivity (p=0,026; r=0,492). Conclusion: There is an association between intakes of amino acid phenylalanine and amino acid tryptophan with hyperactivity of autistic children.


INTRODUCTION
Hyperactive is behavior which demonstrates the attitude of more than normal behavior. 1About 6-7% of people aged 18 and under were estimated have Attention deficit hyperactivity disorder (ADHD), 2 and the rates are more or less the same between countries. 3Its prevalence is diagnosed approximately three times more often in boys than in girls. 4vel of neurotransmitter dopamine and serotonin in the body may be one of the factor of this disorder behavior.High level of phenylalanin and serotonin were found in hyperactive children with autis m.In children with autis m h igh level of phenylalanin causes amino acid phenylalanine can not be converted into amino acid tyrosine.Unalterable amino acid phenylalanine accumulates in the blood that reaches the brain.This leads to a mental disorder that includes autistic behavior. 5High level phenylalanin in the body show that it is not changed into tyrosin so dopamin can not be form.
In children with autism there is an increase of serotonin levels in the brain by 30-40% of normal people. 6Serotonin derived fro m an amino acid tryptophan. 2 Therapy which lowers serotonin levels to balance with dopamine levels can improve the response of children with autism, imp rove the speaking ability and affect behavioral disorders in children with autis m. 7 This research aimed to understand the relationship between phenylalanine and tryptophan intake and hyperactivity of child ren with autism.

MATERIALS AND METHODS
This study was an analytical study with cross sectional design.This research was conducted at Autistic Daycare in Patrang district, Jember.The subjects in this study were children with autism diagnosed with ASD using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM -IV). 1 Variables of this study were phenylalanine intake, tryptophan intake and hyperactivity level.Phenylalanine and tryptophan intake were defined as the amount of phenylalanine and tryptophan that were consumed for the last month collected by Semi Quantitative Food Frequency Questionnaire (SQ-FFQ) fro m subject's mother.Hyperactivity level was defined as behavior which demonstrates restlessness attitude based on 7 hyperactivity symptoms in DSM-IV guidelines that classified into 4 levels: low (score <8), moderate (score 8-14), h igh (score 15-21) and very high (score 22-28).Each sympto m has 4 rating scale score, they were scored 1 for not at all, 2 for just a little, 3 for pretty much and 4 for very much. 8eachers in a day care helped and did observvation and collected hyperactivity data.
This study had been reviewed and approved by KEPK (Ko misi Et ik Penelitian Kesehatan) Politekn ik Negeri Jember.Informed consent to participate in this study was signed by subject's mother.
Rank Spearman test (with α 0.05) had been used to analyze association between phenylalanine and tryptophan intake and hyperactivity.

RES ULTS
This study was conducted to understand the association between phenylalanine and tryptophan intake to hyperactivity of children with autism.Twenty children in Autistic Daycare in Patrang district, Jember who were participated in this study consist of 13 boys and 3 girls.They were aged 5-17 years old.Protein intake were108.8g±34.24, 37.77g and 169.42g respectively for Mean±SD, min imu m and maximu m protein intake.

Table 2. Phenylalanin and Tryptophan Intake
This study revealed that there was relationship between phenylalanine intake and hyperactivity (p=0.034;r=0.477) and there was relationship between tryptophan intake and hyperactivity (p=0.026;r=0.492).

DISCUSS ION
Autistic disorders and its symptoms like hyperactivity are associated with conditions that have neurological lesions, especially rubella, phenylketonuria, tuberous sclerosis and Rett disorders. 1,9 n children with autism high level of phenylalanine causes amino acid phenylalanine can not be converted into amino acid tyrosine.Unalterable amino acid phenylalanine accu mu lates in the blood that reaches the brain.This leads to a mental disorder that includes autistic behavior. 5The more amount of phenylalanine in the blood, the more it will accumulated in the brain.Accu mulated phenylalanine in the brain affects the levels of dopamine in the brain, so that influence behavior and mental of autistic children. 5,10 e direct precursor of dopamine, L-DOPA, can be synthesized indirectly fro m the essential amino acid phenylalanine or directly fro m the non-essential amino acid tyrosine. 11These amino acids are found in nearly every protein and so are readily available in food, with tyrosine being the most common.Although dopamine is also found in many types of food, it is incapable of crossing the blood-brain barrier that surrounds and protects the brain. 12It must therefore be synthesized inside the brain to perform its neuronal activity. 12ince the phenylalanine cannot be converted into tyrosine, it causes reduction of blood tyrosine amount.Little amount of tyrosine can reduce the production of dopamine which causes children show difficulty to concentrate, focus and hyperactivity. 9,13hile dopamine co mes from tyrosine, serotonin is derived fro m tryptophan.Increase of blood serotonin level were found in autistic children. 7Serotonin is synthesized fro m several enzy mat ic processes by the first process starting with tryptophan hydroxylase. 14erotonin effect on behavioral disorders in people with autism.Thus the decrease of serotonin can help decrease autistic behavior disorder). 5Restricted intake of tryptophan will decrease serotonin levels in the blood.This is because the concentration of tryptophan in the body is an important substrate as a precursor of serotonin formation. 15,16

CONCLUS ION
There is a relationship between intake of amino acid phenylalanine and amino acid t ryptophan with hyperactivity of children with autism.

Table 1 .
Frequency distribution of hyperactivity level Table2describes phenylalanine and tryptophan intake of all subjects.