Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation. Are Bilirubin and Plasma Lipid Profiles of Premature Infants Dependent on the Lipid Emulsion Infused? Plasma and tissue levels of lipids, fatty acids and plasma carnitine in neonates receiving a new fat emulsion Parenteral nutrition in preterm neonates with and without carnitine supplementation Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition. Lack of Effect of L-Carnitine Supplementation on Weight Gain in Very Preterm Infants Carnitine does not improve weight loss outcomes in valproate-treated bipolar patients consuming an energy-restricted, low-fat diet. L-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis. A Combination of (ω–3) Polyunsaturated Fatty Acids, Polyphenols and L-Carnitine Reduces the Plasma Lipid Levels and Increases the Expression of Genes Involved in Fatty Acid Oxidation in Human Peripheral Blood Mononuclear Cells and HepG2 Cells Role of L-carnitine in apnea of prematurity: a randomized, controlled trial. Levocarnitine administration in multiple sclerosis patients with immunosuppressive therapy-induced fatigue L-carnitine in haemodialysed patients. Changes in lipid pattern. The influence of a formula supplemented with dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in healthy full-term infants: a double-blind randomized controlled trial Nutritional effects of carnitine supplementation in hemodialysis patients. Lipid-lowering effect of carnitine in chronically uremic patients treated with maintenance hemodialysis. Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant Clinical effects of L-carnitine supplementation on apnea and growth in very low birth weight infants. Effects of carnitine on peripheral blood mitochondrial DNA copy number and liver function in non-alcoholic fatty liver disease. Krill oil reduces plasma triacylglycerol level and improves related lipoprotein particle concentration, fatty acid composition and redox status in healthy young adults - a pilot study Safety and efficacy of omega-3 fatty acids in the nutrition of very low birth weight infants: soy oil and marine oil supplementation of formula. Hypoglycemic effect of lipoic Acid, carnitine and nigella sativa in diabetic rat model. Impact of Early Dietary Intake and Blood Lipid Composition of Long-Chain Polyunsaturated Fatty Acids on Later Visual Development Growth and Fatty Acid Profiles of VLBW Infants Receiving a Multicomponent Lipid Emulsion From Birth
To investigate whether L-carnitine supplementation may correct nutritional carnitine deficiency and associated metabolic disturbances in premature infants receiving total parenteral nutrition , an intravenous fat tolerance test ( 1 gm/kg Intralipid over four hours ) was performed in 29 premature infants 6 to 10 days of age ( 15 receiving carnitine supplement 10 mg/kg . day L-carnitine IV , and 14 receiving no supplement ) .  Total carnitine plasma values were normal or slightly elevated in supplemented but decreased in nonsupplemented infants . In both groups , fat infusion result ed in an increase in plasma concentrations of triglycerides , free fatty acids , D-beta-hydroxybutyrate , and short-chain and long-chain acylcarnitine , but total carnitine values did not change . After fat infusion , the free fatty acids/D-beta-hydroxybutyrate ratios were lower and the increase of acylcarnitine greater in supplemented infants of 29 to 33 weeks ' gestation than in nonsupplemented infants of the same gestational age . This study provides evidence that premature infants of less than 34 weeks ' gestation requiring total parenteral nutrition develop nutritional carnitine deficiency with impaired fatty acid oxidation and ketogenesis .  Carnitine supplementation improves this metabolic disturbance Summary The effect of a lipid emulsion containing longchain triglycerides ( LCT ) and supplemented with L-carnitine on plasma lipids and bilirubin in premature neonates on total parenteral nutrition was compared to that of lipid emulsions containing either LCT or a mixture of LCT and medium-chain triglycerides ( MCT ) . In a double-blind r and omized study 49 premature neonates received one of the three fat emulsions , given intravenously , over 16–20 h daily for 6 days . Plasma carnitine levels increased significantly in the supplemented group only ; the addition of carnitine did not seem to affect any of the parameters studied . Mean plasma triglycerides rose by 193 and 199 % in the carnitine-supplemented and the LCT groups , respectively , and by 314 % in the MCT/LCT group . On the sixth day of the study free fatty acids were significantly higher in the MCT/LCT group than in the other two groups . Plasma phospholipids and free cholesterol increased ( p < 0.05 ) progressively in all groups and were correlated ( r = 0.74 , p < 0.001 ) . At the end of the 6-day study all groups showed a similar decline in free and total bilirubin levels despite the significant increase in plasma lipids and free fatty acids result ing from the stepwise increase in lipid load . No correlation was found between free fatty acids and free bilirubin . Since hyperbilirubinemia and hypertriglyceridemia appear to be clinical ly independent factors , the infusion of lipids should not be withheld from jaundiced infants on total parenteral nutrition This study was undertaken to compare Intralipid ® with a new fat emulsion containing gamma‐linolenic acid and carnitine , named Pediatric Fat Emulsion 4501 , in neonates with regard to lipid and carnitine metabolism over a short period of total parenteral nutrition . There were 10 neonates in each group and they tolerated the total parenteral nutrition well . In spite of the gamma‐linolenic acid supplementation in the new emulsion , arachidonic acid decreased significantly in plasma lipid esters and adipose tissue in both groups after 5 d of treatment . Also , there was a decrease in plasma docosahexaenoic acid which was more pronounced in the treatment group . The relative percentage values of linoleic and linolenic acids in adipose tissue were increased , indicating that newborns have a rapid accretion of fatty acids . Plasma triglycerides were effectively cleared during the periods without fat infusion . In the group that received Pediatric Fat Emulsion 4501 the means of both free and total plasma carnitine concentrations increased significantly , whereas they tended to decrease in the Intralipid ® group The effects of carnitine supplementation on fat and glucose metabolism and carnitine balance were studied in 12 preterm neonates receiving full or partial parenteral nutrition ( PN ) for 5 to 21 days . The gestational age ranged from 27 to 32 weeks and the birth weight from 790 to 2090 g. The neonates were assigned at r and om to receive either L‐carnitine 10 mg/kg ( n=6 ) or saline ( n=6 ) . In the carnitine group , increased concentrations in plasma of total and free carnitine were observed . Less than 50 % of the given dose was recovered in urine . In the placebo group no changes in the total plasma carnitine concentration were seen . In all neonates plasma triglycerides , free fatty acids , glycerol , alanine , 3‐hydroxybutyrate ( BOB ) , glucose and lactate were measured at predetermined intervals . The only significant difference between the groups was higher BOB‐concentrations in the carnitine group 2 days after the start of parenteral nutrition . Elevated BOB concentrations are an indicator of improved fatty acid oxidation in the carnitine group . In this study , only a temporary effect of the carnitine supplementation was found Parenterally fed preterm neonates are known to be at risk for carnitine deficiency . We studied substrate utilization in low-birth-weight infants receiving total parenteral nutrition ( TPN ) with ( A ) and without ( B ) supplementation of 48 mg carnitine.kg-1.d-1 on days 4 - 7 ( birth weights 1334 + /- 282 vs 1318 + /- 248 g , gestational age 32 + /- 2 vs 32 + /- 2 wk , A vs B , respectively ) . TPN consisted of 11 g glucose.kg-1.d-1 and 2.4 g.kg-1.d-1 of both protein and fat . Plasma carnitine concentrations at day 7 were for free carnitine 11.8 + /- 5.0 vs 164 + /- 56 mumol/L and for acyl carnitine 3.8 + /- 2.0 vs 33.9 + /- 15.4 mumol/L , respectively . Indirect calorimetry at day 7 showed a higher fat oxidation ( 0.21 , -0.31 to + 0.60 vs 1.18 , 0.70 to 1.95 g. kg-1.d-1 , respectively , P less than 0.02 , median and interquartile range ) in group B and a higher protein oxidation ( 0.37 , 0.30 - 0.43 vs 0.63 , 0.53 - 0.88 g.kg-1.d-1 , P less than 0.001 ) . The time to regain birth weight was also higher in group B ( 7 , 5.5 - 9 vs 9 , 7 - 14 d , P less than 0.05 ) . Carnitine supplementation and calorie intake were the best explanatory variables for metabolic rate ( R2 = 0.45 , P less than 0.002 ) . We conclude that carnitine supplementation of TPN in this dosage does not seem advisable OBJECTIVE Carnitine transfer across the placenta occurs predominantly during the third trimester . Unless L-carnitine is provided , very preterm infants develop carnitine deficiency . Although breast milk and infant formulas contain L-carnitine , parenteral nutrition solutions do not routinely provide L-carnitine . We hypothesized that prolonged L-carnitine supplementation in very preterm infants would improve weight gain and shorten length of stay in the hospital . STUDY DESIGN The study was a double-blind parallel placebo-controlled  r and omized clinical trial . Eligible patients were < 29 weeks of gestation , < 72 hours of age , and did not have a potentially life-threatening congenital malformation or hereditary metabolic disorder . Patients were stratified by gestational age ( 23 to 256/7 and 26 to 286/7 weeks ) , and r and omized to receive , either L-carnitine at a dose of 50 μmol/kg/day , or placebo . Carnitine was provided intravenously until the infants tolerated 16 ml/day of feeds . The sample size was calculated to have 80 % power to detect a 10 % increase in weight gain from birth until 36 weeks of postmenstrual age or discharge from the hospital . Secondary outcome variables included food efficiency ( defined as weight gain divided by caloric intake ) , weight gain at 4 weeks of age , time to regain birth weight and length of stay . RESULTS Among the 63 infants enrolled in the trial , 32 were r and omized to L-carnitine and 31 to placebo . L-Carnitine supplementation did not significantly affect average daily weight gain from birth until 36 weeks or hospital discharge , or any of the secondary outcome variables . CONCLUSION Prolonged supplementation of L-carnitine did not improve long-term weight gain in very preterm infants OBJECTIVES Carnitine deficiency impairs fatty acid beta-oxidation and may partly explain weight gain in valproate-treated patients . The aim of this study was to determine whether l-carnitine supplementation improves weight loss outcomes in bipolar patients taking sodium valproate .  METHODS Sixty bipolar patients with clinical ly significant weight gain thought to be related to sodium valproate , who had been taking sodium valproate for > or=6 months , were r and omized to l-carnitine ( 15 mg/kg/day ) or placebo for 26 weeks , in conjunction with a moderately energy-restricted , low-fat diet . The primary outcome measure was weight change . RESULTS l-carnitine had no effect on mean weight loss compared with placebo ( -1.9 kg versus - 0.9 kg ) ( F = 0.778 , df = 1,58 , p = 0.381 ) . The number of people in each group able to lose any weight was identical ( = 0 , p = 1.0 ) ; more patients in the carnitine group ( nine versus five ) achieved a clinical ly significant weight loss ( > or=5 % ) but this was not statistically significant ( p = 1.0 , Fisher 's exact test ) . CONCLUSIONS At the dose prescribed in this study carnitine supplementation did not improve weight loss outcomes in valproate-treated bipolar patients consuming an energy-restricted , low-fat diet Nutritional factors are among the postulated causes of fatigue , a highly prevalent symptom in the cancer population , with serious impact on patients ' quality of life . Deficiency of the micronutrient carnitine may play a role by reducing energy production through fatty acid oxidation . We present preliminary data of an open-label , dose-finding study to determine safety and maximally tolerated dose ( MTD ) of 1 week of L-carnitine supplementation in cancer patients with fatigue and carnitine deficiency . Patients who met inclusion /exclusion criteria underwent carnitine level determination . Eighty-three percent of these patients ( 15/18 ) had carnitine deficiency . Preliminary data analysis of 13 patients showed that total carnitine increased from 30.0 + /- 6.9 to 41.0 + /- 12.1 ( mean + /- SD ) after 1 week of supplementation ( P = 0.01 ) , and free carnitine increased from 24.3 + /- 6.1 to 33.8 + /- 9.8 ( P = 0.004 ) . Outcome measures were fatigue ( BFI score ) , depression ( CES-D ) , sleep disruption ( ESS ) , and performance status ( Karnofsky ) . Median ( min , max ) BFI score at baseline was 73 ( 46 , 82 ) versus 50 ( 3 , 82 ) after 1-week supplementation ( P = 0.009 ) . CES-D score at baseline was 29 ( 16 , 42 ) and 22 ( 8 , 32 ) after 1 week ( P = 0.028 ) . ESS at baseline was 46.5 ( 0 , 69 ) and 30.4 ( 0 , 72 ) after 1 week ( P = 0.015 ) . Karnofsky score did not change significantly ( P = 0.38 ) . We are currently conducting a r and omized , double-blind , placebo-controlled study to rigorously assess the role of L-carnitine for the treatment of fatigue and depression in cancer patients Background : Hyperlipidemia and obesity are associated with metabolic syndrome and increased risk in developing diabetes and cardiovascular disease . Nutritional supplements , e.g. L-carnitine and polyunsaturated fatty acids ( PUFAs ) , exert lipid-lowering effects . Hence , the hypothesis that dietetic intervention reduces plasma lipid levels and metabolic enzymes in overweight hyperlipidemic subjects was tested . Subjects and Methods : In a prospect i ve placebo-controlled double-blind study in 22 moderately hyperlipidemic obese humans consuming low-fat yoghurt enriched with a combination of low-dose PUFAs , polyphenols and L-carnitine ( PPC ) twice a day for 12 weeks were compared to 20 matching participants ingesting low-fat yoghurt .  The effects on plasma lipids and expression of enzymes involved in regulation of fatty acid oxidation in peripheral blood mononuclear cells ( P BMC s ) and HepG2 cells were evaluated . Results : PPC consumption led to significantly reduced plasma free fatty acid ( –29 % ) and triglyceride ( –24 % ) concentrations ( each p < 0.05 ) . PPC application increased significantly peroxisome proliferator-activated receptor α ( PPARα ) mRNA abundances and those of PPARα target genes ( carnitine palmitoyltransferases-1 , CPT1A and CPT1B , carnitine acetyltransferase and organic cation transporter 2 ; each p < 0.05 ) in P BMC s. In controls , plasma lipid levels and P BMC gene expression did not change . These findings were substantiated by the results of cell culture experiments in HepG2 cells . Conclusion : Supplementation of PPC  had marked lipid-lowering effects and P BMC gene expression profiles seemed to reflect nutrition-related metabolic changes OBJECTIVE Carnitine is thought to be a conditionally essential biological cofactor for premature infants . A preliminary study suggested that carnitine could significantly reduce  apnea of prematurity .  The objective of this study was to evaluate critically the role of carnitine in idiopathic apnea of prematurity and to determine whether the use of carnitine would facilitate discontinuation of mechanical ventilatory support , shorten the duration of ventilatory support , and reduce the amount of time that such infants are exposed to both mechanical ventilation and oxygen . We also wanted to determine the effects of supplemental carnitine on weight gain , time to regain birth weight , time to achieve full enteral feedings , and length of hospital stay . METHODS A prospect i ve , r and omized , blinded trial was conducted on 44 preterm infants who were from the same neonatal intensive care unit and who were < or = 32 weeks ' gestational age with a postnatal age < 48 hours and a birth weight < 1500 g and required total parenteral nutrition ( TPN ) . Infants were r and omized to receive carnitine supplementation or placebo without crossover . Carnitine-supplemented infants received 30 mg/kg/d carnitine in their TPN until the they were tolerating 120 mL/kg/d enteral feedings , and then they received 30 mg/kg/d oral carnitine . The placebo group received TPN without supplemental carnitine ; when they tolerated 120 mL/kg/d enteral feedings , they received an oral placebo . The 2 groups continued on their respective supplemental carnitine or placebo until 34 weeks ' adjusted age , at which time the study period was completed . Twelve-hour cardiorespiratorygrams to record heart rate , respiratory impedance , and oxygen saturation , and a nasal thermistor to detect expiratory airflow were performed every 4 days on 3 occasions and at 30 and 34 weeks ' adjusted age . Plasma carnitine levels were measured at day 14 . RESULTS There were no significant differences between the 2 groups in the occurrence of apnea as detected by cardiorespiratorygram or nursing observation . There were no significant differences between the groups in regard to total days on ventilator , days of nasal continuous positive airway pressure , time to regain birth weight , time to reach enteral feedings of 120 mL/kg/d , discharge weight , adjusted age at discharge , need for oxygen at 28 days ' and 36 weeks ' adjusted age , or length of stay . The plasma carnitine level was a median of 15.5 micromol/L ( range : 7.6 - 30.5 ) for the placebo infants compared with a median of 195.3 micromol/L ( range : 71.7 - 343.6 ) for the carnitine infants . CONCLUSIONS In this blinded , r and omized , placebo-controlled study , we found that infants who received supplemental carnitine did not demonstrate any reduction in apnea of prematurity , ventilator or nasal continuous positive airway pressure days , or the need for supplemental oxygen therapy . Although carnitine may be of significant nutritional benefit for very low birth weight infants , our study does not support its use to reduce apnea of prematurity or decrease dependence on mechanical ventilation Nutritional factors and comedications are among the postulated causes of fatigue , a highly prevalent symptom in the multiple sclerosis ( MS ) population , with serious impact on patients ’ quality of life . Deficiency of carnitine may play a role by reducing energy production through fatty acid oxidation and numerous MS therapies can induce fatigue syndrome . The aim of this prospect i ve open-labelled study was to collect and study serum carnitine levels in MS patients with and without disease-modifying treatment-induced fatigue syndrome . We investigated whether restoration of the carnitine pool might improve treatment-induced fatigue in MS patients . In our study , there was no statistical difference in fatigue frequency between treated and untreated patients ( P=0.5 ) . Matched to age , gender and treatments , carnitine levels were lower for MS treated patients compared to untreated MS patients ( P<0.05 ) or controls ( P<0.001 ) . Consecutive patients with low plasma carnitine levels who experienced fatigue were substituted . Treatment consisted of oral levocarnitine , 3 - 6 g daily . All patients achieved normal plasma carnitine levels . For 63 % of patients treated with immunosuppressive or immunomodulatory therapies , oral levocarnitine adjunction decreased fatigue intensity , especially in patients treated with cyclophosphamide and interferon beta Carnitine is a selective carrier of free fatty acids from the cytoplasm to the mitochondria . Dialysed patients are chronically and progressively carnitine deficient due to loss in the dialysate . Simultaneously such patients present impaired lipid metabolism and this may provoke varied pathological conditions ranging from isolated hypertriglyceridaemia to frank forms of hyperlipoproteinaemia types IIa , IIb , and IV , and to apparently normolipaemic situations falling within a lipoprotein pattern tending to become pathological with low levels of HDL-cholesterol . In the present investigation we evaluated the effect of l-carnitine ( versus placebo ) on the lipid pattern in a group of apparently normolipaemic dialysed patients , but with altered coronary risk factors ( HDL-cholesterol , beta : alpha lipoprotein ratio ) .  Examinations showed no significant changes at the 15th and 30th day of placebo treatment , whereas the l-carnitine treated group displayed a statistical significant increase in HDL-cholesterol accompanied by reduced pre-beta-lipoproteins and decreased beta : alpha ratio Background Human milk is the optimal nutrition for infants . When breastfeeding is not possible , supplementation of infant formula with long chain polyunsaturated fatty acids appears to promote neurodevelopmental outcome and visual function .  Plant oils , that are the only source of fat in most of infant formulas , do not contain specific fatty acids that are present in human and cow milk and do not encounter milk fat triglyceride structure . Experimental data suggest that a mix of dairy lipids and plant oils can potentiate endogenous synthesis of n-3 long chain polyunsaturated fatty acids . This trial aims to determine the effect of an infant formula supplemented with a mixture of dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in full-term infants ( primary outcome ) . Erythrocyte membrane long chain polyunsaturated fatty acids and fatty acids content , the plasma lipid profile and the insulin-growth factor 1 level , the gastrointestinal tolerance , the changes throughout the study in blood fatty acids content , in growth and body composition are evaluated as secondary outcomes . Methods / Design In a double-blind controlled r and omized trial , 75 healthy full-term infants are r and omly allocated to receive for four months a formula supplemented with a mixture of dairy lipids and plant oils or a formula containing only plant oils or a formula containing plant oils supplemented with arachidonic acid and docosahexaenoic acid .  Twenty-five breast-fed infants constitute the reference group .  Erythrocyte membrane omega-3 fatty acid profile , long chain polyunsaturated fatty acids and the other fatty acids content , the plasma lipid profile and the insulin-growth factor 1 level are measured after four months of intervention . Gastrointestinal tolerance , the changes in blood fatty acids content , in growth and body composition , assessed by means of an air displacement plethysmography system , are also evaluated throughout the study . Discussion The achievement of an appropriate long chain polyunsaturated fatty acids status represents an important goal in neonatal nutrition . Gaining further insight in the effects of the supplementation of a formula with dairy lipids and plant oils in healthy full-term infants could help to produce a formula whose fat content , composition and structure is more similar to human milk . Trial registration Clinical Trials.gov Identifier AIMS Carnitine is involved in fatty acid metabolism and it is cleared by dialysis . As it plays a role in energy utilization and because malnutrition is a frequent complication of HD treatment , we studied the effects of carnitine supplementation on several nutritional parameters in HD patients . MATERIAL AND METHODS The main selection criterion was a body mass index ( BMI ; body weight/(height)2 ) < 22 kg/m2 . Fifty-three patients were enrolled to participate in this open and r and omized study . For 6 months , 28 patients received 15 mg/kg of intravenous L-carnitine at the end of each  hemodialysis ( HD ) treatment  ( Group A ) , the remaining 25 patients were controls ( Group B ) . The measured parameters were the post-dialysis body weight , serum albumin concentration ( nephelemetry ) , food intake assessed by a 3-day food question naire , nPNA ( normalized protein equivalent of nitrogen appearance ) , creatinine generation , and anthropometry . RESULTS Forty-five patients completed the study ( Group A : 14 F/9 M , 66.7 years old ; Group B : 11 F/11 M , 65.2 years old ) . At the beginning of the study , there were no differences between the groups for age , gender , HD duration , BMI , diabetes prevalence , plasma carnitine levels and measured nutritional parameters . 65.2 % and 77.3 % in each group were carnitine-deficient ( plasma total carnitine level < 35 micromol/l ) . After 6 months of L-carnitine supplementation , none of the nutritional parameters had changed in either group , except that serum albumin concentration decreased in both groups . Dividing each group according to their respective median serum albumin concentrations , daily energy and protein intakes , creatinine generation or triceps skinfold thickness did not show any difference in the various nutritional parameters with or without carnitine supplementation . CONCLUSION Carnitine supplementation , despite normalization of plasma carnitine levels , has no effect on the nutritional status of HD patients Hypertriglyceridemia is often present in chronically uremic patients treated with maintenance hemodialysis and has been considered a risk factor in the accelerated development of atheroma . Muscle carnitine content is low in hemodialyzed patients . This abnormality may help to explain the myopathy and cardiomyopathy often observed in these subjects . In addition , carnitine might play a role in the hypertriglyceridemia in renal failure . Carnitine , which is necessary for fatty acid oxidation , has been recently reported to lower serum triglycerides in patients with type IV hyperlipoproteinemia .  Carnitine was administered intravenously three times weekly at the end of hemodialysis in eight patients .  Carnitine was given in 0.5 g doses for 8 weeks and then in 1.0 g doses for 6 additional weeks . There was a significant decrease in serum triglycerides at the end of treatment . In contrast , serum lipids in eight hemodialysis patients receiving placebo  did not change significantly . Carnitine administration does not cause any side effect except some euphoria . These results suggest that carnitine may be effective in the treatment of hypertriglyceridemia in dialysis patients Objective : The primary aim of this study was to determine if an association exists between amino-acid levels and development of cholestasis . The secondary aim of our amino-acid dose comparison trial was to identify factors associated with the development of prolonged cholestatic jaundice . Study Design : We compared demographic characteristics and amino-acid levels in neonates who developed cholestasis with those who did not . Parenteral-associated cholestatic liver disease was defined as a direct serum bilirubin above 5 mg per 100 ml any time during the first 28 days after birth in neonates with no history of biliary atresia or viral hepatitis . We obtained filter paper blood spots for amino acid and acylcarnitine measurements on the day of r and omization and days 7 and 28 of age to identify a profile of values that could be used to identify neonates with evidence of abnormal liver function . Result : We enrolled 122 neonates in our study ; 13 ( 10.7 % ) developed cholestasis . Neonates who developed cholestasis were more immature , had lower birth weight , were exposed to parenteral nutrition for a longer period , had a higher cumulative dose of amino acids , were less often on enteral nutrition by day 7 of age , more often had a patent ductus arteriosus and severe intraventricular hemorrhage and were more commonly treated with steroids by 28 days of age . Amino acid and acylcarnitine values were not different for the two groups on the day of r and omization . On day 7 ( parenteral phase of nutrition ) , blood urea nitrogen , citrulline , histidine , methionine and succinyl carnitine were higher , and serine , glutamate and thyroxine levels were lower in the neonates who developed cholestasis than in who did not . Conclusion : Cholestasis remains an important complication of parenteral nutrition , and several clinical and biochemical factors may be helpful in identifying high-risk patients OBJECTIVE Systemic carnitine deficiency may present with apnea , hypotonia , and  poor growth . Premature infants often manifest these symptoms and are at risk of developing carnitine deficiency because of immaturity of the biosynthetic pathway , lack of sufficient predelivery transplacental transport , and lack of sufficient exogenous supplementation . This study was undertaken to examine the effect of carnitine supplementation in premature infants . METHODS Eighty preterm infants < 1500 g were enrolled in a prospect i ve , double-blind , placebo-controlled study of carnitine supplementation within 96 hours of delivery . Growth , length of hospital stay , and frequency and severity of apnea were the primary outcome measures . RESULTS Weight gain and change in length , fronto-occipital head circumference , mid arm circumference , and triceps skinfold thickness were similar between the carnitine-supplemented and placebo groups . The amount and severity of apnea and the overall length of hospitalization were also similar between the 2 groups . The carnitine levels in the supplemented group were significantly higher than in the placebo group at 4 and 8 weeks after study entry . CONCLUSION Although preterm infants < 1500 g have low carnitine levels , routine supplementation with carnitine has no demonstrable effect on growth , apnea , or length of hospitalization and thus seems to be unnecessary BACKGROUND / AIMS Functional and anatomical abnormalities of mitochondria play an important role in developing steatohepatitis . Carnitine is essential for enhanced mitochondrial beta oxidation through the transfer of long-chain fatty acids into the mitochondria . We examined the impact of carnitine complex on liver function and peripheral blood mitochondria copy number in NAFLD patients . METHODS Forty-five NAFLD patients were enrolled . Patients were categorized into the carnitine complex-administered group and control group . Before and 3 months after drug administration , a liver function test and peripheral blood mitochondrial DNA and 8-oxo-dG quantitive analysis were conducted . RESULTS In carnitine treatment group , ALT , AST , and total bilirubin were reduced after medication . There was no difference in AST , ALT , and total bilirubin between before and after treatment in control group . In carnitine group , peripheral mitochondrial DNA copy number was significantly increased from 158.8+/-69.5 copy to 241.6+/-180.6 copy ( p=0.025 ) . While in control group the mitochondrial copy number was slightly reduced from 205.5+/-142.3 to 150.0+/-109.7 . 8-oxo-dG level was also tended to decrease in carnitine group ( p=0.23 ) and tended to increase in control group ( p=0.07 ) . CONCLUSIONS In NAFLD , the carnitine improved liver profile and peripheral blood mitochondrial DNA copy number . This results suggest that carnitine activate the mitochondria , thereby contributing to the improvement of NAFLD Background Lipid abnormalities , enhanced inflammation and oxidative stress seem to represent a vicious circle in atherogenesis , and therapeutic options directed against these processes seems like a reasonable approach in the management of atherosclerotic disorders . Krill oil ( RIMFROST Sublime ® ) is a phospholipid-rich oil with eicosapentaenoic acid ( EPA ) : docosahexaenoic acid ( DHA ) ratio of 1.8:1 . In this pilot study we determined if krill oil could favourable affect plasma lipid parameters and parameters involved in the initiation and progression of atherosclerosis . Methods The study was conducted as a 28 days intervention study examining effect-parameters of dietary supplementation with krill oil ( 832.5 mg EPA and DHA per day ) . 17 healthy volunteers in the age group 18–36 ( mean age 23 ± 4 years ) participated . Plasma lipids , lipoprotein particle sizes , fatty acid composition in plasma and red blood cells ( RBCs ) , plasma cytokines , antioxidant capacity , acylcarntines , carnitine , choline , betaine , and trimethylamine-N-oxide ( TMAO ) were measured before and after supplementation . Results Plasma triacylglycerol ( TAG ) and large very-low density lipoprotein ( VLDL ) & chylomicron particle concentrations decreased after 28 days of krill oil intake . A significant reduction in the TAG/HDL cholesterol result ed . Krill oil supplementation  decreased n-6/n-3 polyunsaturated fatty acids ( PUFA ) ratio both in plasma and RBCs . This was due to increased EPA , DHA and docosapentaenoic acid ( DPA ) and reduced amount of arachidonic acid ( AA ) . The increase of n-3 fatty acids and wt % of EPA and DHA in RBC was of smaller magnitude than found in plasma . Krill oil intake increased the antioxidant capacity , double bond index ( DBI ) and the fatty acid anti-inflammatory index . The plasma atherogenicity index remained constant whereas the thrombogenicity index decreased . Plasma choline , betaine and the carnitine precursor , γ-butyrobetaine were increased after krill oil supplementation whereas the TMAO and carnitine concentrations remained unchanged . Conclusion Krill oil consumption is considered health beneficial as it decreases cardiovascular disease risk parameters through effects on plasma TAGs , lipoprotein particles , fatty acid profile , redox status and possible inflammation . Noteworthy , no adverse effects on plasma levels of TMAO and carnitine were found Because formula-fed preterm infants may be at risk of omega 3 essential fatty acid deficiency , we tested experimental formulas supplemented with soy oil to provide alpha-linolenic acid or marine oil to provide preformed omega 3 long-chain polyunsaturated fatty acids at a level comparable to that of human milk . This report addresses the effect of feeding formula supplemented with soy oil or with soy and marine oils on growth , clinical tolerance , coagulation test results , changes in erythrocyte membrane fluidity , and plasma concentrations of vitamins A and E in very low birth weight infants from 30 to 57 weeks of postconceptional age . " Healthy " preterm infants were maternally selected to receive human milk or selected at r and om to receive commercial ready-to-feed  liquid formula  , which provided limited omega 3 fatty acid , or experimental formulas supplemented with soy oil or soy and marine oils . Results of this study indicate that formula enriched with soy oil or soy and marine oils containing preformed omega 3 long-chain polyunsaturated fatty acids does not induce abnormalities in growth , clotting function , erythrocyte membrane fluidity , or vitamin A or E levels in healthy very low birth weight preterm infants . Additional studies to evaluate safety in a representative preterm population are required OBJECTIVES Evaluation of therapeutic potentials of α-lipoic acid ( α-LA ) , L-carnitine , Nigella sativa ( N. sativa ) or combination of them in carbohydrate and lipid metabolism of DM type I. METHODS Rat model of diabetes was induced by single i.p injection of Streptozocin ( STZ ) 65 mg/kg . The rats were r and omly assigned to 6 groups ( G ) : healthy reference ( HR ) , diabetic ( DM ) , DM treated with α-lipoic acid , DM treated with L-carnitine , DM treated with N. sativa , and DM treated with combination of the 3 compounds . After 30 days from onset of diabetes , serum and tissue homogenate were obtained for evaluation of glucose metabolism as fasting blood glucose , insulin , insulin sensitivity , HOMA , C-peptide , and pyruvate dehydrogenase ( PDH ) activity . For lipid metabolism evaluation , total cholesterol and triacylglycerol ( TG ) were determined . Markers of antioxidants and oxidative status as total antioxidant capacity ( TAC ) , glutathione-S-transeferase ( GST ) , 8-hydroxy-2-deoxyguanosine ( 8-OH-dG ) were measured . RESULTS Either α-LA or N. sativa significantly reduced the elevated blood glucose level . The combination of 3 compounds significantly increased the level of insulin and C-peptide . Also , increased the antioxidant activity measured by TAC and decreased the oxidative damage of DNA as measured by 8-OH-dG. HOMA- β increased in G3 and G6 compared to G2 . However , the decrease in TG , and total cholesterol levels were non-significant in all groups . CONCLUSION Combination of α-LA , L-carnitine and N. sativa will contribute significantly in improvement of the carbohydrate metabolism and to less extent lipid metabolism in diabetic rats , thus increasing the rate of success in management of DM . Also , this combination will have implication s in clinical studies and clinical applications Background In contrast to human milk , current infant formulas in the United States do not contain ω3 and ω6 long-chain polyunsaturated fatty acids . This may lead to suboptimal blood lipid fatty acid profiles and to a measurable diminution of visual function in developing term infants . The need for docosahexaenoic acid and arachidonic acid supplementation in the infant diet was evaluated in a double-blind , r and omized clinical trial . Methods Healthy term infants were r and omized to diets of ( 1 ) commercial formula , ( 2 ) docosahexaenoic acid – enriched formula ( 0.35 % of total fatty acids ) , or ( 3 ) docosahexaenoic acid– ( 0.36 % ) and arachidonic acid– ( 0.72 % ) enriched formula .  Eighty-seven infants completed the 17-week nutritional trial , and 58 were observed until 52 weeks of life . A reference group was exclusively breast fed for at least 17 weeks ( n = 29 ) . Outcome measures included electroretinographic responses , visual evoked potentials , and blood fatty acid analysis in infants at birth and at 6 , 17 , and 52 weeks of age . Results Commercial formula-fed infants had 30 % to 50 % lower content of docosahexaenoic acid in total red blood cell lipids during the 17-week feeding trial compared with breast-fed infants . Significant differences persisted at the 1-year follow-up . Arachidonic acid content was consistently reduced in the commercial formula group by 15 % to 20 % . Infants fed long-chain polyunsaturated fatty acid – enriched formulas had docosahexaenoic acid and arachidonic acid blood lipid profiles resembling those of human milk-fed infants . Infants receiving this enriched formula had more mature electroretinographic responses than commercial formula-fed infants at 6 weeks of age . Human milk-fed and docosahexaenoic acid-enriched formula-fed infants had better visual acuity than commercial formula-fed infants at both 17 and 52 weeks of age . Early ( 17-week ) fatty acid profiles in blood lipids were correlated with later ( 52-week ) visual function development in study infants . Conclusions Results from this clinical trial demonstrate that long-chain polyunsaturated fatty acid supplementation of formula in term infants produces blood lipid fatty acid profiles that are similar to those observed in breast-fed infants . This supplementation leads to better visual function later in life ( i.e. , 1 year of age ) than that shown by infants fed commercial formula Objectives : Very-low-birth-weight ( VLBW ) infants are dependent on parenteral nutrition after birth . A parenteral lipid emulsion with a multicomponent composition may improve growth and neurodevelopment and may prevent liver injury , which is often observed in association with long-term parenteral nutrition with pure soybean oil . Our aim was to evaluate the safety and efficacy of a multicomponent lipid emulsion containing 30 % soybean oil , 30 % medium-chain triacylglycerol , 25 % olive oil , and 15 % fish oil compared with a conventional pure soybean oil emulsion in VLBW infants . Methods : We conducted a double-blind r and omized controlled trial in VLBW infants r and omized to parenteral nutrition with the multicomponent ( study group ) or pure soybean oil emulsion ( control group ) from birth at a dose of 2 to 3 g · kg−1 · day−1 until the infants were receiving full enteral nutrition . We assessed efficacy by growth rates and measuring plasma fatty acid profiles ( representative subset ) . Safety was evaluated by assessing hematologic and biochemical parameters , potentially harmful phytosterol concentrations ( same subset ) , and clinical neonatal outcome parameters . Results : Ninety-six infants were included ( subsets n = 21 ) . The multicomponent emulsion was associated with higher weight and head circumference z scores during admission . Plasma eicosapentaenoic acid and docosahexaenoic acid concentrations were higher in the study group . The hematological , biochemical , and neonatal outcomes were not different between groups , whereas the plasma concentrations of phytosterols were higher in the control group . Conclusions : The multicomponent lipid emulsion was well tolerated and associated with improved growth and higher plasma fatty acid profiles in VLBW infants in comparison with the pure soybean oil emulsion
Among infants supplemented with carnitine , there was no evidence of effect on weight gain , lipid utilization or ketogenesis .
REVIEW ER 'S CONCLUSIONS We found no evidence to support the routine supplementation of parenterally fed neonates with carnitine
BACKGROUND Carnitine , a quaternary amino acid , plays an important role in the oxidation of long chain fatty acids .
Both breast milk and infant formulas contain carnitine .
However , it is not routinely provided in parenteral nutrition solutions .
Non supplemented parenterally fed infants have very low tissue carnitine levels .
The clinical significance of this is uncertain .
Carnitine deficiency may be an etiological factor in the limited ability of premature babies to utilize parenteral lipid .
In vitro studies have suggested that fatty acid oxidation is impaired when the tissue carnitine levels fall below 10 % of normal .
Therefore relative carnitine deficiency may impair fatty acid oxidation , thus reducing the available energy and impairing growth .
OBJECTIVES The primary aim of this review is to determine whether carnitine supplementation of parenterally fed neonates will improve weight gain .
The secondary aims are to determine the effect on lipid tolerance and ketogenesis .