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Nutrition Management of Fatty Acid Oxidation Disorders

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Nutrition Management of Inherited Metabolic Diseases
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Abstract

Long-Chain Fatty Acid Oxidation Disorders

  • Management of acute illness and the avoidance of prolonged fasting are important treatment strategies to minimize the reliance on fat as an energy source.

  • Nutrition management depends on the degree of disease severity; in the most severe forms, long-chain fat is limited to 10% of total energy intake.

  • Diets restricted in long-chain fat require monitoring of essential fatty acids and fat-soluble vitamins.

Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)

  • Management of acute illness and the avoidance of prolonged fasting are important treatment strategies to minimize the reliance on fat as an energy source.

  • MCT should be avoided in MCAD, however, the restriction of other fats is not indicated, and a normal, healthy diet is recommended.

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References

  1. Aoyama T, Uchida Y, Kelley RI, Marble M, Hofman K, Tonsgard JH, et al. A novel disease with deficiency of mitochondrial very-long-chain acyl-CoA dehydrogenase. Biochem Biophys Res Commun. 1993;191(3):1369–72.

    Article  CAS  Google Scholar 

  2. Knottnerus SJG, Bleeker JC, Wust RCI, Ferdinandusse S, IJlst L, Wijburg FA, et al. Disorders of mitochondrial long-chain fatty acid oxidation and the carnitine shuttle. Rev Endocr Metab Disord. 2018;19(1):93–106.

    Article  CAS  Google Scholar 

  3. Merritt JL 2nd, Chang IJ. Medium-chain acyl-coenzyme A dehydrogenase deficiency. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, LJH B, Mirzaa G, et al., editors. GeneReviews((R)). Seattle: University of Washington, Seattle; 1993.

    Google Scholar 

  4. Gallant NM, Leydiker K, Tang H, Feuchtbaum L, Lorey F, Puckett R, et al. Biochemical, molecular, and clinical characteristics of children with short chain acyl-CoA dehydrogenase deficiency detected by newborn screening in California. Mol Genet Metab. 2012;106(1):55–61.

    Article  CAS  Google Scholar 

  5. Rinaldo P, Cowan TM, Matern D. Acylcarnitine profile analysis. Genet Med. 2008;10(2):151–6.

    Article  Google Scholar 

  6. Van Calcar SC, Sowa M, Rohr F, Beazer J, Setlock T, Weihe TU, et al. Nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD): an evidence- and consensus-based approach. Mol Genet Metab. 2020;131(1–2):23–37.

    Article  Google Scholar 

  7. Hesse J, Braun C, Behringer S, Matysiak U, Spiekerkoetter U, Tucci S. The diagnostic challenge in very-long chain acyl-CoA dehydrogenase deficiency (VLCADD). J Inherit Metab Dis. 2018;41(6):1169–78.

    Article  CAS  Google Scholar 

  8. Arnold GL, Van Hove J, Freedenberg D, Strauss A, Longo N, Burton B, et al. A Delphi clinical practice protocol for the management of very long chain acyl-CoA dehydrogenase deficiency. Mol Genet Metab. 2009;96(3):85–90.

    Article  CAS  Google Scholar 

  9. Spiekerkoetter U, Lindner M, Santer R, Grotzke M, Baumgartner MR, Boehles H, et al. Treatment recommendations in long-chain fatty acid oxidation defects: consensus from a workshop. J Inherit Metab Dis. 2009;32(4):498–505.

    Article  CAS  Google Scholar 

  10. Potter BK, Little J, Chakraborty P, Kronick JB, Evans J, Frei J, et al. Variability in the clinical management of fatty acid oxidation disorders: results of a survey of Canadian metabolic physicians. J Inherit Metab Dis. 2012;35(1):115–23.

    Article  CAS  Google Scholar 

  11. New England Consortium. Acute illness protocols for very long chain acyl-CoA dehydrogenase deficiency. 2020. Available from: https://www.newenglandconsortium.org/vlcadd.

  12. Walter JH. Tolerance to fast: rational and practical evaluation in children with hypoketonaemia. J Inherit Metab Dis. 2009;32(2):214–7.

    Article  CAS  Google Scholar 

  13. GMDI/SERN nutrition management guidelines for VLCAD. 2019. Available from: www.southeastgenetics/ngp.

  14. Gillingham MB, Elizondo G, Behrend A, Matern D, Schoeller DA, Harding CO, et al. Higher dietary protein intake preserves lean body mass, lowers liver lipid deposition, and maintains metabolic control in participants with long-chain fatty acid oxidation disorders. J Inherit Metab Dis. 2019;42(5):857–69.

    Article  CAS  Google Scholar 

  15. Cox GF, Souri M, Aoyama T, Rockenmacher S, Varvogli L, Rohr F, et al. Reversal of severe hypertrophic cardiomyopathy and excellent neuropsychologic outcome in very-long-chain acyl-coenzyme A dehydrogenase deficiency. J Pediatr. 1998;133(2):247–53.

    Article  CAS  Google Scholar 

  16. Odle J. New insights into the utilization of medium-chain triglycerides by the neonate: observations from a piglet model. J Nutr. 1997;127(6):1061–7.

    Article  CAS  Google Scholar 

  17. Gillingham MB, Connor WE, Matern D, Rinaldo P, Burlingame T, Meeuws K, et al. Optimal dietary therapy of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. Mol Genet Metab. 2003;79(2):114–23.

    Article  CAS  Google Scholar 

  18. Liu YM. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia. 2008;49:33–6.

    Article  Google Scholar 

  19. Saudubray JM, Martin D, de Lonlay P, Touati G, Poggi-Travert F, Bonnet D, et al. Recognition and management of fatty acid oxidation defects: a series of 107 patients. J Inherit Metab Dis. 1999;22(4):488–502.

    Article  CAS  Google Scholar 

  20. Roe CR, Brunengraber H. Anaplerotic treatment of long-chain fat oxidation disorders with triheptanoin: review of 15 years experience. Mol Genet Metab. 2015;116(4):260–8.

    Article  CAS  Google Scholar 

  21. Food and Drug Administration. Dojolvi prescribing information. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213687s000lbl.pdf.

  22. Gillingham MB, Heitner SB, Martin J, Rose S, Goldstein A, El-Gharbawy AH, et al. Triheptanoin versus trioctanoin for long-chain fatty acid oxidation disorders: a double blinded, randomized controlled trial. J Inherit Metab Dis. 2017;40(6):831–43.

    Article  CAS  Google Scholar 

  23. Vockley J, Charrow J, Ganesh J, Eswara M, Diaz GA, McCracken E, et al. Triheptanoin treatment in patients with pediatric cardiomyopathy associated with long chain-fatty acid oxidation disorders. Mol Genet Metab. 2016;119(3):223–31.

    Article  CAS  Google Scholar 

  24. Vockley J, Burton B, Berry G, Longo N, Phillips J, Sanchez-Valle A, et al. Effects of triheptanoin (UX007) in patients with long-chain fatty acid oxidation disorders: results from an open-label, long-term extension study. J Inherit Metab Dis. 2021;44(1):253–63.

    Article  CAS  Google Scholar 

  25. Vockley J, Burton B, Berry GT, Longo N, Phillips J, Sanchez-Valle A, et al. UX007 for the treatment of long chain-fatty acid oxidation disorders: safety and efficacy in children and adults following 24weeks of treatment. Mol Genet Metab. 2017;120(4):370–7.

    Article  CAS  Google Scholar 

  26. Roe CR, Roe DS, Wallace M, Garritson B. Choice of oils for essential fat supplements can enhance production of abnormal metabolites in fat oxidation disorders. Mol Genet Metab. 2007;92(4):346–50.

    Article  CAS  Google Scholar 

  27. Gillingham MB, Weleber RG, Neuringer M, Connor WE, Mills M, van Calcar S, et al. Effect of optimal dietary therapy upon visual function in children with long-chain 3-hydroxyacyl CoA dehydrogenase and trifunctional protein deficiency. Mol Genet Metab. 2005;86(1–2):124–33.

    Article  CAS  Google Scholar 

  28. Spiekerkoetter U, Bastin J, Gillingham M, Morris A, Wijburg F, Wilcken B. Current issues regarding treatment of mitochondrial fatty acid oxidation disorders. J Inherit Metab Dis. 2010;33(5):555–61.

    Article  CAS  Google Scholar 

  29. Gillingham MB, Matern D, Harding CO. Effect of feeding, exercise and genotype on plasma 3-hydroxyacylcarnitines in children with LCHAD deficiency. Top Clin Nutr. 2009;24(4):359–65.

    Article  Google Scholar 

  30. Derks TG, van Spronsen FJ, Rake JP, van der Hilst CS, Span MM, Smit GP. Safe and unsafe duration of fasting for children with MCAD deficiency. Eur J Pediatr. 2007;166(1):5–11.

    Article  Google Scholar 

  31. Van Hove JL, Myers S, Kerckhove KV, Freehauf C, Bernstein L. Acute nutrition management in the prevention of metabolic illness: a practical approach with glucose polymers. Mol Genet Metab. 2009;97(1):1–3.

    Article  Google Scholar 

  32. Maier EM, Gersting SW, Kemter KF, Jank JM, Reindl M, Messing DD, et al. Protein misfolding is the molecular mechanism underlying MCADD identified in newborn screening. Hum Mol Genet. 2009;18(9):1612–23.

    Article  CAS  Google Scholar 

  33. Yusupov R, Finegold DN, Naylor EW, Sahai I, Waisbren S, Levy HL. Sudden death in medium chain acyl-coenzyme a dehydrogenase deficiency (MCADD) despite newborn screening. Mol Genet Metab. 2010;101(1):33–9.

    Article  CAS  Google Scholar 

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Correspondence to Fran Rohr .

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Rohr, F. (2022). Nutrition Management of Fatty Acid Oxidation Disorders. In: Bernstein, L.E., Rohr, F., van Calcar, S. (eds) Nutrition Management of Inherited Metabolic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-94510-7_23

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  • DOI: https://doi.org/10.1007/978-3-030-94510-7_23

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