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Triacylglycerol infusion does not improve hyperlactemia in resting patients with mitochondrial myopathy due to complex I deficiency^1,2,3

¹ From the Department of Pediatric Gastroenterology (MJR) and the Laboratory for Metabolic Diseases (HWHCS, MB, and RB), the University Children's Hospital, Utrecht, Netherlands; the Department of Clinical Chemistry, Vrije Universiteit Medical Center, Amsterdam (KM); the Laboratory for Metabolic Diseases, the Department of Pediatrics, the University Hospital Groningen, Groningen, Netherlands (D-JR); and the Robert Schwartz, MD, Center for Metabolism and Nutrition, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland (SCK).

Background: A high-fat diet has been recommended for correction of biochemical abnormalities and muscle energy state in patients with complex I (NADH dehydrogenase) deficiency (CID).

Objective: This study evaluated the effects of intravenous infusion of isoenergetic amounts of triacylglycerol or glucose on substrate oxidation, glycolytic carbohydrate metabolism, and energy state in patients with CID.

Design: Four CID patients and 15 matched control subjects were infused with triacylglycerol (1.85 mg·kg^-1·min^-1) or glucose (5 mg·kg^-1·min^-1) while at rest. Respiratory calorimetry was used to evaluate mitochondrial substrate oxidation. Metabolism of glycolytic carbohydrate was determined on the basis of the rates of appearance and concentrations of plasma lactate from dilution of [1-¹³C]lactate measurements. In addition, high-energy phosphate metabolism was measured in forearm muscle by ³¹P magnetic resonance spectroscopy.

Results: Whole-body oxygen consumption rates were higher in the patients than in the control subjects (P < 0.05). Oxygen consumption and high-energy phosphate metabolism in forearm muscle were not significantly different between the 2 infusion groups. The rates of appearance and concentrations of plasma lactate were higher in each of the 4 patients than in the control subjects (P < 0.05) and were lower during the triacylglycerol infusion than during the glucose infusion (P < 0.05); the differences were comparable in the patients and control subjects.

Conclusions: We conclude that triacylglycerol infusion, relative to glucose infusion, does not improve the oxidation of substrates or the energy state of skeletal muscle and does not lower the rates of appearance and concentrations of plasma lactate to normal values in CID patients at rest.

Key Words: Mitochondrial myopathy • hyperlactemia • complex I deficiency • triacylglycerol infusion • glucose infusion • substrate oxidation • stable isotopes • 31P magnetic resonance spectroscopy

This article has been cited by other articles:

				M. J. Roef, K. de Meer, S. C. Kalhan, H. Straver, R. Berger, and D.-J. Reijngoud Gluconeogenesis in humans with induced hyperlactatemia during low-intensity exercise Am J Physiol Endocrinol Metab, June 1, 2003; 284(6): E1162 - E1171. [Abstract] [Full Text] [PDF]

				M. J Roef, K. de Meer, D.-J. Reijngoud, H. W. Straver, M. de Barse, S. C Kalhan, and R. Berger Triacylglycerol infusion improves exercise endurance in patients with mitochondrial myopathy due to complex I deficiency Am. J. Clinical Nutrition, February 1, 2002; 75(2): 237 - 244. [Abstract] [Full Text] [PDF]