Dietary fatty acids are metabolized into fuel sources using beta-oxidation. Fatty acid conversion into Acetyl-CoA requires transport across the mitochondrial membrane via the carnitine shuttle. When beta-oxidation is impaired, fats are metabolized using an alternate pathway called omega-oxidation. Omega-oxidation results in elevated levels of dicarboxylic acids such as adipic acid and suberic acid. Impaired beta-oxidation occurs in carnitine deficiency or enzymatic dysfunction due to lack of nutrient cofactors. Vitamin B2 and magnesium play a role in optimizing beta-oxidation.
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Elevated levels of adipic and suberic acid may reflect insufficient carnitine or lack of nutrient cofactors for proper beta-oxidation.
Clinical Associations: Increased omega-oxidation metabolites can be seen in ketosis, insulin resistance, diabetes, fasting, or low carbohydrate intake. Elevations of suberic and adipic acid can lead to further mitochondrial dysfunction by injuring the cell membrane and producing free-radical damage.
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