Which populations have carnitine deficiency concern?

• A. Healthy adults and athletes
• B. Elderly with liver disease
• C. Preterm infants and chronic renal failure
• D. Infants with jaundice

Answer: (C)

Carnitine is needed to shuttle long‑chain fatty acids into mitochondria for beta‑oxidation, which is a major energy source in many tissues, especially in neonates and individuals with limited ability to synthesize or retain carnitine. The populations at risk are those with inadequate production or increased losses. In preterm infants, stores of carnitine are low and the enzymes needed to synthesize it are immature, while their rapid growth and high energy needs make them particularly vulnerable to insufficient fatty acid oxidation if carnitine is lacking. In chronic renal failure, carnitine is lost in the urine and, for those on dialysis, dialytic processes remove carnitine from the blood; and the kidney’s contribution to endogenous production is reduced, all of which can lead to deficiency. That combination of reduced synthesis and/or increased loss makes these groups the ones with concern for carnitine deficiency. Healthy adults and athletes generally have adequate carnitine status, and neonatal jaundice per se isn’t a primary driver of carnitine deficiency.