L-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese women. Carnitine does not improve weight loss outcomes in valproate-treated bipolar patients consuming an energy-restricted, low-fat diet. L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN) - a randomized multicentre trial Effects of Oral L-Carnitine Supplementation on Leptin and Adiponectin Levels and Body Weight of Hemodialysis Patients: a Randomized Clinical Trial. Effect of L-carnitine supplementation in comparison with moderate aerobic training on serum inflammatory parameters in healthy obese women. Weight loss associated with reduced intake of carbohydrate reduces the atherogenicity of LDL in premenopausal women. Influence of A Thermogenic Dietary Supplement on Safety Markers, Body Composition, Energy Expenditure, Muscular Performance and Hormone Concentrations: A Randomized, Placebo-Controlled, Double-Blind Trial. Lack of Effect of L-Carnitine Supplementation on Weight Gain in Very Preterm Infants L-carnitine treatment in incident hemodialysis patients: the multicenter, randomized, double-blinded, placebo-controlled CARNIDIAL trial. Effect of lysine, vitamin B(6), and carnitine supplementation on the lipid profile of male patients with hypertriglyceridemia: a 12-week, open-label, randomized, placebo-controlled trial. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a phase I/II study. Randomised controlled trial of L-carnitine as a nutritional supplement in preterm infants Nutritional effects of carnitine supplementation in hemodialysis patients. Results of a single blind, randomized, placebo-controlled clinical trial to study the effect of intravenous L-carnitine supplementation on health-related quality of life in Indian patients on maintenance hemodialysis. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial Role of L-carnitine in apnea of prematurity: a randomized, controlled trial. The Effects of L‐Carnitine L‐Tartrate Supplementation on Hormonal Responses to Resistance Exercise and Recovery Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults. Phase II Open Label Study of Valproic Acid in Spinal Muscular Atrophy Potential inhibitory effects of L-carnitine supplementation on tissue advanced glycation end products in patients with hemodialysis. Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition. Clinical effects of L-carnitine supplementation on apnea and growth in very low birth weight infants. Conjugated linoleic acid improves glycemic response, lipid profile, and oxidative stress in obese patients with non-alcoholic fatty liver disease: a randomized controlled clinical trial Parenteral nutrition in preterm neonates with and without carnitine supplementation Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients. Effects of L-carnitine on oxidative stress responses in patients with renal disease. Effects of carnitine on peripheral blood mitochondrial DNA copy number and liver function in non-alcoholic fatty liver disease. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial. Urinary, plasma, and erythrocyte carnitine concentrations during transition to a lactoovovegetarian diet with vitamin B-6 depletion and repletion in young adult women. Carnitine supplementation in premature neonates: effect on plasma and red blood cell total carnitine concentrations, nutrition parameters and morbidity. SMA CARNI-VAL Trial Part I: Double-Blind, Randomized, Placebo-Controlled Trial of L-Carnitine and Valproic Acid in Spinal Muscular Atrophy Effects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients. L-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis. A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction. Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation. Hemodynamic Stabilizing Effects of L-Carnitine in Chronic Hemodialysis Patients Orlistat and L-carnitine compared to orlistat alone on insulin resistance in obese diabetic patients. [A controlled randomized trial of the use of combined L-carnitine and acetyl-L-carnitine treatment in men with oligoasthenozoospermia]. Serum carnitine levels during the doxorubicin therapy. Its role in cardiotoxicity.
L-Carnitine ( L-C ) transports fatty acids into mitochondria for oxidation and is marketed as a weight loss supplement . In a double-blind investigation to test the weight loss efficacy of L-C , 36 moderately overweight premenopausal women were pair matched on Body Mass Index ( BMI ) and r and omly assigned to two groups ( N = 18 ) . For 8 weeks the L-C group ingested 2 g twice daily of L-C , while the placebo ( P ) group ingested the same amount of lactose . All subjects walked for 30 min ( 60 - 70 % maximum heart rate ) 4 days/week . Body composition , resting energy expenditure ( REE ) and substrate utilization were estimated before and after treatment . For the subjects who completed the study ( 15 P , 13 L-C ) , no significant changes in mean total body mass ( TBM ) , fat mass FM , and resting lipid utilization occurred over time , nor were there any significant differences between groups for any variable . Conversely REE increased significantly for all subjects , but no between group differences existed . Five of the L-C group experienced nausea or diarrhea and consequently did not complete the study . Eight weeks of L-C ingestion and walking did not significantly alter the TBM or FM of overweight women , thereby casting doubt on the efficacy of L-C supplementation for weight loss 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 Background Cachexia , a > 10 % loss of body-weight , is one factor determining the poor prognosis of pancreatic cancer . Deficiency of L-Carnitine has been proposed to cause cancer cachexia . Findings We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospect i ve , multi-centre , placebo-controlled , r and omized and double-blinded trial to receive oral L-Carnitine ( 4 g ) or placebo for 12 weeks . At entry patients reported a mean weight loss of 12 ± 2,5 ( SEM ) kg . During treatment body-mass-index increased by 3,4 ± 1,4 % under L-Carnitine and decreased ( −1,5 ± 1,4 % ) in controls ( p < 0,05 ) . Moreover , nutritional status ( body cell mass , body fat ) and quality -of-life parameters improved under L-Carnitine . There was a trend towards an increased overall survival in the L-Carnitine group ( median 519 ± 50 d versus 399 ± 43 d , not significant ) and towards a reduced hospital-stay ( 36 ± 4d versus 41 ± 9d , n.s . ) . Conclusion While these data are preliminary and need confirmation they indicate that patients with pancreatic cancer may have a clinical ly relevant benefit from the inexpensive and well tolerated oral supplementation of L-Carnitine INTRODUCTION Carnitine supplementation may improve the general health and quality of life of hemodialysis patients by improving adipokines levels . The aim of the study was to investigate the effects of L-carnitine supplementation on leptin levels , adiponectin levels , and body weight of hemodialysis patients . MATERIAL S AND METHODS Fifty hemodialysis patients were r and omly divided into the carnitine group , who received oral L-carnitine , 1 g/L for 3 months , and the control group . Anthropometric measurements and serum levels of adipokines were measured at baseline and at the end of the intervention . RESULTS Forty-two participants completed the study . Serum leptin concentrations decreased after 12 weeks of the intervention in both groups , but these changes were not significant . The mean change of leptin concentration were , -1.7 ± 19.0 µg/mL and -7.1 ± 20.0 µg/mL in the carnitine group and the control group , respectively ( P = .39 ) . The mean adiponectin levels at baseline and after the intervention were 8.6 ± 11.19 µg/mL and 9.8 ± 4.1 µg/mL in the carnitine group ( P = .67 ) and 5.0 ± 2.5 µg/mL and 11.2 ± 5.4 µg/mL in the control group , respectively ( P < .001 ) . Serum adiponectin levels increased significantly in the control group only . The decrease in body mass index was not significant . CONCLUSIONS This study showed that a daily supplementation of 1000 mg oral syrup of L-carnitine for 12 weeks did not affect leptin and adiponectin levels or the body weight or body mass index of hemodialysis patients AIM Obesity is an important worldwide public health problem and considered a disease of chronic low- grade inflammation . The aim of this study was to evaluate the effect of L-carnitine supplementation in comparison with moderate aerobic exercise training on serum inflammatory parameters in healthy obese women . METHODS In this double-blind r and omized controlled clinical trial , 44 obese women were r and omly assigned to 4 groups ( N.=11 ) as follows : 1 : L-carnitine supplementation ( 2 g/day ) ( CAR ) , 2 : aerobic training + placebo ( EXR+PLA ) , 3 : L-carnitine supplementation + aerobic training ( CAR+EXR ) and 4 : placebo ( PLA ) . All intervention periods were eight weeks and subjects of aerobic training groups underwent 8-week aerobic training protocol ( 3 sessions a week [ 24 sessions ] ) . Body Mass Index , daily dietary intake and serum free L-carnitine , IL-6 , high-sensitivity C-reactive protein ( Hs-CRP ) and IL-10 levels of subjects were measured before and after interventions . RESULTS Interventions had no significant effects on body weight , BMI , daily dietary intake and serum IL-10 levels of subjects in all groups . Serum free L-carnitine concentration increased significantly after interventions in CAR and CAR+EXR groups . Significant decreases of IL-6 were observed in EXR+PLA and CAR+EXR groups compared with placebo group . L-carnitine supplementation plus aerobic training led to significant decrease of serum Hs-CRP levels in CAR+EXR group compared with baseline values . CONCLUSION L-carnitine supplementation did not affect serum IL-6 , Hs-CRP and IL-10 levels in obese women .  Aerobic training alone or in combination with L-carnitine had favorable effect on serum Il-6 and Hs-CRP levels as markers of inflammation in studied subjects The effect of a 3-tier intervention including dietary modifications ( ie , moderate energy restriction , decreased carbohydrate , increased protein ) , increased physical activity , and the use of carnitine as a dietary supplement was evaluated on plasma lipids and the atherogenicity of low-density lipoprotein ( LDL ) particles in a population of overweight and obese premenopausal ( aged 20 - 45 years ) women .  Carnitine or a placebo ( cellulose ) was r and omly assigned to the participants using a double-blind design . Carnitine supplementation was postulated to enhance fat oxidation result ing in lower concentrations of plasma triglycerides . Seventy women completed the 10-week protocol , which followed a reduction in their energy intake by 15 % and a macronutrient energy distribution of 30 % protein , 30 % fat , and 40 % carbohydrate . In addition , subjects increased the number of steps taken per day by 4500 . As no differences were observed between the carnitine and placebo groups in all the measured parameters , all subjects were pooled together for statistical analysis . Participants decreased ( P<.01 ) their caloric intake ( between 4132.8 and 7770 kJ ) and followed prescribed dietary modifications as assessed by dietary records . The average number of steps increased from 8950+/-3432 to 12764+/-4642 ( P<.001 ) . Body weight , plasma total cholesterol , LDL cholesterol , and triglyceride were decreased by 4.5 % , 8.0 % , 12.3 % , and 19.2 % ( P<.0001 ) , respectively , after the intervention . Likewise , apolipoproteins B and E decreased by 4.5 % and 15 % ( P<.05 ) after 10 weeks . The LDL mean particle size was increased from 26.74 to 26.86 nm ( P<.01 ) , and the percent of the smaller LDL subfraction ( P<.05 ) was decreased by 26.5 % ( P<.05 ) after 10 weeks . In addition , LDL lag time increased by 9.3 % ( P<.01 ) , and LDL conjugated diene formation decreased by 23 % ( P<.01 ) , indicating that the susceptibility of LDL to oxidation was decreased after the intervention . This study suggests that moderate weight loss ( < 5 % of body weight ) associated with reduced caloric intake , lower dietary carbohydrate , and increased physical activity impacts the atherogenicity of LDL Dietary supplementation is commonly employed by individuals seeking to improve body composition and exercise performance . The purpose of the present study was to examine the safety and effectiveness of a commercially available dietary supplement design ed to promote thermogenesis and fat loss . In a r and omized double-blind trial , participants were assigned to consume placebo or a multi-ingredient supplement containing caffeine , green tea extract , l-carnitine , evodiamine and other ingredients that purportedly enhance thermogenesis . The study included acute baseline testing , a 6-week progressive resistance training and supplementation intervention , and post-intervention testing . Laboratory assessment s included resting energy expenditure responses to acute supplement ingestion , evaluation of body composition and muscular performance , and analysis of blood variables ( metabolic panel , testosterone , estrogen and cortisol ) . Dependent variables were analyzed using ANOVA with repeated measures . No unfavorable effects of supplementation were reported , and the supplement did not adversely affect safety markers . However , the supplement did not reduce fat mass or increase lean mass relative to placebo . In the supplement group , lower body maximal strength was increased relative to placebo ( + 18 % , d=1.1 vs. + 10 % , d=0.5 ) , and cortisol concentrations were decreased relative to placebo ( -16 % ; d=-0.4 vs. + 15 % , d=.75 ) . However , no differences were observed for upper body maximal strength or muscular endurance . REE increased in response to both supplement and placebo ingestion ( placebo : + 5 % ; supplement : + 11.5 % ) , but the difference between conditions was not statistically significant . Overall , some select parameters may have been beneficially modified by supplementation , but this did not result in superior weight or fat loss over 6 weeks of supplementation and resistance training 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 BACKGROUND L-carnitine levels decrease rapidly and steadily with duration of hemodialysis , and carnitine depletion can impair response to recombinant human erythropoietin ( rHuEPO ) . The study hypothesis was that L-carnitine supplementation during the first year of hemodialysis would improve this response . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS From October 2006 through March 2010 , this multicenter , r and omized , double-blinded study assigned 92 incident hemodialysis patients to receive placebo or 1 g of intravenous L-carnitine after each dialysis session for 1 year . The primary outcome measure compared the groups for  rHuEPO resistance index ( EPO-RI ) , defined as weekly rHuEPO doses ( IU/kg body weight divided by hemoglobin level ) ( g/dl ) . RESULTS In the L-carnitine group , carnitine concentration increased from a mean ± SD of 79 ± 51 µmol/L to 258 ± 137 µmol/L ; in the placebo group , it declined from 68 ± 25 µmol/L to 53 ± 24 µmol/L ( interaction group × time , P<0.001 ) . Carnitine deficiency affected about 30 % of the patients in the placebo group during the study period . EPO-RI varied from 15.8 ± 11.3 to 9.5 ± 5.8 IU/kg per g/dl in the placebo group and from 20.6 ± 12.8 to 15.6 ± 15.9 IU/kg per g/dl in the L-carnitine group , for a mean variation of -3.94 ± 12.5 IU/kg per g/dl and -2.98 ± 15.5 IU/kg per g/dl , respectively ( P=0.7 ) . After adjustment for baseline characteristics , the EPO-RI course was similar in each group ( difference between groups , P=0.10 ; interaction group × time , P=0.9 ) . CONCLUSIONS Carnitine levels decrease by about 11 % ± 33 % during the first year of hemodialysis . Treatment of incident hemodialysis patients with L-carnitine does not improve their response to rHuEPO BACKGROUND Fat metabolism is known to be altered in hypertriglyceridemia . Fat oxidation requires carnitine , which can be obtained either from the diet ( animal or dairy products ) or through synthesis in the body using both lysine and vitamin B(6 ) . OBJECTIVE The goal of this study was to investigate the effect of lysine , vitamin B(6 ) , and carnitine supplementation on both glycemia and the lipid profiles , specifically triglyceride ( TG ) levels , in men with hypertriglyceridemia . METHODS This 12-week , r and omized , placebo-controlled clinical trial was conducted at a Lebanese medical center . A total of 85 hypertriglyceridemic ( TG > 150 mg/dL ) male patients were r and omized to 1 of 5 groups and given supplements of lysine ( 1 g/d ) , vitamin B(6 ) ( 50 mg/d ) , lysine ( 1 g/d ) + vitamin B(6 ) ( 50 mg/d ) , carnitine ( 1 g/d ) , or placebo for 12 weeks . The lipid profile ( TG , total cholesterol , LDL-C , and HDL-C ) and fasting plasma glucose levels were assessed at baseline and at 6 and 12 weeks . RESULTS Adults ( ∼50 years ) Lebanese males from a low socioeconomic status in Beirut were given the appropriate supplements . Vitamin B(6 ) supplementation was associated with a significant reduction in total cholesterol and HDL-C of ∼10 % . In addition , plasma TG was reduced by 36.6 mg/dL at 6 weeks , whereas levels in the placebo group increased by 18 mg/dL ; this difference failed to reach statistical significance . No major changes in the lipid profile were observed in the lysine and carnitine groups or when lysine was added to vitamin B(6 ) . CONCLUSION Vitamin B(6 ) supplementation in these male patients with hypertriglyceridemia reduced plasma total cholesterol and HDL-C concentrations Carnitine deficiency is among the many metabolic disturbances that may contribute to fatigue in patients with cancer . Administration of exogenous L-carnitine may hold promise as a treatment for this common symptom . Little is known about L-carnitine  safety , tolerability , and dose-response in patients with cancer . We conducted a Phase I/II open-label trial to assess the safety and tolerability of exogenous L-carnitine and clarify the safe dose range associated with symptom effects for future controlled trials . Adult patients with advanced cancer , carnitine deficiency ( free carnitine < 35 for males or < 25 microM/L for females , or acyl/free carnitine ratio > 0.4 ) , moderate to severe fatigue , and a Karnofsky Performance Status ( KPS ) score > or = 50 were entered by groups of at least three into a st and ard maximum tolerated dose design . Each successive group received a higher dose of L-carnitine ( 250 , 750 , 1250 , 1750 , 2250 , 2750 , 3000 mg/day , respectively ) , administered in two daily doses for 7 days . To compare symptom outcomes before and after supplementation , patients completed vali date d measures of fatigue ( Brief Fatigue Inventory [ BFI ] ) , depressed mood ( Center for Epidemiologic Studies Depression Scale [ CES-D ] ) , quality of sleep ( Epworth Sleeplessness Scale [ ESS ] ) , and KPS at baseline and 1 week later . Of the 38 patients screened for carnitine levels , 29 were deficient ( 76 % ) . Twenty-seven patients participated ( " intention to treat , ITT " ) ( 17 males , 10 females ) , and 21 completed the study ( " completers " ) ; 17 of these patients ( " responders , " mean+/-[SD ] age=57.9+/-15 ) had increased carnitine levels at the end of the supplementation period . The highest dose achieved was 3000 mg/day . No patient experienced significant side effects and no toxicities were noted . Analysis of all the patients accrued ( ITT , n=27 ) showed a total carnitine increase from 32.8+/-10 to 54.3+/-23 microM/L ( P<0.001 ) and free carnitine increase from 26.8+/-8 to 44.1+/-17 microM/L ( P<0.001 ) . BFI decreased significantly , from 66+/-12 to 39.7+/-26 ( P<0.001 ) ; ESS decreased from 12.9+/-12 to 9+/-6 ( P=0.001 ) ; and CES-D decreased from 29.2+/-12 to 19+/-12 ( P<0.001 ) . A separate analysis of the 17 " responders " showed a dose-response relationship for total- ( r=0.54 , P=0.03 ) , free-carnitine ( r=0.56 , P=0.02 ) levels , and fatigue ( BFI ) scores ( r=-0.61 , P=0.01 ) . These findings suggest that l-carnitine may be safely administered at doses up to 3000 mg/day and that positive effects may be more likely at relatively higher doses in this range . This study provides the basis for the design of future placebo-controlled studies of l-carnitine supplementation for cancer-related fatigue AIMS To evaluate the effect of L-carnitine supplementation ( 25 mg/kg/d ) on the growth and incidence of hypoglycaemia in preterm infants . METHODS A double blind , placebo controlled r and omised trial , stratified for gestational age , was conducted of 86 preterm infants between 28 and 34 gestational weeks . The median gestational ages in the carnitine group and placebo groups were 30.7 weeks ( range 28.0 to 33.6 ) and 31.4 weeks ( range 28.0 to 33.9 ) , respectively . The median birthweights were 1.557 kg ( range 0.944 to 2.275 ) and 1.645 kg ( range 0.885 to 2.545 ) , respectively . RESULTS Mean plasma free carnitine concentrations were below values for normal term infants in both groups on day 1 ( carnitine group 44.8 μmol/l , placebo group 25.5 μmol/l ) in the placebo group on day 7 ( 50.7 μmol/l ) , but in neither group on days 14 and 28 . Total , free , and acylcarnitine concentrations were significantly increased in both urine and blood in the L-carnitine group . There was no significant difference between the placebo and carnitine supplemented groups in growth rate , as assessed by weight , length , skinfold thickness and head circumference measurements , or in the incidence of episodes of hypoglycaemia . CONCLUSION The addition of carnitine as a nutritional supplement at a dose of 25mg/kg/day did not improve growth in our group of preterm infants nor protect them from episodes of hypoglycaemia 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 BACKGROUND Carnitine insufficiency is responsible for various co-morbid conditions in maintenance hemodialysis ( MHD ) patients .  L-carnitine supplementation is expected to improve the quality of life ( QoL ) of patients on MHD . AIMS To study the effect of L-carnitine supplementation on QoL of Indian patients on MHD . SETTING AND DESIGN This was a single ( patient ) blind , r and omized , placebo-controlled clinical trial conducted on patients on MHD attending hemodialysis unit of the study center . MATERIAL S AND METHODS Twenty patients on MHD suffering from hemodialysis-related symptoms were r and omly assigned to receive intravenous L-carnitine 20 mg/kg or placebo after every dialysis session for 8 weeks . SF36 ( Short Form with 36 questions ) score for QoL , laboratory investigations and dialysis related symptoms were recorded at baseline and after 8 weeks . Improvement in QoL , laboratory parameters and dialysis related symptoms in the two groups after 8 weeks was compared . STATISTICAL ANALYSIS USED Depending on normality of data , unpaired T test or Mann Whitney U test was used for comparison of change ( 8 weeks-baseline ) in SF36 scores and laboratory parameters observed in the two groups . RESULTS L-carnitine supplementation increased total SF36 score by 18.29 + /- 12.71 ( 95 % CI : 10.41 to 26 ) while placebo result ed in reduction in total SF36 score by 6.4 + /- 16.39 ( 95 % CI : -16.59 to 3.73 ) . L-carnitine also result ed in significant increase in hemoglobin and serum albumin and decrease in serum creatinine as compared to placebo . More patients were relieved of dialysis related symptoms in L-carnitine group . CONCLUSION Intravenous L-carnitine supplementation improves QoL in patients on MHD Background Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems . Amino acid deficiency , including L-carnitine , has been proposed to be associated with its pathophysiology . Nevertheless , the efficacy of L-carnitine supplementation on frailty status has not been documented . Thus , this study aim ed to determine the effect of 10-week L-carnitine supplement ( 1.5 g/day ) on frailty status and its biomarkers and also physical function , cognition , and nutritional status among prefrail older adults in Klang Valley , Malaysia . Methodology This study is a r and omized , double-blind , placebo-controlled clinical trial conducted among 50 prefrail subjects r and omized into two groups ( 26 in L-carnitine group and 24 in placebo group ) . Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit , selected frailty biomarkers ( interleukin-6 , tumor necrosis factor-alpha , and insulin-like growth factor-1 ) , physical function , cognitive function , nutritional status and biochemical profile . Results The results indicated that the mean scores of Frailty Index score and h and grip test were significantly improved in subjects supplemented with L-carnitine ( P<0.05 for both parameters ) as compared to no change in the placebo group . Based on Fried criteria , four subjects ( three from the L-carnitine group and one from the control group ) transited from prefrail status to robust after the intervention . Conclusion L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults 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 The purpose of this investigation was to examine the influence of L-carnitine L-tartrate ( LCLT ) supplementation using a balanced , cross-over , placebo-controlled research design on the anabolic hormone response ( i.e. , testosterone [ T ] , insulin-like growth factor-I , insulin-like growth factor-binding pro-tein-3 [ IGFBP-3 ] , and immunofunctional and immunoreac-tive growth hormone [ GHif and GHir ] ) to acute resistance exercise . Ten healthy , recreationally weight-trained men ( mean ± SD age 23.7 ± 2.3 years , weight 78.7 ± 8.5 kg , and height 179.2 ± 4.6 cm ) volunteered and were matched , and after 3 weeks of supplementation ( 2 g LCLT per day ) , fasting morning blood sample s were obtained on six consecutive days ( D1-D6 ) . Subjects performed a squat protocol ( 5 sets of 15–20 repetitions ) on D2 . During the squat protocol , blood sample s were obtained before exercise and 0 , 15 , 30 , 120 , and 180 minutes postexercise . After a 1-week washout period , subjects consumed the other supplement for a 3-week period , and the same experimental protocol was repeated using the exact same procedures . Expected exercise-induced increases in all of the hormones were observed for GHir , GHif , IGFBP-3 , and T. Over the recovery period , LCLT reduced the amount of exercise-induced muscle tissue damage , which was assessed via magnetic resonance imaging scans of the thigh . LCLT supplementation significantly ( p < 0.05 ) increased IGFBP-3 concentrations prior to and at 30 , 120 , and 180 minutes after acute exercise . No other direct effects of LCLT supplementation were observed on the absolute concentrations of the hormones examined , but with more undamaged tissue , a greater number of intact receptors would be available for hormonal interactions . These data support the use of LCLT as a recovery supplement for hypoxic exercise and lend further insights into the hormonal mechanisms that may help to mediate quicker recovery Because carnitine has been shown to decrease oxidative stress and improve endothelial cell functioning , we examined the effects of carnitine supplementation on postpr and ial flow-mediated dilation ( FMD ) and circulating biomarkers of inflammation and oxidative stress after a high-fat meal . A r and omized , double-blind , placebo-controlled , crossover study design was used . Thirty men and women ( age 30 + /- 8 year , body mass 72.9 + /- 17.1 kg , body fat 13.0 + /- 6.4 % ) participated in 2 vascular testing days , each preceded by 3 weeks of supplementation with either 2 g/day of L-Carnitine ( L-Carnitine L-Tartrate ) or placebo with a 3- to 5-week washout period between trials . Brachial artery FMD in response to 5 minutes of upper arm occlusion and circulating markers of oxidative stress and inflammation were measured in the fasting state and after a st and ardized high-fat meal . After 3 weeks of supplementation , peak FMD in the fasting state was similar between the carnitine and placebo trials , averaging 6.6 % . Peak FMD during the postpr and ial period decreased to 5.8 % at 1.5 hours during placebo and increased to 7.7 % during the carnitine trial ( n = 30 : p = 0.043 for supplement by time interaction effect ) . This improvement in postpr and ial vascular function was most dramatic in subjects who showed a decrease in peak FMD in response to the meal ( n = 15 : p = 0.003 for supplement by time interaction effect ) . There was a significant increase in postpr and ial lipemia and plasma interleukin-6 but no effect of supplementation . There were no significant postpr and ial changes or supplement effects for plasma tumor necrosis factor-alpha and malondialdehyde . In conclusion , consistent with other work showing a beneficial effect of carnitine on vascular function , these findings indicate that carnitine supplementation in healthy individuals improves postpr and ial FMD after a high-fat meal Preliminary in vitro and in vivo studies with valproic acid ( VPA ) in cell lines and patients with spinal muscular atrophy ( SMA ) demonstrate increased expression of SMN , supporting the possibility of therapeutic benefit . We performed an open label trial of VPA in 42 subjects with SMA to assess safety and explore potential outcome measures to help guide design of future controlled clinical trials . Subjects included 2 SMA type I ages 2–3 years , 29 SMA type II ages 2–14 years and 11 type III ages 2–31 years , recruited from a natural history study .  VPA was well-tolerated and without evident hepatotoxicity . Carnitine depletion was frequent and temporally associated with increased weakness in two subjects . Exploratory outcome measures included assessment of gross motor function via the modified Hammersmith Functional Motor Scale ( MHFMS ) , electrophysiologic measures of innervation including maximum ulnar compound muscle action potential ( CMAP ) amplitudes and motor unit number estimation ( MUNE ) , body composition and bone density via dual-energy X-ray absorptiometry ( DEXA ) , and quantitative blood SMN mRNA levels . Clear decline in motor function occurred in several subjects in association with weight gain ; mean fat mass increased without a corresponding increase in lean mass . We observed an increased mean score on the MHFMS scale in 27 subjects with SMA type II ( p≤0.001 ) ; however , significant improvement was almost entirely restricted to participants < 5 years of age . Full length SMN levels were unchanged and Δ7SMN levels were significantly reduced for 2 of 3 treatment visits . In contrast , bone mineral density ( p≤0.0036 ) and maximum ulnar CMAP scores ( p≤0.0001 ) increased significantly . Conclusions While VPA appears safe and well-tolerated in this initial pilot trial , these data suggest that weight gain and carnitine depletion are likely to be significant confounding factors in clinical trials . This study highlights potential strengths and limitations of various c and i date outcome measures and underscores the need for additional controlled clinical trials with VPA targeting more restricted cohorts of subjects . Trial Registration Clinical BACKGROUND AND AIMS Advanced glycation end products ( AGEs ) contribute to cardiovascular disease in patients with hemodialysis ( HD ) . We have recently found that carnitine levels are inversely associated with skin AGE levels in HD patients . We examined whether L-carnitine supplementation reduced skin AGE levels in HD patients with carnitine deficiency . METHODS This was a single-center study . One hundred and two HD patients ( total carnitine levels < 50 μmol/L ) were enrolled and r and omized to either oral administration of L-carnitine ( 900 mg/day ) ( n=51 ) or control ( n=51 ) . After 6 months , metabolic and inflammatory variables , including serum levels of carnitine , were measured . Skin AGE levels were determined by evaluating skin auto-fluorescence with an AGE-reader . RESULTS There were no significant differences of clinical variables at baseline between the  control and L-carnitine therapy group . Thirty-two patients did not complete the assessment or treatment of the study .  Oral L-carnitine supplementation for 6 months significantly increased low-density lipoprotein cholesterol ( LDL-C ) , triglycerides , total , free , and acyl carnitine levels , while it decreased alanine transaminase , acyl/free carnitine ratio , β₂-microglobulin , and skin AGE values . Change in total carnitine values from baseline ( Δtotal carnitine ) and Δfree carnitine were inversely associated with Δskin AGE levels  in L-carnitine-treated patients ( p=0.036 and p=0.016 , respectively ) . In multiple regression analysis , Δfree carnitine was a sole independent determinant of Δskin AGEs ( R²=0.178 ) . CONCLUSIONS The present study demonstrated that oral L-carnitine supplementation significantly decreased skin AGE levels in HD patients with carnitine deficiency . These observations suggest that supplementation of L-carnitine might be a novel therapeutic strategy for preventing the accumulation of tissue AGEs in carnitine-deficient patients with HD 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 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 Aim To investigate if conjugated linoleic acid supplementation ( CLA ) affects metabolic factors and oxidative stress in non-alcoholic fatty liver disease ( NAFLD ) . Methods The study was a r and omized , controlled clinical trial conducted in specialized and subspecialized clinics of Tabriz University of Medical Sciences from January 2014 to March 2015 . 38 obese NAFLD patients were r and omly allocated into either the intervention group , receiving three 1000 mg softgel of CLA with a weight loss diet and 400 IU vitamin E , or into the control group , receiving only weight loss diet and 400 IU vitamin E for eight weeks . Dietary data and physical activity , as well as anthropometric , body composition , metabolic factors , and oxidative stress were assessed at baseline and at the end of the study . Results Weight , body composition , and serum oxidative stress , insulin , and lipid profile significantly improved in both groups , while hemoglobin A1c ( HbA1c ) levels ( P = 0.004 ) , total cholesterol to high density lipoprotein ratio ( P = 0.008 ) , low density lipoprotein to high density lipoprotein ratio ( LDL/HDL ) ( P = 0.002 ) , and alanine aminotransferase to aspartate aminotransferase ( ALT/AST ) ratio ( P = 0.025 ) significantly decreased in the intervention group . At the end of the study , fat mass ( P = 0.001 ) , muscle mass ( P = 0.023 ) , total body water ( P = 0.004 ) , HbA1c ( P < 0.001 ) , triglycerides ( P = 0.006 ) , LDL/HDL ratio ( P = 0.027 ) , and ALT/AST ratio ( P = 0.046 ) were significantly better in the CLA group than in the control group . Conclusion CLA improved insulin resistance , lipid disturbances , oxidative stress , and liver function in NAFLD . Therefore , it could be considered as an effective complementary treatment in NAFLD . Registration number : I RCT 2014020516491N1 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 To evaluate the effects of 1-year treatment with orlistat plus L-carnitine compared to orlistat alone on body weight , glycemic and lipid control , and inflammatory parameters in obese type 2 diabetic patients . Two hundred and fifty-eight patients with uncontrolled type 2 diabetes mellitus ( T2DM ) [ glycated hemoglobin ( HbA(1c ) ) > 8.0 % ] in therapy with different oral hypoglycemic agents or insulin  were enrolled in this study and r and omized to take orlistat 120 mg three times a day plus L-carnitine 2 g one time a day or orlistat 120 mg three times a day . We evaluated the following parameters at baseline and after 3 , 6 , 9 , and 12 months : body weight , body mass index ( BMI ) , glycated hemoglobin ( HbA(1c ) ) , fasting plasma glucose ( FPG ) , postpr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triglycerides ( Tg ) , adiponectin ( ADN ) , leptin , tumor necrosis factor-α ( TNF-α ) , vaspin , and high-sensitivity C-reactive protein ( Hs-CRP ) . We observed a better decrease in body weight , glycemic profile , HOMA-IR , LDL-C , and ADN and a faster improvement in FPI , TC , Tg , leptin , TNF-α , Hs-CRP  with orlistat plus L-carnitine compared to orlistat alone . We also recorded an improvement in vaspin  with orlistat plus l-carnitine not reached with orlistat alone . Orlistat plus L-carnitine gave a better improvement in body weight , glycemic and lipid profile compared to orlistat alone ; furthermore , a faster and better improvement in inflammatory parameters was observed with orlistat plus L-carnitine compared to orlistat alone PURPOSE Hemodialyzed patients demonstrate elevated oxidative stress and reduced functional status . Exercise induces health benefits , but acute exertion up-regulates oxidative stress responses in patients undergoing hemodialysis . Therefore , the aim of the present study was to examine the effect of L-carnitine supplementation on i ) exercise performance and ii ) blood redox status both at rest and after exercise . METHODS Twelve hemodialysis patients received either L-carnitine ( 20 mg kg(-1 ) i.v . ) or placebo in a double-blind , placebo-controlled , counterbalanced , and crossover design for 8 wk . Participants performed an exercise test to exhaustion before and after supplementation . During the test , V˙O2 , respiratory quotient , heart rate , and time to exhaustion were monitored . Blood sample s , collected before and after exercise , were analyzed for lactate , malondialdehyde , protein carbonyls , reduced and oxidized glutathione , antioxidant capacity , catalase , and glutathione peroxidase activity . RESULTS Blood carnitine increased by L-carnitine supplementation proportionately at rest and after exercise . L-carnitine supplementation  increased time to fatigue ( 22 % ) and decreased postexercise lactate ( 37 % ) , submaximal heart rate , and respiratory quotient but did not affect V˙O2peak . L-carnitine supplementation  increased reduced/oxidized glutathione ( 2.7-fold at rest , 4-fold postexercise ) and glutathione peroxidase activity ( 4.5 % at rest , 10 % postexercise ) and decreased malondialdehyde ( 19 % at rest and postexercise ) and protein carbonyl ( 27 % at rest , 40 % postexercise ) concentration . CONCLUSIONS Data suggest that a 2-month L-carnitine supplementation may be effective in attenuating oxidative stress responses , enhancing antioxidant status , and improving performance of patients with end-stage renal disease 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 OBJECTIVES This study was performed to evaluate the effects of L-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infa rct ion . BACKGROUND Carnitine is a physiologic compound that performs an essential role in myocardial energy production at the mitochondrial level . Myocardial carnitine deprivation occurs during ischemia , acute myocardial infa rct ion and cardiac failure . Experimental studies have suggested that exogenous carnitine administration during these events has a beneficial effect on function . METHODS The L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico ( CEDIM ) trial was a r and omized , double-blind , placebo-controlled , multicenter trial in which 472 patients with a first acute myocardial infa rct ion and high quality two-dimensional echocardiograms received either  placebo ( 239 patients ) or L-carnitine  ( 233 patients ) within 24 h of onset of chest pain . Placebo or L-carnitine was given at a dose of 9 g/day intravenously for the first 5 days and then 6 g/day orally for the next 12 months . Left ventricular volumes and ejection fraction were evaluated on admission , at discharge from hospital and at 3 , 6 and 12 months after acute myocardial infa rct ion . RESULTS A significant attenuation of left ventricular dilation in the first year after acute myocardial infa rct ion was observed in patients treated with L-carnitine compared with those receiving placebo . The percent increase in both end-diastolic and end-systolic volumes from admission to 3- , 6- and 12-month evaluation was significantly reduced in the L-carnitine group . No significant differences were observed in left ventricular ejection fraction changes over time in the two groups . Although not design ed to demonstrate differences in clinical end points , the combined incidence of death and congestive heart failure after discharge was 14 ( 6 % ) in the L-carnitine treatment group versus 23 ( 9.6 % ) in the placebo group ( p = NS ) . Incidence of ischemic events during follow-up was similar in the two groups of patients . CONCLUSIONS L-Carnitine treatment initiated early after acute myocardial infa rct ion and continued for 12 months can attenuate left ventricular dilation during the first year after an acute myocardial infa rct ion , result ing in smaller left ventricular volumes at 3 , 6 and 12 months after the emergent event The purpose of the present study was to determine whether vitamin B-6 depletion and repletion influence carnitine concentrations in the plasma , erythrocytes , and urine of young adult women consuming a low-carnitine ( 30 micromol/d ) , lactoovovegetarian diet .  Doses of vitamin B-6 were administered sequentially as follows : 1.60 mg/d during adjustment for 9 d , 0.46 mg/d during depletion for 27 d , 1.26 mg/d during the first repletion for 21 d , 1.66 mg/d during the second repletion for 21 d , and 2.06 mg/d during the third repletion for 14 d. Urinary carnitine tended to decline but was not significantly different throughout the 92-d study period . Plasma short-chain acylcarnitine and total carnitine decreased during vitamin B-6 depletion ; however , the ratio of plasma acylcarnitine to total carnitine was not significantly different during changes in vitamin B-6 intake . Erythrocyte long-chain acylcarnitine increased during vitamin B-6 depletion , but the ratio of erythrocyte acylcarnitine to total carnitine did not respond to changes in vitamin B-6 intake . Plasma free and total carnitine concentrations were only weakly correlated with plasma pyridoxal-P concentration ( r = 0.28 and r = 0.29 , respectively ; P < 0.01 ) . No significant correlations were observed between urinary carnitine excretion or erythrocyte carnitine concentrations and plasma or erythrocyte pyridoxal-P concentrations . Thus , a vitamin B-6 intake of 0.5 mg/d does not affect carnitine concentrations in biological fluids and therefore is unlikely to affect endogenous carnitine synthesis over 27 d. The changes in carnitine indexes that we observed were probably due to adaptation to a vegetarian pattern of exogenous carnitine consumption BACKGROUND & AIMS Carnitine may be considered conditionally essential in the neonatal population . The purpose of this study was to evaluate the effects of long-term carnitine supplementation on total carnitine status and morbidity in premature neonates . METHODS In this prospect i ve , r and omized , placebo-controlled , double-blinded study , premature neonates received carnitine supplementation ( 20mg/kg/day ) or placebo .  Plasma ( nmol/ml ) and red blood cell ( RBC ) ( nmol/mg hemoglobin ) total carnitine concentrations , 24-h nitrogen excretion , intake and weight , and respiratory , gastroesophageal , and infectious morbidity were assessed . RESULTS Twenty-nine neonates ( 13 placebo , 16 carnitine ; 27+/-2 weeks gestation ; 976+/-259 g birthweight ) were studied for up to 8 weeks . Plasma total carnitine concentrations exceeded the reference range in the carnitine group ( weeks 1 - 8 ) ; however , concentrations did not reach reference range until week 4 in the placebo group . RBC total carnitine concentrations increased , but remained below reference range in both the carnitine ( weeks 1 - 6 ) and placebo ( weeks 1 - 8 ) groups . Carnitine group neonates regained their birthweight more rapidly than placebo group neonates ( day of life 11.8+/-6 vs. 16.9+/-6.3 , P=0.034 ) . In addition , percent periodic breathing calculated from cardiopulmonary trend monitor data ( weeks 1 - 8 ) was lower in the carnitine group ( 0.4+/-0.9 vs. 1.4+/-1.9 , P=0.014 ) . There was no difference with respect to other markers of respiratory , gastroesophageal and infectious morbidity or nitrogen balance . CONCLUSIONS Carnitine supplementation at 20mg/kg/day results in increased plasma and RBC total carnitine concentrations , has a positive effect on catch-up growth , and may improve periodic breathing in premature neonates Background Valproic acid ( VPA ) has demonstrated potential as a therapeutic c and i date for spinal muscular atrophy ( SMA ) in vitro and in vivo . Methods Two cohorts of subjects were enrolled in the SMA CARNIVAL TRIAL , a non-ambulatory group of “ sitters ” ( cohort 1 ) and an ambulatory group of “ walkers ” ( cohort 2 ) . Here , we present results for cohort 1 : a multicenter phase II r and omized double-blind intention-to-treat protocol in non-ambulatory SMA subjects 2–8 years of age . Sixty-one subjects were r and omized 1∶1 to placebo or treatment for the first six months ; all received active treatment the subsequent six months . The primary outcome was change in the modified Hammersmith Functional Motor Scale ( MHFMS ) score following six months of treatment . Secondary outcomes included safety and adverse event data , and change in MHFMS score for twelve versus six months of active treatment , body composition , quantitative SMN mRNA levels , maximum ulnar CMAP amplitudes , myometry and PFT measures . Results At 6 months , there was no difference in change from the baseline MHFMS score between treatment and placebo groups ( difference = 0.643 , 95 % CI = −1.22–2.51 ) . Adverse events occurred in > 80 % of subjects and were more common in the treatment group . Excessive weight gain was the most frequent drug-related adverse event , and increased fat mass was negatively related to change in MHFMS values ( p = 0.0409 ) . Post-hoc analysis found that children ages two to three years that received 12 months treatment , when adjusted for baseline weight , had significantly improved MHFMS scores ( p = 0.03 ) compared to those who received placebo the first six months . A linear regression analysis limited to the influence of age demonstrates young age as a significant factor in improved MHFMS scores ( p = 0.007 ) . Conclusions This study demonstrated no benefit from six months treatment with VPA and L-carnitine in a young non-ambulatory cohort of subjects with SMA .  Weight gain , age and treatment duration were significant confounding variables that should be considered in the design of future trials . Trial Registry Clinical trials.gov The aim of the study was to evaluate the effects of 12-month treatment with sibutramine plus L-carnitine compared with sibutramine alone on body weight , glycemic control , insulin resistance , and inflammatory state in type 2 diabetes mellitus patients . Two hundred fifty-four patients with uncontrolled type 2 diabetes mellitus ( glycated hemoglobin [ HbA(1c ) ] > 8.0 % ) in therapy with different oral hypoglycemic agents or insulin  were enrolled in this study and r and omized to take sibutramine 10 mg plus L-carnitine 2 g or sibutramine 10 mg in monotherapy . We evaluated at baseline and after 3 , 6 , 9 , and 12 months these parameters : body weight , body mass index , HbA(1c ) , fasting plasma glucose , postpr and ial plasma glucose , fasting plasma insulin , homeostasis model assessment of insulin resistance index , total cholesterol , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , triglycerides , leptin , tumor necrosis factor-α , adiponectin , vaspin , and high-sensitivity C-reactive protein .  Sibutramine plus L-carnitine gave a faster improvement of fasting plasma glucose , postpr and ial plasma glucose , lipid profile , leptin , tumor necrosis factor-α , and high-sensitivity C-reactive protein compared with sibutramine alone . Furthermore , there was a better improvement of body weight , HbA(1c ) , fasting plasma insulin , homeostasis model assessment of insulin resistance index , vaspin , and adiponectin  with sibutramine plus L-carnitine compared with sibutramine alone . Sibutramine plus L-carnitine gave a better and faster improvement of all the analyzed parameters compared with sibutramine alone without giving any severe adverse effect 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 In a r and omised , double-blind placebo-controlled trial , the effects of the administration of oral L-carnitine ( 2 g/day ) for 28 days were compared in the management of 51 ( carnitine group ) and 50 ( placebo group ) patients with suspected acute myocardial infa rct ion . At study entry , the extent of cardiac disease , cardiac enzymes and lipid peroxides were comparable between the groups , although both groups showed an increase in cardiac enzymes and lipid peroxides . At the end of the 28-day treatment period , the mean infa rct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo . Electrocardiographic assessment of infa rct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo ( 7.4 + /- 1.2 vs 10.7 + /- 2.0 ) , while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group . Lactate dehydrogenase measured on the sixth or seventh day following infa rct ion showed a smaller rise in the carnitine group compared to placebo . Angina pectoris ( 17.6 vs 36.0 % ) , New York Heart Association class III and IV heart failure plus left ventricular enlargement ( 23.4 vs 36.0 % ) and total arrhythmias ( 13.7 vs 28.0 % ) were significantly less in the carnitine group compared to placebo . Total cardiac events including cardiac deaths and nonfatal infa rct ion were 15.6 % in the carnitine group vs 26.0 % in the placebo group . It is possible that L-carnitine supplementation in patients with suspected acute myocardial infa rct ion may be protective against cardiac necrosis and complications during the first 28 days Background Malnutrition is a common consequence of disease in older patients . Both in hospital setting and in community setting oral nutritional support has proven to be effective . However , cost-effectiveness studies are scarce . Therefore , the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients , starting at hospital admission until three months after discharge . Methods This study is a r and omized controlled trial . Patients are included at hospital admission and followed until three months after discharge . Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective st and ards : Body Mass Index ( BMI in kg/m2 ) < 20 and /or ≥ 5 % unintentional weight loss in the previous month and /or ≥ 10 % unintentional weight loss in the previous six months . We will compare usual nutritional care with transmural nutritional support ( energy and protein enriched diet , two additional servings of an oral nutritional supplement , vitamin D and calcium supplementation , and consultations by a dietitian ) . Each study arm will consist of 100 patients . The primary outcome parameters will be changes in activities of daily living ( determined as functional limitations and physical activity ) between intervention and control group . Secondary outcomes will be changes in body weight , body composition , quality of life , and muscle strength . An economic evaluation from a societal perspective will be conducted alongside the r and omised trial to evaluate the cost-effectiveness of the intervention in comparison with usual care . Conclusion In this r and omized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge , compared to usual care . Primary endpoints of the study are changes in activities of daily living , body weight , body composition , quality of life , and muscle strength . An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care . Trial registration Netherl and s Trial Register ( IS RCT N29617677 , registered 14-Sep-2005 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 Background : The effects of L-carnitine on the hemodynamic state of chronic hemodialysis patients have been debated . In order to clarify the effect of administered L-carnitine on cardiac function and hypotensive episodes during the hemodialysis procedure , a r and omized double-blind placebo-controlled study was performed for 3 months . Methods and Results : Twenty stable out patients undergoing hemodialysis treatment were divided into two groups : controls ( placebo ) and treated patients ( L-carnitine 900 mg p.o . daily ) . After 3 months , cardiac function was reevaluated by echocardiography , and hypotensive episodes during hemodialysis were assessed . Free and acyl carnitine levels increased significantly from 22.3 ± 7.1 to 140.3 ± 57.5 μmol/l and from 15.8 ± 2.8 to 94.8 ± 50.4 μmol/l , respectively , in the treated group . The ejection fraction significantly increased from 61.8 ± 16.0 to 64.4 ± 13.8 % ( p < 0.05 ) in the treated group . However , there was no difference in other echocardiographic parameters between the two groups . Hypotensive episodes significantly decreased from 4.0 ± 1.7 to 1.3 ± 0.9 times per month ( p < 0.05 ) , although patients ' body weight did not change significantly . Conclusions : Beneficial effects of L-carnitine on the hemodynamic state of chronic hemodialysis patients were observed . L-Carnitine supplementation might be considered especially for chronic hemodialysis patients with unstable hemodynamic conditions Our study wants to evaluate the effects of one year treatment with orlistat plus L-carnitine compared to orlistat alone on body weight , glycemic and lipid control , and insulin resistance state in type 2 diabetic patients . Two hundred and fifty-eight patients with uncontrolled type 2 diabetes mellitus ( T2DM ) [ glycated hemoglobin ( HbA(1c ) ) > 8.0 % ] in therapy with different oral hypoglycemic agents or insulin  were enrolled in this study and r and omised to take orlistat 120 mg three times a day plus L-carnitine 2 g one time a day or orlistat 120 mg three times a day . We evaluated at baseline , and after 3 , 6 , 9 , and 12 months these parameters : body weight , body mass index ( BMI ) , HbA(1c ) , fasting plasma glucose ( FPG ) , post-pr and ial plasma glucose ( PPG ) , fasting plasma insulin ( FPI ) , homeostasis model assessment insulin resistance index ( HOMA-IR ) , total cholesterol ( TC ) , low density lipoprotein-cholesterol ( LDL-C ) , high density lipoprotein-cholesterol ( HDL-C ) , triglycerides ( Tg ) , retinol binding protein-4 ( RBP-4 ) , resistin , visfatin , high sensitivity-C reactive protein ( Hs-CRP ) . We observed a faster , and better decrease of body weight , HbA(1c ) , FPG , PPG , LDL-C , HOMA-IR with orlistat plus L-carnitine compared to orlistat . A faster improvement of TC , Tg , FPI , resistin , RBP-4 , visfatin , and Hs-CRP was reached with orlistat plus L-carnitine compared to orlistat . We can safely conclude that the association of orlistat plus L-carnitine was better than orlistat in improving body weight , glycemic and lipid profile , insulin resistance , and inflammatory parameters and no significant adverse events were recorded OBJECTIVE To determine the efficacy and safety of combined L-carnitine and acetyl-L-carnitine therapy in infertile males with oligoasthenozoospermia . METHODS One hundred fifty patients with oligoasthenozoospermia were r and omized selected into treatment and control groups . The treatment group with 90 patients were given L-carnitine ( 2 g/d ) and acetyl-L-carnitine ( 1 g/d ) orally , twice a day . The patients in control group were given Vitamin E 100 mg plus Vitamin C 100 mg , tid . The oral therapy lasted three months and patients accepted sperm analysis every one month . The L-carnitine level in seminal plasma was examined by high performance liquid chromatography ( HPC ) . Side effects as well as pregnant rate were observed . RESULTS In the treatment group , 85 patients out of 90 finished the three month treatment . Female spouses of 10 patients ( 11.6 % ) achieved pregnancy . Moreover , their forward motile sperm per ejaculation , total motile sperm , as well as the concentration of L-carnitine in seminal plasma were increased significantly ( P < 0.01 ) . In control group , 53 patients out of 60 completed three months therapy . Two pregnancy ( 3.7 % ) was observed . Though some increase was seen in number of forward motile sperm and total motile sperm per ejaculation , the changes were not statistically significant ( P > 0.05 ) . The difference of the pregnant rate between two groups was statistically significant . No side effects were found . CONCLUSION Combined treatment with L-carnitine and acetyl-L-calmitine can be an effective and safe option for treating oligoasthenozoospermia by means of significantly improving forward motile sperm and total motile sperm per ejaculation , as well as increasing pregnant rates Doxorubicin is an anthracycline antibiotic with a broad spectrum of antineoplastic activity . Cardiotoxicity is a serious long-term complication of the drug . Simultaneous administration of carnitine has been proposed to prevent cardiotoxicity . We aim ed to monitor the serum carnitine levels during the treatment of doxorubicin and to determine a relationship between serum carnitine levels and cardiac dysfunction . Fifteen patients were evaluated prospect ively . Measurement of carnitine levels and evaluation of cardiac function were performed prior to treatment , and after cumulative doses of 180 and 300 mg/m2 of doxorubicin .  A group of 20 healthy children served as control group to obtain reference values . We found sub clinical abnormalities in cardiac function , while the cumulative doses of the doxorubicin was increasing . The mean end diastolic and end systolic left ventricular dimensions of the patient group after completion of the treatment were significantly increased compared with initial values . The ejection and shortening fraction of the patient group after cumulative doses of 300 mg/m2 of doxorubicin were significantly lower than those of the control group . A statistically significant augmentation was observed in mitral A , with a decrease in mitral E/A ratio . There was a trend towards lower serum carnitine levels with higher cumulative doses of doxorubicin , although it was not statistically significant . Our results invite new detailed investigations depending on the measurement of serum and urinary free and acyl carnitine and myocardial carnitine levels to evaluate possible roles of carnitine in the prevention of doxorubicin-induced  cardiotoxicity
No significant effect was seen for waist circumference ( WC ) and body fat percent .
A non-linear dose-response association was seen between l-carnitine supplementation and body weight reduction ( P < 0.001 ) suggesting that ingestion of 2000 mg l-carnitine per day provides the maximum effect in adults .
This association was not seen for BMI , WC and body fat percent .
CONCLUSIONS l-carnitine supplementation provides a modest reducing effect on body weight , BMI and fat mass , especially among adults with overweight/obesity
BACKGROUND AND AIM Clinical evidence which investigated the effects of l-carnitine , a vitamin-like substance , on weight loss had led to inconsistent results .
This study therefore aim ed to examine the effect of l-carnitine supplementation on body weight and composition by including the maximum number of r and omized controlled trials ( RCTs ) and to conduct a dose-response analysis , for the first time .