Citrin is the liver-type aspartate-glutamate carrier that resides within the inner mitochondrial membrane. Citrin deficiency
(due to homozygous or compound heterozygous mutations in the gene
SLC25A13) causes both adult-onset type II citrullinaemia (CTLN2) and neonatal intrahepatic cholestasis (NICCD). Clinically, CTLN2
is characterized by hyperammonaemia and citrullinaemia, whereas NICCD has a much more varied and transient presentation that
can include multiple aminoacidaemias, hypoproteinaemia, galactosaemia, hypoglycaemia, and jaundice. Personal histories from
CTLN2 patients have repeatedly described an aversion to carbohydrate-rich foods, and clinical observations of dietary and
therapeutic outcomes have suggested that their unusual food preferences may be directly related to their pathophysiology.
In the present study, we monitored the food intake of 18 Japanese citrin-deficient subjects whose ages ranged from 1 to 33 years,
comparing them against published values for the general Japanese population. Our survey confirmed a marked decrease in carbohydrate
intake, which accounts for a smaller proportion of carbohydrates contributing to the total energy intake (PFC ratio) as well
as a shift towards a lower centile distribution for carbohydrate intake relative to age- and sex-matched controls. These results
strongly support an avoidance of carbohydrate-rich foods by citrin-deficient patients that may lead to worsening of symptoms.
Communicating editor: Ertan Mayatepek
Competing interests: None declared
References to electronic databases: Citrullinaemia, type II, adult-onset (CTLN2): OMIM 603471. Citrullinaemia, type II, neonatal-onset (neonatal intrahepatic
cholestasis caused by citrin deficiency, NICCD): OMIM 605814.