Blood metabolomes distinguish malnutrition and reflect treatment response in adult thalassemia patients: a randomized controlled trial

The nutritional condition of thalassemia patients (Thal) needs to be monitored and treated. However, the roles of metabolomics in Thal with malnutrition have never been determined. Twenty non-Thal healthy subjects, twenty Thal without malnutrition, and twenty Thal with malnutrition were enrolled onto the study. Anthropometry, serum albumin and transferrin, and macronutrient-related metabolomic profile in plasma were measured. Thal with malnutrition were then randomized to receive either oral nutritional supplements (ONS) or nutritional advice (NA). After 12 weeks of interventions, all parameters were re-evaluated. We found that tyrosine, tryptophan, and fatty acid-derived acylcarnitines were higher in Thal with malnutrition. However, the levels of neither serum albumin nor serum transferrin differed between groups. Following 12 weeks of intervention, almost all fatty acid-derived acylcarnitines decreased in the ONS group, but all of them increased in the NA group. Percentage changes from baseline to week 12 between the two interventions were compared, changes in almost all fatty acid-derived acylcarnitines differed between groups. However, there were no significant differences in percentage changes in anthropometry, serum albumin, and serum transferrin between groups. These results suggested that plasma amino acid and acylcarnitine concentrations differed by nutritional status and changed over 12 weeks of ONS. These findings are exploratory and will facilitate hypothesis-generation, requiring validation with formal diagnostic performance analysis.