Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning

Abstract Purpose This study aimed to explore metabolite pathways and identify residual metabolites during the post-neonatal intrahepatic cholestasis caused by citrin deficiency (post-NICCD) phase, while developing a predictive model for failure to thrive (FTT) using selected metabolites. Method A ca...

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Main Authors: Peiyao Wang, Duo Zhou, Lingwei Hu, Pingping Ge, Ziyan Cen, Zhenzhen Hu, Qimin He, Kejun Zhou, Benqing Wu, Xinwen Huang
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Nutrition & Metabolism
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Online Access:https://doi.org/10.1186/s12986-025-00928-x
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author Peiyao Wang
Duo Zhou
Lingwei Hu
Pingping Ge
Ziyan Cen
Zhenzhen Hu
Qimin He
Kejun Zhou
Benqing Wu
Xinwen Huang
author_facet Peiyao Wang
Duo Zhou
Lingwei Hu
Pingping Ge
Ziyan Cen
Zhenzhen Hu
Qimin He
Kejun Zhou
Benqing Wu
Xinwen Huang
author_sort Peiyao Wang
collection DOAJ
description Abstract Purpose This study aimed to explore metabolite pathways and identify residual metabolites during the post-neonatal intrahepatic cholestasis caused by citrin deficiency (post-NICCD) phase, while developing a predictive model for failure to thrive (FTT) using selected metabolites. Method A case-control study was conducted from October 2020 to July 2024, including 16 NICCD patients, 31 NICCD-matched controls, 34 post-NICCD patients, and 70 post-NICCD-matched controls. Post-NICCD patients were further stratified into two groups based on growth outcomes. Biomarkers for FTT were identified using Lasso regression and random forest analysis. A non-invasive predictive model was developed, visualized as a nomogram, and internally validated using the enhanced bootstrap method. The model’s performance was evaluated with receiver operating characteristic curves and calibration curves. Metabolite concentrations (amino acids, acylcarnitines, organic acids, and free fatty acids) were measured using liquid chromatography or ultra-performance liquid chromatography-tandem mass spectrometry. Results The biosynthesis of unsaturated fatty acids was identified as the most significantly altered pathway in post-NICCD patients. Twelve residual metabolites altered during both NICCD and post-NICCD phases were identified, including: 2-hydroxyisovaleric acid, alpha-ketoisovaleric acid, C5:1, 3-methyl-2-oxovaleric acid, C18:1OH, C20:4, myristic acid, eicosapentaenoic acid, carnosine, hydroxylysine, phenylpyruvic acid, and 2-methylcitric acid. Lasso regression and random forest analysis identified kynurenine, arginine, alanine, and aspartate as the optimal biomarkers for predicting FTT in post-NICCD patients. The predictive model constructed with these four biomarkers demonstrated an AUC of 0.947. Conclusion While post-NICCD patients recover clinically and biochemically, their metabolic profiles remain incompletely restored. The predictive model based on kynurenine, arginine, alanine, and aspartate provides robust diagnostic performance for detecting FTT in post-NICCD patients.
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spelling doaj-art-0694adac77d44cc9aa80ffa08ef9b27b2025-08-20T03:10:17ZengBMCNutrition & Metabolism1743-70752025-05-0122111210.1186/s12986-025-00928-xMetabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learningPeiyao Wang0Duo Zhou1Lingwei Hu2Pingping Ge3Ziyan Cen4Zhenzhen Hu5Qimin He6Kejun Zhou7Benqing Wu8Xinwen Huang9Department of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthSchool of Geography Science and Geomatics Engineering, Suzhou University of Science and TechnologyHuman Metabolomics Institute, Inc.Children’s Medical Center, Shenzhen Guangming District People’s HospitalDepartment of Genetics and Metabolism, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child HealthAbstract Purpose This study aimed to explore metabolite pathways and identify residual metabolites during the post-neonatal intrahepatic cholestasis caused by citrin deficiency (post-NICCD) phase, while developing a predictive model for failure to thrive (FTT) using selected metabolites. Method A case-control study was conducted from October 2020 to July 2024, including 16 NICCD patients, 31 NICCD-matched controls, 34 post-NICCD patients, and 70 post-NICCD-matched controls. Post-NICCD patients were further stratified into two groups based on growth outcomes. Biomarkers for FTT were identified using Lasso regression and random forest analysis. A non-invasive predictive model was developed, visualized as a nomogram, and internally validated using the enhanced bootstrap method. The model’s performance was evaluated with receiver operating characteristic curves and calibration curves. Metabolite concentrations (amino acids, acylcarnitines, organic acids, and free fatty acids) were measured using liquid chromatography or ultra-performance liquid chromatography-tandem mass spectrometry. Results The biosynthesis of unsaturated fatty acids was identified as the most significantly altered pathway in post-NICCD patients. Twelve residual metabolites altered during both NICCD and post-NICCD phases were identified, including: 2-hydroxyisovaleric acid, alpha-ketoisovaleric acid, C5:1, 3-methyl-2-oxovaleric acid, C18:1OH, C20:4, myristic acid, eicosapentaenoic acid, carnosine, hydroxylysine, phenylpyruvic acid, and 2-methylcitric acid. Lasso regression and random forest analysis identified kynurenine, arginine, alanine, and aspartate as the optimal biomarkers for predicting FTT in post-NICCD patients. The predictive model constructed with these four biomarkers demonstrated an AUC of 0.947. Conclusion While post-NICCD patients recover clinically and biochemically, their metabolic profiles remain incompletely restored. The predictive model based on kynurenine, arginine, alanine, and aspartate provides robust diagnostic performance for detecting FTT in post-NICCD patients.https://doi.org/10.1186/s12986-025-00928-xCitrin deficiencyMetabolomicsFailure to thriveAmino acidsLipids
spellingShingle Peiyao Wang
Duo Zhou
Lingwei Hu
Pingping Ge
Ziyan Cen
Zhenzhen Hu
Qimin He
Kejun Zhou
Benqing Wu
Xinwen Huang
Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
Nutrition & Metabolism
Citrin deficiency
Metabolomics
Failure to thrive
Amino acids
Lipids
title Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
title_full Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
title_fullStr Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
title_full_unstemmed Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
title_short Metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
title_sort metabolic profiles and prediction of failure to thrive of citrin deficiency with normal liver function based on metabolomics and machine learning
topic Citrin deficiency
Metabolomics
Failure to thrive
Amino acids
Lipids
url https://doi.org/10.1186/s12986-025-00928-x
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