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However, during high-fat diet (HFD) feeding, obesity and insulin resistance, the accumulation of medium-chain and long-chain acylcarnitines due to incomplete -oxidation may negatively regulate the expression of nuclear-encoded mitochondrial genes, further reducing mitochondrial number and function and creating a vicious metabolic cycle [33]

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L-carnitine facilitates transport of long-chain fatty acids into the mitochondrial matrix, where it can reduce oxidative stress and may reduce markers of inflammation.17-19 During ischemic events that block blood flow to the heart, carnitine prevents the fatty acid ester accumulation that can lead to fatal ventricular arrhythmias.18 However, results of clinical trials of the effects of carnitine supplements on CVD have been mixed

Acknowledgements The authors would like to thank the experimental apparatus and technical support provided by the Key Laboratory for Metabolic Diseases in Chinese Medicine, Nanjing University of Chinese Medicine