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Test ID: FAPCP Fatty Acid Profile, Comprehensive (C8-C26), Serum

Reporting Name

Fatty Acid Profile, Comprehensive,S

Useful For

Monitoring patients undergoing diet therapy for mitochondrial or peroxisomal disorders (possibly inducing essential fatty acid deficiency in response to restricted fat intake) using serum specimens


Monitoring treatment of essential fatty acid deficiency


Monitoring the response to provocative tests (fasting tests, loading tests)

Clinical Information

Fatty Acid Deficiency/Excess:

Fats are important sources of energy for tissues and for the function and integrity of cellular membranes. Deficiencies are commonly caused by inadequate dietary intake of lipids due to an unbalanced diet, long-term parenteral nutrition, or by intestinal malabsorption. Linoleic acid, an omega-6 fatty acid, and alpha-linolenic acid, an omega-3 fatty acid, are considered essential fatty acids in that they cannot be made by the body and are essential components of the diet.


The major clinical manifestations associated with essential fatty acid deficiency (EFAD) include dermatitis, increased water permeability of the skin, increased susceptibility to infection, and impaired wound healing. Biochemical abnormalities may be detected before the onset of recognizable clinical manifestations. EFAD can be detected by diminished levels of the essential fatty acids, linoleic and alpha-linolenic acid, as well as by increases in the triene:tetraene ratio.


Excess dietary fatty acids have been linked to the onset of cardiovascular disease. Elevated levels of linoleic acid can contribute to overproduction of the proinflammatory 2-series local hormones. The Academy of Nutrition and Dietetics recommends that dietary fat for the healthy adult population should provide 20% to 35% of energy, with an increased consumption of n-3 polyunsaturated fatty acids and limited intake of saturated and trans fats.(1)


Fatty Acid Oxidation Disorders:

Mitochondrial beta-oxidation is the main source of energy to skeletal and heart muscle during periods of fasting. When the body's supply of glucose is depleted, fatty acids are mobilized from adipose tissue and converted to ketone bodies through a series of steps providing an alternate source of energy. Deficient enzymes at any step in this pathway prevent the production of energy during periods of physiologic stress such as fasting or intercurrent illness.


The major clinical manifestations associated with fatty acid oxidation (FAO) disorders include hypoketotic hypoglycemia, liver disease and failure, skeletal myopathy, dilated/hypertrophic cardiomyopathy, and sudden unexpected death in early life. Signs and symptoms may vary greatly in severity, combination, and age of presentation. Life-threatening episodes of metabolic decompensation frequently occur after periods of inadequate calorie intake or intercurrent illness. When properly diagnosed, patients with FAO disorders respond favorably to fasting avoidance, diet therapy, and aggressive treatment of intercurrent illnesses, with significant reduction of morbidity and mortality.


Disease-specific characteristic patterns of metabolites from FAO disorders are detectable in blood, bile, urine, and cultured fibroblasts of living and many deceased individuals. Quantitative determination of C8-C18 fatty acids is an important element of the work-up and differential diagnosis of candidate patients. Fatty acid profiling can detect quantitatively modest, but nevertheless significant, abnormalities even when patients are asymptomatic and under dietary treatment. Confirmatory testing for many of the FAO disorders is also available. For more information see FAO / Fatty Acid Oxidation Probe Assay, Fibroblast Culture and HFAOP / Fatty Acid Oxidation Gene Panel, Varies.


Peroxisomal Disorders:

Peroxisomes are organelles present in all human cells except mature erythrocytes. They carry out essential metabolic functions including beta-oxidation of very long-chain fatty acids (VLCFA), alpha-oxidation of phytanic acid, and biosynthesis of plasmalogen and bile acids. Peroxisomal disorders include disorders of peroxisomal biogenesis with defective assembly of the entire organelle, and single peroxisomal enzyme/transporter defects where the organelle is intact but a specific function is disrupted. Peroxisomal beta-oxidation of VLCFA is impaired in all disorders of peroxisomal biogenesis and in selected single enzyme deficiencies, particularly X-linked adrenoleukodystrophy, resulting in elevated concentrations of VLCFA in serum or plasma. POXP / Fatty Acid Profile, Peroxisomal (C22-C26), Plasma or POX / Fatty Acid Profile, Peroxisomal (C22-C26), Serum is the preferred screening test for evaluating patients with possible peroxisomal disorders, single-enzyme defects of peroxisomal metabolism such as X-linked adrenoleukodystrophy, or peroxisomal biogenesis disorders (Zellweger syndrome spectrum). Confirmatory testing for X-linked adrenoleukodystrophy via molecular genetic analysis is available; see XALDZ / X-Linked Adrenoleukodystrophy, Full Gene Analysis, Varies.


An increased triene:tetraene ratio is consistent with essential fatty acid deficiency.


Fatty acid oxidation disorders are recognized on the basis of disease-specific patterns that are correlated to the results of other investigations in plasma (carnitine, acylcarnitines) and urine (organic acids, acylglycines).


Increased concentrations of serum very long-chain fatty acids (VLCFA) C24:0 and C26:0 are seen in peroxisomal disorders, X-linked adrenoleukodystrophy, adrenomyeloneuropathy, and Zellweger syndrome (cerebrohepatorenal syndrome).


Increased concentrations of serum phytanic acid (along with normal pristanic acid concentrations) are seen in Refsum disease (phytanase deficiency). Serum phytanic acid concentration also may be increased in other peroxisomal disorders and, when combined with the VLCFA, pristanic acid and pipecolic acid allow differential diagnosis of peroxisomal disorders.

Report Available

3 to 5 days

Day(s) Performed

Monday through Friday

Clinical Reference

1. Vannice G, Rasmussen H: Position of the Academy of Nutrition and Dietetics: Dietary fatty acids for healthy adults. J Acad Nutr Diet. 2014 Jan;114(1):136-153. doi: 10.1016/j.jand.2013.11.001

2. Rinaldo P, Matern D, Bennett MJ: Fatty acid oxidation disorders. Ann Rev Physiol. 2002;64:477-502

3. Jeppesen PB, Christensen MS, Hoy CE, Mortensen PB: Essential fatty acid deficiency in patients with severe fat malabsorption. Am J Clin Nutr. 1997 Mar;65(3):837-843

4. McCowen KC, Bistrian BR: Essential fatty acids and their derivatives. Curr Opin Gastroenterol. 2005 Mar;21(2):207-215

5. VerHoeven NM, Jakobs C: Human metabolism of phytanic acid and pristanic acid. Prog in Lipid Res. 2001 Nov;40(6):453-466

Method Name

Gas Chromatography-Mass Spectrometry (GC-MS) Stable Isotope Dilution

Specimen Type


Ordering Guidance

This test is not the recommended initial screening test for evaluating patients with possible peroxisomal disorders, single-enzyme defects of peroxisomal metabolism such as X-linked adrenoleukodystrophy, or peroxisomal biogenesis disorders (Zellweger syndrome spectrum). For these purposes, the preferred tests are either POXP / Fatty Acid Profile, Peroxisomal (C22-C26), Plasma or POX / Fatty Acid Profile, Peroxisomal (C22-C26), Serum.

Necessary Information

1. Patient's age is required.

2. Include information regarding treatment, family history, and tentative diagnosis.

Specimen Required

Patient Preparation:

1. For nutritional assessment, patient should fast overnight (12-14 hours); for patients with a suspected fatty acid oxidation disorder, collect prior to next feeding as fasting is contraindicated.

2. Patient must not consume any alcohol for 24 hours before the specimen is collected.

Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial.

Specimen Minimum Volume

0.15 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Frozen (preferred) 92 days
  Refrigerated  72 hours

Reference Values

Octanoic Acid, C8:0

<1 year: 7-63 nmol/mL

1-17 years: 9-41 nmol/mL

≥18 years: 8-47 nmol/mL


Decenoic Acid, C10:1

<1 year: 0.8-4.8 nmol/mL

1-17 years: 1.6-6.6 nmol/mL

≥18 years: 1.8-5.0 nmol/mL


Decanoic Acid, C10:0

<1 year: 2-62 nmol/mL

1-17 years: 3-25 nmol/mL

≥18 years: 2-18 nmol/mL


Lauroleic Acid, C12:1

<1 year: 0.6-4.8 nmol/mL

1-17 years: 1.3-5.8 nmol/mL

≥18 years: 1.4-6.6 nmol/mL


Lauric Acid, C12:0

<1 year: 6-190 nmol/mL

1-17 years: 5-80 nmol/mL

≥18 years: 6-90 nmol/mL


Tetradecadienoic Acid, C14:2

<1 year: 0.3-6.5 nmol/mL

1-17 years: 0.2-5.8 nmol/mL

≥18 years: 0.8-5.0 nmol/mL


Myristoleic Acid, C14:1

<1 year: 1-46 nmol/mL

1-17 years: 1-31 nmol/mL

≥18 years: 3-64 nmol/mL


Myristic Acid, C14:0

<1 year: 30-320 nmol/mL

1-17 years: 40-290 nmol/mL

≥18 years: 30-450 nmol/mL


Hexadecadienoic Acid, C16:2

<1 year: 4-27 nmol/mL

1-17 years: 3-29 nmol/mL

≥18 years: 10-48 nmol/mL


Hexadecenoic Acid, C16:1w9

<1 year: 21-69 nmol/mL

1-17 years: 24-82 nmol/mL

≥18 years: 25-105 nmol/mL


Palmitoleic Acid, C16:1w7

<1 year: 20-1,020 nmol/mL

1-17 years: 100-670 nmol/mL

≥18 years: 110-1,130 nmol/mL


Palmitic Acid, C16:0

<1 year: 720-3,120 nmol/mL

1-17 years: 960-3,460 nmol/mL

≥18 years: 1,480-3,730 nmol/mL


Gamma-Linolenic Acid, C18:3w6

<1 year: 6-110 nmol/mL

1-17 years: 9-130 nmol/mL

≥18 years: 16-150 nmol/mL


Alpha-Linolenic Acid, C18:3w3

<1 year: 10-190 nmol/mL

1-17 years: 20-120 nmol/mL

≥18 years: 50-130 nmol/mL


Linoleic Acid, C18:2w6

≤31 days: 350-2,660 nmol/mL

32 days-11 months: 1,000-3,300 nmol/mL

1-17 years: 1,600-3,500 nmol/mL

≥18 years: 2,270-3,850 nmol/mL


Oleic Acid, C18:1w9

<1 year: 250-3,500 nmol/mL

1-17 years: 350-3,500 nmol/mL

≥18 years: 650-3,500 nmol/mL


Vaccenic Acid, C18:1w7

<1 year: 140-720 nmol/mL

1-17 years: 320-900 nmol/mL

≥18 years: 280-740 nmol/mL


Stearic Acid, C18:0

<1 year: 270-1,140 nmol/mL

1-17 years: 280-1,170 nmol/mL

≥18 years: 590-1,170 nmol/mL


EPA, C20:5w3

<1 year: 2-60 nmol/mL

1-17 years: 8-90 nmol/mL

≥18 years: 14-100 nmol/mL


Arachidonic Acid, C20:4w6

<1 year: 110-1,110 nmol/mL

1-17 years: 350-1,030 nmol/mL

≥18 years: 520-1,490 nmol/mL


Mead Acid, C20:3w9

≤31 days: 8-60 nmol/mL

32 days-11 months: 3-24 nmol/mL

≥1 year: 7-30 nmol/mL


Homo-Gamma-Linolenic Acid, C20:3w6

<1 year: 30-170 nmol/mL

1-17 years: 60-220 nmol/mL

≥18 years: 50-250 nmol/mL


Arachidic Acid, C20:0

<1 year: 30-120 nmol/mL

1-17 years: 30-90 nmol/mL

≥18 years: 50-90 nmol/mL


DHA, C22:6w3

<1 year: 10-220 nmol/mL

1-17 years: 30-160 nmol/mL

≥18 years: 30-250 nmol/mL


DPA, C22:5w6

<1 year: 3-70 nmol/mL

1-17 years: 10-50 nmol/mL

≥18 years: 10-70 nmol/mL


DPA, C22:5w3

<1 year: 6-110 nmol/mL

1-17 years: 30-270 nmol/mL

≥18 years: 20-210 nmol/mL


DTA, C22:4w6

<1 year: 2-50 nmol/mL

1-17 years: 10-40 nmol/mL

≥18 years: 10-80 nmol/mL


Docosenoic Acid, C22:1

<1 year: 2-20 nmol/mL

≥1 year: 4-13 nmol/mL


Docosanoic Acid, C22:0

0.0-96.3 nmol/mL


Nervonic Acid, C24:1

<1 year: 30-150 nmol/mL

1-17 years: 50-130 nmol/mL

≥18 years: 60-100 nmol/mL


Tetracosanoic Acid, C24:0

0.0-91.4 nmol/mL


Hexacosenoic Acid, C26:1

<1 year: 0.2-2.1 nmol/mL

≥1 year: 0.3-0.7 nmol/mL


Hexacosanoic Acid, C26:0

0.00-1.30 nmol/mL


Pristanic Acid, C15:0(CH3)4

≤4 months: 0.00-0.60 nmol/mL

5-8 months: 0.00-0.84 nmol/mL

9-12 months: 0.00-0.77 nmol/mL

13-23 months: 0.00-1.47 nmol/mL

≥2 years: 0.00-2.98 nmol/mL


Phytanic Acid, C16:0(CH3)4

≤4 months: 0.00-5.28 nmol/mL

5-8 months: 0.00-5.70 nmol/mL

9-12 months: 0.00-4.40 nmol/mL

13-23 months: 0.00-8.62 nmol/mL

≥2 years: 0.00-9.88 nmol/mL


Triene/Tetraene Ratio

≤31 days: 0.017-0.083

32 days-17 years: 0.013-0.050

≥18 years: 0.010-0.038


Total Saturated Acid

<1 year: 1.2-4.6 mmol/L

1-17 years: 1.4-4.9 mmol/L

≥18 years: 2.5-5.5 mmol/L


Total Monounsaturated Acid

<1 year: 0.3-4.6 mmol/L

1-17 years: 0.5-4.4 mmol/L

≥18 years: 1.3-5.8 mmol/L


Total Polyunsaturated Acid

<1 year: 1.1-4.9 mmol/L

1-17 years: 1.7-5.3 mmol/L

≥18 years: 3.2-5.8 mmol/L


Total w3

<1 year: 0.0-0.4 mmol/L

1-17 years: 0.1-0.5 mmol/L

≥18 years: 0.2-0.5 mmol/L


Total w6

<1 year: 0.9-4.4 mmol/L

1-17 years: 1.6-4.7 mmol/L

≥18 years: 3.0-5.4 mmol/L


Total Fatty Acids

<1 year: 3.3-14.0 mmol/L

1-17 years: 4.4-14.3 mmol/L

≥18 years: 7.3-16.8 mmol/L

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
FAPCP Fatty Acid Profile, Comprehensive,S 43674-1


Result ID Test Result Name Result LOINC Value
16965 Octanoic Acid, C8:0 35145-2
16966 Decenoic Acid, C10:1 35147-8
16967 Decanoic Acid, C10:0 35146-0
16968 Lauroleic Acid, C12:1 35151-0
16969 Lauric Acid, C12:0 35150-2
16970 Tetradecadienoic Acid, C14:2 35148-6
16971 Myristoleic Acid, C14:1 35158-5
16972 Myristic Acid, C14:0 35157-7
16973 Hexadecadienoic Acid, C16:2 35154-4
16974 Hexadecenoic Acid, C16:1w9 35155-1
16975 Palmitoleic Acid, C16:1w7 35162-7
16976 Palmitic Acid, C16:0 35161-9
16977 g-Linolenic Acid, C18:3w6 35163-5
16978 a-Linolenic Acid, C18:3w3 35164-3
16979 Linoleic Acid, C18:2w6 35165-0
16980 Oleic Acid, C18:1w9 35166-8
16981 Vaccenic Acid, C18:1w7 35167-6
16982 Stearic Acid, C18:0 35149-4
16983 EPA, C20:5w3 35173-4
16984 Arachidonic Acid, C20:4w6 35168-4
16985 Mead Acid, C20:3w9 35172-6
16986 h-g-Linolenic Acid, C20:3w6 35171-8
16987 Arachidic Acid, C20:0 35169-2
16988 DHA, C22:6w3 35174-2
16989 DPA, C22:5w6 35181-7
16990 DPA, C22:5w3 35180-9
16991 DTA, C22:4w6 35182-5
16992 Docosenoic Acid, C22:1 35160-1
16993 Docosanoic Acid, C22:0 30194-5
16994 Nervonic Acid, C24:1w9 35170-0
16995 Tetracosanoic Acid, C24:0 30195-2
16996 Hexacosenoic Acid, C26:1 33036-5
16997 Hexacosanoic Acid, C26:0 30197-8
16998 Pristanic Acid, C15:0(CH3)4 22761-1
16999 Phytanic Acid, C16:0(CH3)4 22671-2
17000 Triene Tetraene Ratio 35411-8
17001 Total Saturated 35175-9
17002 Total Monounsaturated 35176-7
17003 Total Polyunsaturated 35177-5
17004 Total w3 35178-3
17005 Total w6 35179-1
17006 Total Fatty Acids 24461-6
17056 Interpretation 59462-2
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