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Nutrients
Volume 17
Issue 19
10.3390/nu17193130
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Review

Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips

by
Alice Di Stefano
1,†,
Luca Ricci
1,†,
Davide Ferrari
1,
Francesco Frigerio
1,2,
Marianna Minnetti
1,
Mario Fontana
3,
Lorenzo M. Donini
1,
Andrea M. Isidori
1,
Silvia Migliaccio
1 and
Eleonora Poggiogalle
1,*
1
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University, 00185 Rome, Italy
2
Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy
3
Department of Biochemical Sciences, Sapienza University, 00185 Rome, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Nutrients 2025, 17(19), 3130; https://doi.org/10.3390/nu17193130
Submission received: 14 August 2025 / Revised: 18 September 2025 / Accepted: 21 September 2025 / Published: 30 September 2025
(This article belongs to the Special Issue Nutrition 3.0: Between Tradition and Innovation)
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Abstract

Background: Adrenoleukodystrophy is a rare, inherited X-linked disease related to mutations in the ABCD1 gene. Peroxisomal β-oxidation is impaired, underpinning the tissue accumulation of very long-chain fatty acids (VLCFAs), especially in the central nervous system (i.e., the white matter and axons), adrenal glands, and testes. VLCFA accumulation contributes to oxidative stress, neuroinflammation, and progressive demyelination, leading to severe neurological sequelae. Though gene therapies and drug development are advancing, dietary management may still play a crucial role in modulating lipid metabolism and mitigating disease progression. Methods: A narrative review of studies published up to May 2025 in major scientific databases was conducted, focusing on biochemical and clinical outcomes, including VLCFA plasma modulation and nutritional status. Results: VLCFA restriction alone has shown limited efficacy due to the counteractive effect of endogenous synthesis. “Lorenzo’s Oil” inhibits VLCFA elongation, yet with inconsistent clinical benefits. Novel dietary strategies, such as the “Bambino Diet” and innovative dietary supplements similar to Lorenzo’s Oil, composed of glyceryl trioleate, glyceryl trierucate, and antioxidants, provide promising biochemical effects, such as reducing VLCFA plasma levels and improving lipid profiles. Malnutrition risk is also increased in X-ALD patients, underscoring the need for personalized nutritional interventions. Conclusions: Dietary strategies are one of the pillars of X-ALD management, to be further combined with pharmacological, gene therapies, and hematopoietic stem cell transplantation. Future research should refine emerging therapies, assess long-term effects, and develop personalized nutritional strategies.
Keywords: adrenoleukodystrophy; VLCFA; dietary management; nutritional interventions adrenoleukodystrophy; VLCFA; dietary management; nutritional interventions
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MDPI and ACS Style

Di Stefano, A.; Ricci, L.; Ferrari, D.; Frigerio, F.; Minnetti, M.; Fontana, M.; Donini, L.M.; Isidori, A.M.; Migliaccio, S.; Poggiogalle, E. Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips. Nutrients 2025, 17, 3130. https://doi.org/10.3390/nu17193130

AMA Style

Di Stefano A, Ricci L, Ferrari D, Frigerio F, Minnetti M, Fontana M, Donini LM, Isidori AM, Migliaccio S, Poggiogalle E. Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips. Nutrients. 2025; 17(19):3130. https://doi.org/10.3390/nu17193130

Chicago/Turabian Style

Di Stefano, Alice, Luca Ricci, Davide Ferrari, Francesco Frigerio, Marianna Minnetti, Mario Fontana, Lorenzo M. Donini, Andrea M. Isidori, Silvia Migliaccio, and Eleonora Poggiogalle. 2025. "Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips" Nutrients 17, no. 19: 3130. https://doi.org/10.3390/nu17193130

APA Style

Di Stefano, A., Ricci, L., Ferrari, D., Frigerio, F., Minnetti, M., Fontana, M., Donini, L. M., Isidori, A. M., Migliaccio, S., & Poggiogalle, E. (2025). Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips. Nutrients, 17(19), 3130. https://doi.org/10.3390/nu17193130

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