This incidental finding may reflect reduced intake of essential fatty acids, technical or pre-analytical artifacts, or a coexisting inherited metabolic disorder (e.g., carnitine palmitoyltransferase I deficiency) arising from genetic alterations not detectable by standard WES, such as structural rearrangements, deep intronic changes, or regulatory variants. Here, CPT1C is linked to hyperinsulinemic hypoglycemia, familial, 4.