Classical galactosemia (CG) patients frequently develop long-term complications despite early dietary treatment. The highly variable clinical outcome is poorly understood and a lack of prognostic biomarkers hampers individual prognostication and treatment. The aim of this study was to investigate the association between residual galactose oxidation capacity and clinical and biochemical outcomes in CG patients with varying geno-and phenotypes. The noninvasive 1-13 C galactose breath test was used to assess whole body galactose oxidation capacity.Participants received a 7 mg/kg oral dose of 1-13 C labelled galactose. The galactose oxidation capacity was determined by calculating the cumulative percentage dose of the administered galactose (CUMPCD) recovered as 13 CO 2 in exhaled air.Abbreviations: CG, classical galactosemia; CUMPCD, cumulative percentage of the administered dose recovered; Gal-1-P, galactose-1-phosphate; GALT, galactose-1-phosphate uridyltransferase; IQ, intelligence quotient; MD, movement disorder.