Questions concerning whether malonyl-CoA is regulated in human muscle and whether malonyl-CoA modulates fatty acid oxidation are still unanswered. To address these questions, whole-body fatty acid oxidation and the concentration of malonyl-CoA, citrate, and malate were determined in the vastus lateralis muscle of 16 healthy nonobese Swedish men during a sequential euglycemichyperinsulinemic clamp. Insulin was infused at rates of 0.25 and 1.0 mU · kg -1 · min -1, and glucose was infused at rates of 2.0 ± 0.2 and 8.1 ± 0.7 mg · kg -1 · min -1 , respectively. During the low-dose insulin infusion, whole-body fatty acid oxidation, as determined by indirect calorimetry, decreased by 22% from a basal rate of 0.94 ± 0.06 to 0.74 ± 0.07 mg · kg -1 · min -1 (P = 0.005), but no increase in malonyl-CoA was observed. In contrast, during the highdose insulin infusion, malonyl-CoA increased from 0.20 ± 0.01 to 0.24 ± 0.01 nmol/g (P < 0.001), and whole-body fatty acid oxidation decreased by an additional 41% to 0.44 ± 0.06 mg · kg -1 · min -1 (P < 0.001). The increase in malonylCoA was associated with 30-50% increases in the concentrations of citrate (102 ± 6 vs. 137 ± 7 nmol/g, P < 0.001), an allosteric activator of the rate-limiting enzyme in the malonyl-CoA formation, acetyl-CoA carboxylase, and malate (80 ± 6 vs. 126 ± 9 nmol/g, P = 0.002), an antiporter for citrate efflux from the mitochondria. Significant correlations were observed between the concentration of malonyl-CoA and both glucose utilization (r = 0.53, P = 0.002) and the sum of the concentrations of citrate and malate (r = 0.52, P < 0.001), a proposed index of the cytosolic concentration of citrate. In addition, an inverse correlation between malonyl-CoA concentration and fatty acid oxidation was observed (r = -0.32, P = 0.03). The results indicate that an infusion of insulin and glucose at a high rate leads to increases in the concentration of malonyl-CoA in skeletal muscle and to decreases in whole-body and, presumably, muscle fatty acid oxidation. Furthermore, they suggest that the increase in malonyl-CoA in this situation is due, at least in part, to an increase in the cytosolic concentration of citrate. Because cytosolic citrate is also an inhibitor of phosphofructokinase, an attractive hypothesis is that changes in its concentration are part of an autoregulatory mechanism by which glucose modulates its own use and the use of fatty acids as fuels for skeletal muscle. Diabetes 49:1078-1083, 2000 M alonyl-CoA is an inhibitor of carnitine palmitoyl transferase-1 (CPT1), the enzyme that regulates the transfer of long-chain fatty acyl (LCFA) CoA into the mitochondria where they are oxidized (1). A recent study in humans indicated that during a euglycemic-hyperinsulinemic clamp, intracellular fatty acid oxidation is diminished in muscle due to inhibition of long-chain fatty acid entrance into the mitochondria (2); this finding is compatible with inhibition of CPT1 activity resulting from an increase in malonyl-CoA levels. Increases in malonyl-CoA concentrations oc...