Serum homocysteine in Indian adolescents

Folic acid and plasma lipids: Interactions and effect of folate supplementation

Dyslipidaemia and hyperhomocysteinemia are known risk factors for cardiovascular disease. While it is evident that optimization of plasma lipid is associated with low risk of cardiovascular disease in the general population, it is not yet fully clear whether reduction of homocysteinemia is associated with an improvement in risk in all subjects. The aim of our narrative review is to highlight eventual effects of folate supplementation on LDL-C levels, LDL-C oxidation and atherosclerosis-related complications. A comprehensive literature search was done in electronic database, including PubMed, Web of Science, Cochrane, and Scopus from inception up to January 2024. Based on the available evidence, epidemiological data, pathophysiological observations and meta-analyses of randomized clinical trials suggest that folic acid supplementation may modestly but significantly improve plasma lipid levels, lipid atherogenicity, and atherosclerosis-related early vascular damage, and that folic acid supplementation may significantly reduce the risk of cerebrovascular disease. Considering the low-cost and high safety profile of folic acid, its long-term supplementation could be considered for dyslypidaemic patients in secondary prevention for cardiovascular disease.

Association of low-level blood lead with plasma homocysteine in US children and adolescents

Although research in adults has revealed a positive relationship between blood lead levels (BLLs) and homocysteine (Hcy) levels in adults, few studies have investigated this relationship in children and adolescents. We evaluated the relationship between lowlevel blood lead and Hcy levels in US children and adolescents. A total of 8,313 children and adolescents aged 8-19 participated in this study via the National Health and Nutrition Examination Survey 1999-2006. Multivariable linear regression analyses were performed to examine the association between continuous BLLs and Hcy levels. The dose-dependent relationship between continuous BLLs and Hcy levels was analyzed using smooth curve fitting. The average age of participants was 14.1 ± 3.3 years (50.3% male). The mean values of BLLs and Hcy levels were 1.45 μg/dL and 5.77 μmol/L, respectively. In a multivariable adjusted model, an increase in 1.0 μg/dL of BLLs was associated with an elevation of 0.06 μmol/L in Hcy levels (β = 0.06, 95%CI:0.02-0.10, P = 0.001). A linear relationship between BLLs and Hcy levels was discovered using smooth curve fitting (P non-linearity = 0.464). The relationship between low-level blood lead and Hcy levels was stronger on participants with lower serum folate levels (P for interaction = 0.002). Low BLLs were positively associated with plasma Hcy levels in children and adolescents, which varies depending on the levels of folate, vitamin B, and dietary supplements involved in Hcy metabolism.

Homocysteine levels and cardiovascular risk factors in children and adolescents: systematic review and meta-analysis

CONTEXT

Studies have indicated that homocysteine levels are nontraditional markers for cardiovascular disease. The onset of atherosclerotic disease begins in childhood and adolescence; thus, prevention of its risk factors should occur early.

OBJECTIVE

This systematic review and meta-analysis was conducted to summarize the association between high homocysteine levels and traditional cardiovascular risk factors in children and adolescents.

DATA SOURCES

This systematic review and meta-analysis were developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the protocol was submitted to PROSPERO. Only observational studies in children and adolescents with homocysteine levels as an exposure variable and cardiovascular risk factors as outcome variables were included and searched in the following electronic bibliographic databases: PubMed/MEDLINE, Web of Science, Embase, Latin American and Caribbean Literature in Health Sciences, Ovid and Scopus.

DATA EXTRACTION

Two authors independently extracted data from eligible studies. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale.

DATA ANALYSIS

Seven studies were included in the systematic review; they were published from 1999 to 2017, predominantly were of a cross-sectional design, and mainly evaluated adolescents. In the meta-analysis (n = 6), cross-sectional studies (n = 3) identified that high homocysteine levels were positive and weakly correlated with overweight in children and adolescents (odds ratio, 1.08; 95%CI, 1.04-1.11).

CONCLUSION

High homocysteine levels were weakly associated with overweight in children and adolescents in the reviewed cross-sectional studies. However, for the other traditional cardiovascular risk factors, the findings, although important, were inconclusive. Additional robust longitudinal studies are recommended to be conducted to better identify these associations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018086252.

Metabolic distress in lipid & one carbon metabolic pathway through low vitamin B-12: a population based study from North India

Background

Dyslipidemia and hyper-homocysteinemia are the major independent risk factors of cardio vascular disease. Deficiency of folate and vitamin B-12 are associated with both hyper-homocysteinemia and dyslipidemia. The aim of the study is to evaluate the relationship of homocysteine and its associated dietary determinant levels (Folate and Vitamin B-12) with lipids and obesity parameters (WC, BMI, WHR) in North Indian population.

Methods

The participants were recruited under a major government funded project through household survey covering 15 villages of Haryana, India. Participants were both males and females, between age group 30–65 years, from a north Indian community. Initially 1634 individuals were recruited, of which 1374 were considered for analysis as they were not found to be on any kind of medication for high blood pressure, CAD, diabetes or any other disorder, and had no missing data. 5 mL of intravenous blood sample was collected after obtaining written informed consent from the participants. Homocysteine, folate and vitamin B12 levels were estimated through Immulite 1000 by chemi-luminescence technique. Triglyceride, total cholesterol and HDL-C were estimated by spectrophotometry technique using commercial kits. The values for LDL and VLDL were calculated using Friedwald’s equation. Height, weight, waist circumference (WC), hip circumference (HC) was measured over light clothing. Statistical analysis for data was performed using SPSS 16.0 version.

Results

All the lipid indices, except HDL, showed a trend of negative correlation with homocysteine after controlling for confounders, though not significant. No association was found between obesity (WC, BMI, WHR) and homocysteine in the present study. Vitamin B-12 deficiency was significantly associated with both hyper-homocysteinemia and low HDL. Folate was found to have significantly reduced risk for high TC & LDL.

Conclusions

The “hcy-lipid” hypothesis does not seem to be complementing in the present studied population. The population is vulnerable to severe under-nutrition due to the association of vitamin B-12 with HDL, leading to metabolic disturbance in both the pathways; lipid and one carbon metabolic pathway. Co-factors such as ethnicity, cultural practices, and lifestyle & dietary habits must be considered while making public health policies to control diseases.

Electronic supplementary material

The online version of this article (10.1186/s12944-018-0748-y) contains supplementary material, which is available to authorized users.

A Prospective Study of Homocysteine and its relation to Body Mass Index and Lipid Profile in School Children

OBJECTIVE

To study the serum Homocysteine levels in children and its relation with body mass index (BMI), lipid profile and plasma glucose.

Methods

138 children (age 5-15 y) were enrolled and categorized into normal, overweight and obese group. Blood homocysteine, lipid profile and plasma glucose were estimated.

RESULTS

Out of 138 children, 46 (33%) were normal, 40 (29%) were overweight and 52 (38%) were obese. Hyper-homocysteinemia was found in 34 (24.6%) of children. None of the normal children had hyperhomocysteinemia in contrast to 15 (37.5%) in overweight and 19 (36.5%) in obese group (P=0.001).The median homocysteine levels in obese and overweight children was significantly higher compared to normal children (P=0.001).There was a positive correlation between BMI and homocysteine levels. There was no significant correlation between lipid profile and plasma glucose with homocysteine levels.

CONCLUSION

Serum homocysteine levels are significantly higher in both overweight and obese children compared to normal children.

Serum homocysteine and cysteine levels and changes in the lipid profile of children and adolescents over a 12-month follow-up period

INTRODUCTION

There is evidence of associations between high serum homocysteine (Hcy) and cysteine (Cys) levels and changes in the lipid profile of adults; however, little information is available with respect to these associations in the pediatric age group.

OBJECTIVE

To identify the effect of high baseline serum Hcy and Cys levels, alone or in conjunction, on the lipid profile of children and adolescents over a 12-month follow-up period.

METHODS

A cohort study involving 540 boys and girls of 7-15 years of age was conducted over 12 months. The outcome variables were the lipid indicators and the principal exposure variable was serum Hcy and Cys levels. A generalized estimating equation (GEE) approach was used to identify the associations of interest.

RESULTS

Irrespective of age, sex, socioeconomic status, diet or anthropometric status, when serum Hcy levels were above the 5th quintile of distribution at baseline, HDL-cholesterol decreased by a mean of 2.91 mg/dl (p < 0.01), while triglyceride levels increased by a mean of 1.58 mg/dl (p < 0.01) over the 12-month follow-up period. In individuals with high baseline Cys levels, there was a reduction of 1.95 mg/dl (p < 0.01) and an increase of 1.76 mg/dl (p < 0.01) in mean serum HDL-cholesterol and triglyceride levels, respectively, over the 12-month period. When serum Hcy and Cys levels were both above the 5th quintile of distribution at baseline, there was a reduction of 3.65 mg/dl (p < 0.01) in mean HDL-cholesterol and an increase of 3.53 mg/dl (p < 0.01) in mean triglyceride levels in the 12 months of follow-up.

CONCLUSIONS

High baseline serum Hcy and Cys levels resulted in a reduction in mean HDL-cholesterol levels and an increase in mean triglycerides levels over the 12 months of follow-up in children and adolescents, with these alterations being greater when these two biochemical parameters were simultaneously high at baseline.

Undernutrition and Overnutrition Burden for Diseases in Developing Countries: The Role of Oxidative Stress Biomarkers to Assess Disease Risk and Interventional Strategies

The increased life expectancy, urbanization, and unhealthy lifestyle characterized by a shift towards a sedentary lifestyle and decreased energy expenditure are considered the main drivers of epidemiological transition. In particular, developing countries are facing a double burden caused by coexisting under- and over-nutrition, which causes a change in the disease profile from infectious diseases to a chronic degenerative pattern. This review discusses the under- and over-nutrition context in Mauritania and India, two countries that are experiencing a nutritional transition, and where we began a collaboration with local medical staff to integrate interventional and diagnostic guidelines. If many studies about diet and its relationship to non-communicable diseases are available for India, very few nutrition and cardiovascular risk studies have been conducted in Mauritania. Presently, with the exponential increase of nutrition-related diseases, targeted approaches are needed to provide balanced diets in parallel with the development of national preventive health systems and screening programs adapted to local needs. In this context, the measurement of oxidative stress biomarkers could be promising as an additive tool to assess cardiovascular (CV) risk in general population, and ameliorating prevention in patients at CV risk or with overt CV disease. Moreover, the possibility of improving the outcome by the direct employment of antioxidant remains plausible. Moreover, studies on the content of antioxidant in different foods may be helpful to develop a balanced diet, and achieve the maximal nutritional and functional properties of cultivars with benefits for human health.

Prevalence of Vitamin B12 and Folate Deficiency in School Children Residing at High Altitude Regions in India

OBJECTIVE

To assess the prevalence of vitamin B₁₂ and folate deficiencies among children residing at high altitude regions of Himachal Pradesh, India.

METHODS

A total of 215 school children in the age group of 6-18 y were included. Biochemical estimation of serum vitamin B₁₂ and folate levels was undertaken using chemiluminescence immunoassay method. The consumption pattern of foods high in dietary vitamin B₁₂ and folate was recorded using Food Frequency Questionnaire.

RESULTS

The median levels (interquartile range) of serum vitamin B₁₂ and folate were 326 (259-395) pg/ml and 7.7 (6-10) ng/ml respectively. The prevalence of vitamin B₁₂ and folate deficiency amongst school age children was found as 7.4% and 1.5% respectively.

CONCLUSIONS

A low prevalence of vitamin B₁₂ and folate deficiencies was found amongst children aged 6-18 y living at high altitude regions in India. This is possibly due to high frequency of consumption of foods rich in vitamin B₁₂ and folate.

Serum Homocysteine Levels in Czech Children and Adolescents

Aim: The principal aim was to establish reference paediatric data for the serum homocysteine levels in Czech children and adolescents. Methods and Results: 144 children either healthy or not sufferig from acute or chronic inflammation, autoimmune disorders including rheumatic diseases, inflammatory musculoskeletal disorders, inflammatory bowel disease, diabetes mellitus, hypercholesterolemia, epilepsy, chronic renal failure, aged 0–19.9 years (0–6.9 years, n = 40; 7–10.9 y, n = 28; 11–15.9 y, n = 45; 16–19.9 y, n = 31) had their blood samples collected and the serum homocysteine level (S-homocysteine) was evaluated by chemiluminescence. A significant age dependence of the S-homocysteine levels was observed (R = 0.35, p < 0.01); with highest values of upper reference range in the 11–15.9 and 16–19.9 years’ group, respectively. Conclusion: The establishment of S-homocysteine reference Czech pediatric values is a potentially useful tool for proper evaluation of elevated homocysteine levels and corresponding risks in childhood.

Prevalence of hyperhomocysteinemia in healthy Indian doctors

Currently, hyperhomocysteinemia is a well-known risk factor for variety of vascular diseases. Prevalence of hyperhomocysteinemia increases with age. Hence, the present study was aimed to investigate the prevalence of hyperhomocysteinemia in healthy upper socio-economic class population in India. Total homocysteine (tHcy) concentration was determined in 1243 (906 men & 337 women) healthy Indian doctors with different age group. Using Third National Health and Nutrition Examination Survey (NHANES III) study criteria, the prevalence of hyperhomocysteinemia was 92.85% among men (>11.4 µmol/L) and 81.60% among women (>10.4 µmol/L). The prevalence of hyperhomocysteinemia was higher among men with mean tHcy concentration (21.96 ± 0.38 µmol/L) significantly higher (P<0.0001) than women (15.90 ± 0.39 µmol/L) (95% CI, 4.733- 7.376). Our study showed very high prevalence of hyperhomocysteinemia which may point to the future risk for various pathologies in the present subset of population. Further studies to look at the plasma levels of homocysteine lowering vitamins are warranted to prevent the future risk of vascular diseases.

Vitamin B12 deficiency and hyperhomocysteinemia as correlates of cardiovascular risk factors in Indian subjects with coronary artery disease

BACKGROUND AND PURPOSE

Folate and vitamin B12 are essential components in the metabolism of homocysteine (Hcy). Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. However, the association of Hcy, vitamin B12, and folic acid with cardiovascular risk factors in patients with coronary artery disease (CAD) has not been studied in Indian patients. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels with cardiovascular risk factors in subjects with known CAD.

METHODS AND SUBJECTS

Three hundred patients (216 men; 84 women; aged 25-92 years) who had CAD on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical, nutritional, and inflammatory markers.

RESULTS

Percentage of vitamin B12 and folate deficiency was 86.7% and 2.7%, respectively. Hyperhomocysteinemia was present in 95.3% patients. Vitamin B12 levels were significantly lower and Hcy levels were significantly higher in subjects with dyslipidemia, DM, and/or hypertension. Serum vitamin B12 was inversely associated with triglyceride and very low-density lipoprotein (VLDL) and positively with high-density lipoprotein (HDL). Hcy was positively associated with triglyceride and VLDL and negatively with HDL. Vitamin B12 was inversely correlated with inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) directly related to insulin resistance whereas Hcy showed the opposite pattern.

CONCLUSIONS

Serum vitamin B12 deficiency and hyperhomocysteinemia are related with cardiovascular risk factors in Indian patients with CAD.