The association between lifestyle-related factors and plasma homocysteine levels in healthy individuals from the "ATTICA" Study

A micronutrient supplement modulates homocysteine levels regardless of vitamin B biostatus in elderly subjects

Elevated homocysteine (Hcy) levels (≥15 μmol/L) in the elderly are frequently associated with a higher risk of cardiovascular disease and cognitive decline. Several studies have already shown an Hcy-lowering effect of B vitamin supplementation in cohorts deficient in these nutrients. The aim of this randomized, double-blinded 12-week intervention study was to investigate whether Hcy levels in healthy elderly subjects (75.4±4.5 years, n=133) could be lowered with a micronutrient supplement (i.e., 400 μg folic acid, 100 μg cobalamin). Difference in mean initial Hcy levels between intervention (17.6±7.1 μmol/L, n=65) and placebo group (18.9±6.1 μmol/L, n=68) was not significant. The prevalence of cobalamin and folate deficiency in the total study population was low: 27% had serum-cobalamin levels ≤150 pmol/L, 12% holo-transcobalamin (Holo-TC) levels ≤50 pmol/L, 13% low cobalamin status using the aggregated cobalamin marker 4cB12 and 10% red blood cell (RBC) folate ≤570 nmol/L. Nevertheless, the treated subjects still showed improved cobalamin and folate biostatus (serum cobalamin Δt12-t0: 63±48 pmol/L; Holo-TC Δt12-t0: 17±19 pmol/L; RBC folate Δt12-t0: 326±253 nmol/L) and Hcy levels (Δt12-t0: -3.6±5.7 μmol/L). The effects were statistically significant compared to the placebo group with p=0.005 (serum cobalamin), p=0.021 (Holo-TC), p=0.014 (RBC-folate) and p<0.001 (Hcy). The Hcy-lowering effect was dependent on the initial Hcy levels (p<0.001). Our findings suggest that elevated Hcy levels in elderly subjects can be lowered regardless of the initial cobalamin and folate biostatus.

The effect of diet-induced weight loss on circulating homocysteine levels in people with obesity and type 2 diabetes

BACKGROUND/AIMS

Having type 2 diabetes (T2D) in combination with being overweight results in an additional increase in cardiovascular disease (CVD) risk. In addition, T2D and obesity are associated with increased levels of total homocysteine (tHcy), possibly contributing to the CVD risk. Weight loss dieting has positive effects on several CVD risk factors, but whether it affects tHcy remains unclear. Therefore, the aim of this study was to determine the effect of a calorie restricted diet on tHcy in overweight people with T2D.

METHODS

In this post-hoc analysis of the POWER study, adults with T2D and a BMI greater than 27 kg/m² were included from the outpatient diabetes clinic of the Erasmus Medical Center, Rotterdam. The patients were subjected to a very low-calorie diet with fortified meal replacements for 20 weeks. Before and after this intervention, blood samples were collected to measure tHcy and other CVD risk factors like glycaemic and lipid parameters.

RESULTS

161 overweight participants with T2D were included, with a mean age of 54 years (range 26-74), mean weight of 104.6 ± 19.9 kg and mean HbA1c of 62.7 ± 14.3 mmol/mol. At baseline, men displayed higher tHcy than women, and tHcy level was positively correlated with body weight and triglyceride levels, while it was negatively correlated with renal function and HDL cholesterol. During the intervention, bodyweight was reduced by a mean of 9.7% (from 104.6 ± 19.9 to 94.5 ± 18.1 kg p < 0.001), and all measured glycaemic and lipid blood parameters improved significantly. However, tHcy remained unchanged (from 12.1 ± 4.1 to 12.1 ± 4.2 umol/L, p = 0.880). The change in tHcy during the intervention was negatively associated with the change in weight and BMI (p = 0.01 and p = 0.008, respectively). People who lost < 10 kg (n = 92) had a mean tHcy change of -0.47 umol/L, while people who lost more than ≥ 10 kg (n = 69) had a mean tHcy change of 0.60 umol/L (p = 0.021).

CONCLUSION

In conclusion, our data show that a calorie restricted diet does not affect tHcy in people with T2D and obesity, despite the use of meal replacements fortified with folic acid and vitamin B12. Our data showed a negative correlation between change in tHcy levels and weight loss, suggesting that people who lost more weight (> 10 kg) showed an increase in tHcy. Future studies should explore the potential increase in tHcy induced by weight loss dieting and target the question if tHcy reduction strategies during weight loss could be clinically beneficial.

Plasma homocysteine levels and handgrip strength in postmenopausal women

OBJECTIVE

This study evaluated handgrip strength (HGS), circulating homocysteine levels and related factors in postmenopausal women.

METHODS

This study is a sub-analysis of a prospective cohort of 303 postmenopausal women aged 62.7 ± 6.9 years who had HGS measures with a digital dynamometer as the primary outcome, and plasma homocysteine and creatinine levels and glomerular filtration rate (GFR) measures as the secondary outcomes.

RESULTS

The average HGS was 22.5 ± 4.0 kg, 29.4% of women had dynapenia (HGS < 20 kg), adiposity was 40.3 ± 5.4% and 9.57% of women had hyperhomocysteinemia (homocysteine >15 μmol/l). There were no differences between tertiles of homocysteine and HGS (p = 0.641). Plasma homocysteine levels were unrelated to HGS (r = -0.06) and correlated with age (r = 0.17), GFR (r = -0.28) and creatinine (r = 0.23). Hyperhomocysteinemia was not associated with HGS (odds ratio [OR] = 0.98 [95% confidence interval (CI): 0.89; 1.08]) or dynapenia (OR = 1.10 [95% CI: 0.45; 2.47]). The risk of presenting low HGS were not significantly associated with homocysteine (OR = -0.08 [95% CI: -0.21; 0.06]) and were associated with age (OR = -0.23 [95% CI: -0.29; -0.17]), adiposity (OR = -6.52 [95% CI: -9.53; -3.50]) and creatinine (OR = 6.22 [95% CI: 2.48; 9.97]).

CONCLUSIONS

HGS and dynapenia were unrelated to hyperhomocysteinemia. Age, GFR and creatinine were significantly associated with plasma homocysteine levels.

Sex differences in underweight and body mass index in Chinese early de novo patients with Parkinson's disease

OBJECTIVE

There have been studies investigating sex differences in clinical manifestation of Parkinson's disease (PD). However, sex differences in underweight and body mass index (BMI) in de novo PD patients lacked systematic study. We aimed to compare sex differences in clinical features and related factors of underweight and BMI in Chinese de novo PD patients.

MATERIALS AND METHODS

A total of 253 untreated PD inpatients and 218 controls were recruited from Ningbo. BMI, demographics, Montreal Cognitive Assessment (MoCA), supine and upright blood pressure, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), homocysteine (HCY), uric acid, glycated hemoglobin, and lipid parameters were examined. Patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and Hoehn and Yahr (HY) Rating Scale.

RESULTS

Female patients had a significantly lower incidence of underweight and higher BMI than male patients, and there were sex differences in serum lipids, HCY levels, and depression severity. Binary regression analysis showed that only in male patients was underweight associated with the UPDRS motor score and lower ΔSBP and ΔDBP values (all p < .05). Further multiple regression analysis indicated, in addition to the correlations between BMI and ΔSBP and ΔDBP values in both sexes (all p < .001), BMI was also associated with MoCA and lower UPDRS motor scores in male patients and lower HAMD scores in female patients.

CONCLUSION

Our study suggests that there are significant sex differences in the prevalence of underweight, BMI, and factors associated with underweight and BMI among de novo PD patients.

Sex Differences in Association of Elevated Blood Pressure with Variables Characterizing Cardiometabolic Risk in Young Subjects with or Without Metabolic Abnormalities

Males present higher blood pressure (BP) values, higher prevalence of elevated BP, and a different prevalence of cardiometabolic risk factors when compared with females. We assumed that the trends of risk markers across BP categories (normotension, high normal BP, and hypertension) differ in young males and females, and between subjects without metabolic abnormalities (without obesity, insulin resistance, atherogenic dyslipidemia, hyperuricemia, or microinflammation) and those presenting them. Data from 2543 subjects (48% males) aged from 16 to 23 years were analyzed. The findings showed that 15% of males and 4% of females presented high normal BP while 9% and 1%, respectively, had hypertension. In males, variables characterizing obesity status, insulin sensitivity, atherogenic dyslipidemia, uric acid, adiponectin, a soluble receptor for advanced glycation end-products, and leukocyte counts showed worsening trends across BP categories. Females presented significant trends only for obesity measures, LDL-cholesterol, and non-HDL-cholesterol. Across BP categories, trends of variables characterizing cardiometabolic risk differed among abnormalities-free and presenting males. The multivariate model selected measures of central obesity, atherogenic dyslipidemia, insulin resistance, and uric acid as significant predictors of BP in both genders, and C-reactive protein in females. Sex differences in measures of cardiovascular health in juveniles may remain undiscovered unless two sexes are analyzed separately. These differences may have implications for sex-specific disease risk in adulthood.

Serum homocysteine, folate and vitamin B12 levels in patients with psoriasis: a systematic review and meta-analysis

BACKGROUND

Patients with psoriasis are at increased risk for cardiovascular comorbidities. Previous studies examined the possible contribution of serum homocysteine, folate and vitamin B₁₂ to cardiovascular risks in patients with psoriasis but had conflicting conclusions.

OBJECTIVES

To perform a systematic review and meta-analysis of studies on serum homocysteine, folate and vitamin B₁₂ levels in patients with psoriasis.

METHODS

Online databases were searched on 15 February 2018 to include studies comparing serum homocysteine, folate and vitamin B₁₂ levels between patients with psoriasis and controls. A random effects model was adopted to estimate odds ratios for dichotomous data and standardized mean differences (SMDs) for continuous data.

RESULTS

A comprehensive literature search identified 24 studies eligible for inclusion. Compared with controls, patients with psoriasis had a significantly higher serum homocysteine level [SMD 0·41, 95% confidence interval (CI) 0·21-0·61; I² = 76·7%, 18 studies], a higher prevalence of hyperhomocysteinaemia (odds ratio 3·48, 95% CI 2·08-5·83; I² = 41·1%, seven studies) and a lower serum folate level (SMD -0·94, 95% CI -1·49 to -0·40; I² = 95·6%, 14 studies). However, there was no difference in serum vitamin B₁₂ levels between patients with psoriasis and the control group (SMD 0·004, 95% CI -0·49 to 0·50; I² = 92%, 11 studies). Metaregression analysis revealed a significant inverse correlation between the SMD of homocysteine levels and folate levels.

CONCLUSIONS

Patients with psoriasis might have higher serum homocysteine and lower folate levels than control patients without psoriasis. However, due to significant heterogeneity and other limitations, the associations require further examinations in more studies.

Inverse association between plasma homocysteine concentrations and type 2 diabetes mellitus among a middle-aged and elderly Chinese population

BACKGROUND AND AIMS

Plasma homocysteine concentrations have been reported to be associated with type 2 diabetes mellitus (T2DM) with controversial findings. The aim of the present study was to investigate the association between plasma homocysteine concentrations and T2DM.

METHODS AND RESULTS

A cross-sectional study including 19,085 eligible participants derived from the Dongfeng-Tongji cohort was conducted. Plasma homocysteine concentrations were measured by Abbott Architect i2000 Automatic analyzer and T2DM was defined according to American Diabetes Association criteria. Logistic regression model was used to explore the association between plasma homocysteine concentrations and T2DM. The prevalence of T2DM was 19.0% in the whole population (mean age 62.9 years), 21.8% in males, and 17.1% in females. In the multivariable logistic regression analyses, compared with those in the lowest quintile, the OR (95% CI) of T2DM was 1.05 (0.92-1.21), 0.99 (0.86-1.14), 0.90 (0.78-1.05), and 0.77 (0.66-0.90) for quintile 2 to quintile 5 of homocysteine concentrations after adjustment for potential confounders (P for trend < 0.0001). Homocysteine concentrations were associated with decreased T2DM prevalence risk (OR = 0.88 per SD increase of homocysteine concentration; 95% CI: 0.84-0.93). A significant interaction between homocysteine concentrations and drinking status on T2DM prevalence risk was observed (P for interaction = 0.03). The inverse association of plasma homocysteine concentrations with T2DM prevalence risk was observed in non-drinkers but not in current drinkers.

CONCLUSION

Plasma homocysteine concentrations were inversely correlated with T2DM among a middle-aged and elderly Chinese population.

Relationship between lifestyle factors and hyperhomocysteinemia in general Chinese population: a cross-sectional study

OBJECTIVES

Hyperhomocysteinemia (Hhcy) is a known cardiovascular disease (CVD) risk factor. Observational studies had supported the role of lifestyle factors such as physical activity, diet and alcohol consumption in CVD prevention. Our study aimed to determine the relationship between Hhcy and lifestyle factors in general Chinese population.

METHODS

In this cross-sectional study, a total of 7135 adults (3320 men and 3815 women) aged 35 years or older were recruited from the rural Northeast China. Data on lifestyle factors, such as physical activities, sleep duration, current smoking and drinking status, dietary habits and familial factors were collected in interviews and laboratory examinations were performed by well-trained personnel.

RESULTS

Plasma total homocysteine (tHcy) level was higher in men than in women, and greater in the elderly than in other age groups. Subjects with Hhcy were more likely to be current smokers (men: OR 1.328, 95% CI 1.143-1.543, p<0.001; women: OR 1.465, 95% CI 1.214-1.767, p<0.001). Separately, men with Hhcy were more likely to have an education of primary school or below (OR 1.251, 95% CI 1.068-1.465, p=0.006) and less likely to eat more vegetables (OR 0.927, 95% CI 0.863-0.996, p=0.037) than the normal-tHcy participants. In women, participants with Hhcy were more likely to have longer sleeping time (>9h/d) (OR 1.677, 95% CI 1.292-2.177, p<0.001), low physical activity (OR 1.721, 95% CI 1.197-2.475, p=0.044) and increased diet score (OR 1.126, 95% CI 1.007-1.259, p=0.037) and less likely to be current drinkers (OR 0.488, 95% CI 0.297-0.802, p=0.005) than the normal-tHcy participants.

CONCLUSION

Our study revealed that physical activity and current drinking status were not significantly associated with Hhcy in males, but inversely associated in females. In both genders, current smoking status and dietary habits were significantly associated with Hhcy. Our study supports existing recommendations for Chinese to maintain a physically active behaviors and healthy lifestyle habits.

Derivation and validation of homocysteine score in u.s. Men and women

BACKGROUND

One-carbon metabolism, which is crucial in DNA synthesis and genomic stability, is an interrelated network of biochemical reactions involved in several dietary and lifestyle factors. The development of the homocysteine score using these factors may be useful to reflect the status of one-carbon metabolism in large epidemiologic studies without biologic samples to measure homocysteine directly.

OBJECTIVE

The aim of this study was to develop an homocysteine score that reflects one-carbon metabolism better than individual dietary or lifestyle factors.

METHODS

We divided 2023 participants with measured plasma total homocysteine data in the Nurses' Health Study and the Health Professionals Follow-Up Study into training (n = 1619) and testing (n = 404) subsets. Using multivariable linear regression, we selected lifestyle determinants of plasma homocysteine in the training set and derived the homocysteine score weighted by the β coefficient for each predictor. The validation of the homocysteine score was assessed using the plasma homocysteine in the independent samples of the training set.

RESULTS

In the training set, smoking, multivitamin use, and caffeine, alcohol, and dietary and supplemental folate intake were significant independent determinants of plasma homocysteine in multivariable linear regression (P ≤ 0.01) and were included in the derivation of the homocysteine score. The Pearson correlation of the homocysteine score with plasma homocysteine was 0.30 in the testing subset (P < 0.001). The homocysteine score was positively associated with the plasma homocysteine concentration in the testing subset and in an independent population of women; the mean difference of plasma homocysteine concentration between the extreme quintiles of homocysteine score ranged from 0.83 μmol/L to 1.52 μmol/L. Population misclassification either from the lowest quintile of plasma homocysteine into the highest quintile of the homocysteine score or from the highest quintile of plasma homocysteine into the lowest quintile of the homocysteine score was ≤12%.

CONCLUSION

These data indicate that the homocysteine score may be used with relatively inexpensive and simple questionnaires to rank an individual's one-carbon metabolism status when homocysteine data are not available.

Circadian rhythm of homocysteine is hCLOCK genotype dependent

Homocysteine (Hcy) is known to be a prognostic marker for neurological, cardiovascular and cerebrovascular diseases and several other pathophysiological conditions. A sudden surge in Hcy can increase cardiovascular events. Hemodynamic modulations are known to be associated with individual's chronotype. Therefore, precise monitoring of Hcy is crucial for evaluating its impact on risk. The aim of the present study was to investigate the rhythmicity of Hcy under controlled dietary conditions and whether this rhythmicity is under the genetic control of circadian rhythm. Five subjects were selected from 200 Malayalam speaking healthy ethnic individuals who were screened for functionally critical variants of MTHFR and hCLOCK genes. MTHFR is the rate-limiting enzyme in the methionine cycle and critical for regulating Hcy levels while hCLOCK is a critical gene responsible in regulating the day and night cycles. Rhythmicity in Hcy levels were observed in all the subjects with a consensus on a morning nadir and an evening peak. Gender specific stratification of Hcy levels were observed among similar genotypes of MTHFR and hCLOCK genes. Variations from the conventional rhythmicity of Hcy were observed among similar genotypes of MTHFR and dissimilar hCLOCK genotypes. A reduced plasma Hcy in hCLOCK rs1801260 CC genotype individuals were observed in contrast to CT genotype individuals. The study tends to suggest that Hcy and body time are genetically interdependent and throws light on some of the previously unexplained reasons for variability in Hcy levels. A population specific variation of MTHFR and hCLOCK genes also highlights ethnicity specific risk management.

Consumption of a boiled Greek type of coffee is associated with improved endothelial function: The Ikaria Study

Objective:

The association of coffee consumption with cardiovascular disease remains controversial. Endothelial function is associated with cardiovascular risk. We examined the association between chronic coffee consumption and endothelium function in elderly inhabitants of the island of Ikaria.

Methods:

The analysis was conducted on 142 elderly subjects (aged 66–91 years) of the Ikaria Study. Endothelial function was evaluated by ultrasound measurement of flow-mediated dilation (FMD). Coffee consumption was evaluated based on a food frequency questionnaire and was categorized as ‘low’ (< 200 ml/day), ‘moderate’ (200–450 ml/day), or ‘high’ (> 450 ml/day).

Results:

From the subjects included in the study, 87% consumed a boiled Greek type of coffee. Moreover, 40% had a ‘low’, 48% a ‘moderate’ and 13% a ‘high’ daily coffee consumption. There was a linear increase in FMD according to coffee consumption (‘low’: 4.33 ± 2.51% vs ‘moderate’: 5.39 ± 3.09% vs ‘high’: 6.47 ± 2.72%; p = 0.032). Moreover, subjects consuming mainly a boiled Greek type of coffee had a significantly higher FMD compared with those consuming other types of coffee beverages ( p = 0.035).

Conclusions:

Chronic coffee consumption is associated with improved endothelial function in elderly subjects, providing a new connection between nutrition and vascular health.

Greater coffee intake in men is associated with steeper age-related increases in blood pressure

BACKGROUND

Administration of caffeine or caffeinated coffee in laboratory and ambulatory settings results in small to moderate acute increases in blood pressure (BP). However, habitual coffee intake has not been linked conclusively to long-term increases in basal BP, and findings are inconsistent by sex. This study examined longitudinal relations of habitual coffee use to resting BP and pulse pressure.

METHODS

In a sample of 2,442 participants from the Baltimore Longitudinal Study of Aging (BLSA), coffee consumption was used to predict resting systolic and diastolic BP and pulse pressure using longitudinal mixed-effects regression models adjusted for age, education, antihypertensive, and antihyperlipidemic use, smoking, and body mass index (BMI). Analyses were stratified by sex (865 women and 1,577 men), and age and BMI were examined as possible effect modifiers.

RESULTS

In men, we identified a significant three-way interaction among coffee intake (nonlinear), baseline age, and length of follow-up for systolic BP (SBP) and pulse pressure. A significant interaction of coffee intake and BMI (nonlinear) was also noted for SBP in men. There were no significant relations of coffee intake to BP or pulse pressure in women.

CONCLUSION

Greater coffee intake in men was associated with steeper age-related increases in SBP and pulse pressure, particularly beyond 70 years of age and in overweight to obese men.

A community based study of the relationship between homocysteine and some of the life style factors

Till date no community based data on plasma homocysteine is available in North Eastern Region. Hence, the present study was conducted to analyze and correlate the plasma homocysteine level with some life style factors like diet, alcohol intake, smoking habit and body weight, in a cross-section of population. 12 h fasting samples of 970 apparently healthy, Assamese population of both genders in the age group of 35-86 years, mostly from the urban area of Assam were tested for plasma total homocysteine level over a period of 3 years. Out of 970 volunteers, hyperhomocysteinemia was detected in 533 (55%) individuals with a mean value of 18.41 μmol/l. Of that hyperhomocysteinemia, 89.1% were in the range of moderately high and rest 10.9% were intermediate high. Another finding was that males had a tendency towards greater value (mean = 20.36 μmol/l) than females (mean = 16.37 μmol/l). It was observed that the relationship of homocysteine levels to gender and some of the life style factors were also significant.

Do dietary patterns in older men influence change in homocysteine through folate fortification? The Normative Aging Study

Objective

We aimed to describe the difference in B-vitamin intake and in plasma B-vitamin and homocysteine concentrations before and after folic acid fortification, in relation to dietary patterns.

Design

The Normative Aging Study (NAS) is a longitudinal study on ageing. Between 1961 and 1970, 2280 male volunteers aged 21–80 years (mean 42 years) were recruited. Dietary intake data have been collected since 1987 and assessment of plasma B vitamins and homocysteine was added in 1993.

Setting

Boston, Massachusetts, USA.

Subjects

In the present study, 354 men who had completed at least one FFQ and one measurement of homocysteine, both before and after the fortification period, were included.

Results

Three dietary patterns were identified by cluster analysis: (i) a prudent pattern, with relatively high intakes of fruit, vegetables, low-fat milk and breakfast cereals; (ii) an unhealthy pattern, with high intakes of baked products, sweets and added fats; and (iii) a low fruit and vegetable but relatively high alcohol intake pattern. Dietary intake and plasma concentrations of folate increased significantly (P < 0·05) among all dietary patterns after the fortification period. Homocysteine tended to decrease in supplement non-users and in subjects in the high alcohol, low fruit and vegetable dietary pattern (both P = 0·08).

Conclusions

After fortification with folic acid, folate intake and plasma folate concentration increased significantly in all dietary patterns. There was a trend towards greatest homocysteine lowering in the high alcohol, low fruit and vegetable group.

Moderate coffee consumption lowers the likelihood of developing left ventricular systolic dysfunction in post-acute coronary syndrome normotensive patients

The aim of the present work was to evaluate the association between coffee consumption and the development of left ventricular systolic dysfunction (LVSD) in patients who had had an acute coronary syndrome. During 2006-2007, 144 male (65 +/- 14 years) and 50 female (71 +/- 12 years) post-acute coronary syndrome patients who developed LVSD (ejection fraction <40%) after the cardiac event and 129 male (64 +/- 12 years) and 51 female (67 +/- 10 years) post-acute coronary syndrome patients without LVSD (ejection fraction >50%) were included in the study. Participants were consequently selected. Detailed information regarding their medical records, sociodemographic and anthropometric data, and various psychological and lifestyle characteristics (physical activity, smoking habits, etc.) were recorded. In particular, nutritional habits, including coffee consumption, were evaluated using a semiquantitative food-frequency questionnaire. Multi-adjusted analysis revealed that in normotensive patients coffee consumption of 1-2 cups/day was associated with 88% (95% confidence interval, 0.02-0.84) lower likelihood of developing LVSD and consumption of >3 cups/day with 90% (95% confidence interval, 0.01-0.88) lower likelihood for LVSD, compared with no history of consumption of coffee and after adjusting for various confounders. In contrast, in hypertensive patients coffee consumption of >3 cups/day was associated with 4.5-fold higher likelihood for developing LVSD (95% confidence interval, 0.89-22.58) as compared with no history of coffee consumption. Coffee consumption has opposite effects on the likelihood of developing LVSD in post-acute coronary syndrome patients depending on their blood pressure levels.

Coffee consumption and type 2 diabetes — An extensive review

Coffee is a complex mixture of potentially active chemicals. It contains significant amounts of phenolic polymers, chlorogenic acid and also caffeine. Agricultural factors, roasting, blending, and brewing determine coffee’s chemical composition. Recent epidemiological studies suggest that habitual coffee consumption may help to prevent some chronic diseases including type 2 diabetes. Despite reports from the clinical trials of the effect of caffeine on decreasing insulin sensitivity, long-term prospective studies revealed that coffee may improve fasting glucose, glucose tolerance and insulin sensitivity as well. In the most recent publication habitual coffee drinkers have a lower total and cardiovascular mortality rate among diabetic subjects.

The emerging anti-inflammatory role of HDL-cholesterol, illustrated in cardiovascular disease free population; the ATTICA study

OBJECTIVE

In this work we assessed the relationship between HDL-cholesterol levels and various inflammation markers status in a sample of cardiovascular disease free adult men and women from Greece.

METHODS

The ATTICA study is a population-based cohort that has randomly enrolled 1128 men and 1154 women (aged >18 years old), stratified by age-gender, from the greater area of Athens, during 2001-2002. Adherence to Mediterranean diet was assessed through a diet-score that was based on a validated food-frequency questionnaire. In this study we assessed the relationship between HDL-cholesterol levels and inflammation markers (high sensitivity C-reactive protein, interleukin-6, homocysteine and amyloid-a), after taking into account the effect of several confounders.

RESULTS

46% of men and 40% of women had total serum cholesterol levels >200 mg/dl, while 21% of men and 7% of women had HDL-cholesterol levels <35 mg/dl. The mean value for HDL-cholesterol was 53+/-14 mg/dl in females and 44+/-14 mg/dl in males. HDL-cholesterol levels were inversely correlated to the hs-CRP levels (b=-0.028, P=0.001) and homocysteine levels (b=-0.039, P=0.036), after adjustment for sex, age, body mass index, physical activity status, smoking, total cholesterol levels, lipid lower agents, ethanol intake and diabetes mellitus; while no statistical significance was found between HDL-cholesterol levels and interleukin-6 and serum amyloid-a.

CONCLUSIONS

In this work we evaluated the inverse relationship between HDL-cholesterol levels and inflammatory markers in a sample adult cardiovascular disease free population. This study among others illustrates the anti-inflammatory emerging role of HDL-cholesterol in reducing cardiovascular risk.

A comprehensive view of sex-specific issues related to cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.

Influences of Acute and Chronic Aerobic Exercise on the Plasma Homocysteine Level

BACKGROUND AND AIMS

Elevated plasma homocysteine (PH) levels have been identified as a risk factor for cardiovascular diseases. The aims of this study were to investigate the influences of submaximal acute aerobic exercise and aerobic training on PH levels and lipid profiles.

METHODS

69 volunteer subjects (21.12 +/- 2.08 years) were randomized to three groups as acute, training and control groups. Examination and blood samples were collected before and immediately after exercise in the acute group and before and 6 weeks later in the training and control groups.

RESULTS

A significant increase in PH concentration was recorded immediately after aerobic exercise, compared with baseline values (p = 0.001). Although, in the training group, total cholesterol (p = 0.00) and LDL cholesterol (p = 0.001) decreased significantly after training, no significant changes in PH concentration, HDL cholesterol (p = 0.087) and triglyceride (p = 194) levels were found.

CONCLUSIONS

It can be said that the PH level increases following submaximal acute aerobic exercise, but does not alter after submaximal aerobic training due to training duration or intensity. Therefore, submaximal aerobic training decreases lipid profiles independent of the PH level.

Maternal hyperhomocysteinaemia is a risk factor for congenital heart disease

OBJECTIVE

To investigate the inter-relation between mother and infant homocysteine, folate and vitamin B12 status and the risk of a child with congenital heart disease (CHD).

DESIGN

Case-control study.

SETTING

Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.

POPULATION

Participants were 149 case-mothers and their children with CHD (n = 151) and 183 control-mothers with their children (n = 175).

METHODS

Approximately 17 months after the index-pregnancy maternal fasting, children's random venous blood samples were drawn to measure plasma total homocysteine, serum and red blood cell (RBC) folate, and serum vitamin B12 concentrations. Data were compared between cases and controls using the Mann-Whitney U test. The biochemical parameters were dichotomised according to the cutoff value of the 10th percentile of vitamin concentrations and the 90th percentile of homocysteine concentrations based on control data. Risk estimates for the association between CHD and the biochemical parameters were estimated in a logistic regression model.

MAIN OUTCOME MEASURES

Medians (minimum-maximum) and odds ratios (OR) (95% confidence intervals [CI]).

RESULTS

The OR (95% CI) of having a child with CHD was 2.9 (1.4-6.0) for maternal hyperhomocysteinaemia (>14.3 micromol/l). This finding is substantiated by a significant concentration-dependent risk (Ptrend = 0.004). Hyperhomocysteinaemic case-mothers showed significantly lower serum folate and vitamin B12 concentrations than normohomocysteinaemic case-mothers. Serum and RBC folate concentrations were significantly higher in case-children than that in control-children.

CONCLUSIONS

Maternal hyperhomocysteinaemia is associated with an increased risk of CHD, partially due to low folate and vitamin B12 status. The folate status of children warrants further investigation.

Thoughts on B-vitamins and dementia

The B-vitamins, including vitamins B12, B6, B1, B2, niacin (B3) and folate (B9), have been implicated as protective risk factors against cognitive decline and Alzheimer's disease. This commentary reviews the evidence to support protective relations of these vitamins, including consideration of known vitamin deficiency syndromes, theories of underlying biologic mechanisms, and the epidemiologic evidence. We also comment on the potential benefits and harms of vitamin supplementation as well as make recommendations for the direction of future studies.

Effects of soy isoflavones and phytate on homocysteine, C-reactive protein, and iron status in postmenopausal women

BACKGROUND

Soy protein or its components may protect against the atherosclerotic cardiovascular disease (CVD) risk factors total homocysteine (tHcy), C-reactive protein (CRP), and excess body iron, which generally increase with menopause.

OBJECTIVE

The primary objective of this study was to determine the independent effect of the soy protein components isoflavones and phytate on CVD risk factors in postmenopausal women. The secondary objective was to identify factors [blood lipids, oxidative stress indexes, serum ferritin, plasma folate, plasma vitamin B-12, and body mass index (BMI)] contributing to tHcy and CRP concentrations.

DESIGN

In a double-blind, 6-wk study, 55 postmenopausal women aged 47-72 y were randomly assigned to 1 of 4 soy protein (40 g/d) isolate treatments: native phytate and native isoflavone (n = 14), native phytate and low isoflavone (n = 13), low phytate and native isoflavone (n = 14), or low phytate and low isoflavone (n = 14). We measured iron indexes, tHcy, CRP, and BMI.

RESULTS

Soy protein with native phytate significantly reduced tHcy (P = 0.017), transferrin saturation (P = 0.027), and ferritin (P = 0.029), whereas soy protein with native isoflavones had no effect on any variables. At baseline, BMI was highly correlated with tHcy (r = 0.39, P = 0.003) and CRP (r = 0.55, P < 0.0001), whereas HDL cholesterol was correlated with CRP (r = -0.30, P = 0.02). Multiple regression analysis showed that LDL cholesterol and BMI contributed significantly (R2= 19.9%, P = 0.003) to the overall variance in tHcy.

CONCLUSION

Consuming phytate-rich foods and maintaining a healthy weight may reduce atherosclerotic CVD risk factors in postmenopausal women.

Plasma homocysteine and folate levels in patients with chronic plaque psoriasis

BACKGROUND

Hyperhomocysteinaemia is a well-known risk factor for cardiovascular diseases. Patients with severe chronic plaque psoriasis have a higher risk of death due to arterial and/or venous thrombosis.

OBJECTIVES

To investigate the relationship among plasma homocysteine and folate levels and severity of chronic plaque psoriasis in a selected cohort of patients with psoriasis without known risk factors for acquired hyperhomocysteinaemia.

METHODS

We performed a case-control study in 40 patients with chronic plaque psoriasis and 30 age- and sex-matched healthy controls. Cases and controls were selected excluding individuals with conditions or diseases associated with acquired hyperhomocysteinaemia, and were also asked to stop alcohol and coffee consumption for 1 week before blood sampling. The plasma levels of homocysteine and folic acid were measured and were correlated with the severity of psoriasis (Psoriasis Area and Severity Index, PASI).

RESULTS

Patients with psoriasis had plasma homocysteine levels higher than controls (mean +/- SD 16.0 +/- 5.6 vs. 10.4 +/- 4.7 micro mol L(-1); P < 0.001). Conversely, folic acid levels were lower in patients with psoriasis compared with controls (mean +/- SD 3.6 +/- 1.7 vs. 6.5 +/- 1.7 nmol L(-1); P < 0.001). Plasma homocysteine levels in patients with psoriasis correlated directly with disease severity (PASI) and inversely with folic acid levels. Plasma folic acid levels were inversely correlated with the PASI. No abnormalities of plasma vitamin B(6) and B(12) were found.

CONCLUSIONS

Patients with psoriasis may have a tendency to hyperhomocysteinaemia, which may predispose to higher cardiovascular risk. Dietary modification of this risk factor appears relevant to the global management of patients with moderate to severe psoriasis.

Changes in lifestyle and total homocysteine in relation to MTHFR(C677T) genotype: the Inter99 study

BACKGROUND

Reduction in total homocysteine (tHcy) may be clinically relevant in the prevention of cardiovascular disease (CVD) in the general population.

OBJECTIVE

To examine the effects of changes in various lifestyle habits and lifestyle related biological CVD risk markers on changes in tHcy in relation to MTHFR(C677T) genotype.

DESIGN

A 1 year follow-up study.

SETTING

Copenhagen County, Denmark.

SUBJECTS

Statistical analyses were based on a population-based sample of 915 men and women aged 30-60 years assessed to be at increased CVD risk at baseline and therefore offered lifestyle intervention and re-examination after one year.

RESULTS

None of the studied lifestyle changes-- smoking, physical activity, dietary habits, and coffee, tea, and alcohol consumption-- was significantly associated with changes in tHcy, either overall, or in any of the MTHFR genotype subgroups. In addition, changes in tHcy did not differ between participants randomized to low- and high-intensity lifestyle intervention. However, the MTHFR TT genotype was associated with a significant decrease in tHcy compared with the CC/CT genotype in which an increase was observed. In addition, changes in tHcy were associated with changes in several of the biological CVD risk markers: weight, total cholesterol, HDL cholesterol, LDL cholesterol and systolic blood pressure.

CONCLUSIONS

Our results indicate that tHcy may not be reduced by lifestyle changes; additionally, they suggest that tHcy may be related to biological CVD risk markers through a lifestyle independent pathway.

Plasma total homocysteine level and its association with carotid intima-media thickness in obesity

BACKGROUND

Elevated plasma concentrations of total homocysteine (tHcy) and obesity are risk factors for cardiovascular disease. The relationship between hyperhomocysteinemia and obesity has not been totally elucidated.

OBJECTIVE

The first aim of the study was to investigate whether anthropometric measurements and insulin resistance contribute to the variation in homocysteine levels in obese adults. Our second aim was to determine if any relationship exists between the carotid intima-media thickness (IMT) and plasma tHcy levels in obese subjects without traditional cardiovascular risk factors.

MATERIAL AND METHODS

Fifty-five obese (15 male, 40 female) and 30 (11 male, 19 female) age- and sex-matched apparently healthy volunteers were included. Exclusion criteria were smoking, hypertension, diabetes, vitamin ingestion, hyperlipidemia, renal failure, liver disease, pregnancy, menopause and secondary obesity such as Cushing's syndrome, hypothyroidism. tHcy, folate, vitamin B12 levels, fasting insulin, glucose, total cholesterol, triglycerides, HDL, LDL particles, uric acid, creatinine and creatinine clearance were measured. Non-invasive ultrasound measurements of carotid IMT were performed.

RESULTS

tHcy levels and carotid IMT were comparable between obese and non-obese subjects. Waist/hip ratio (WHR) was related to tHcy and carotid IMT. Hyperhomocysteinemic subjects (tHcy >19.2 micromol/l) had greater WHR than normo-homocysteinemic subjects. Both tHcy levels and carotid IMT were higher in male subjects both in obese and non-obese subjects. No association was observed between insulin resistance and tHcy and carotid IMT. Renal function and abdominal obesity were significant predictors of plasma tHcy levels.

CONCLUSIONS

We concluded that, in obese subjects who are free from atherosclerosis and impaired renal function, plasma tHcy levels do not differ from healthy subjects. Plasma tHcy concentrations are not related to carotid IMT in obese subjects during the non-atherogenic stage. Although no significant difference was observed between insulin-resistant and insulin-sensitive subjects compared to the plasma tHcy levels, the relationship between tHcy levels and some components of the insulin resistance syndrome may support the opinion that tHcy may be considered a component of the insulin resistance syndrome.

Daily rhythms in plasma levels of homocysteine

BACKGROUND: There is accumulated evidence that plasma concentration of the sulfur-containing amino-acid homocysteine (Hcy) is a prognostic marker for cardiovascular morbidity and mortality. Both fasting levels of Hcy and post methionine loading levels are used as prognostic markers. The aim of the present study was to investigate the existence of a daily rhythm in plasma Hcy under strictly controlled nutritional and sleep-wake conditions. We also investigated if the time during which methionine loading is performed, i.e., morning or evening, had a different effect on the resultant plasma Hcy concentration. METHODS: Six healthy men aged 23-26 years participated in 4 experiments. In the first and second experiments, the daily rhythm in Hcy as well as in other amino acids was investigated under a normal or an inverse sleep-wake cycle. In the third and fourth, Hcy concentrations were investigated after a morning and evening methionine loading. To standardize food consumption in the first two experiments, subjects received every 3 hours 150 ml of specially designed low-protein liquid food (Ensure(R) formula). RESULTS: In both the first and second experiments there was a significant daily rhythm in Hcy concentrations with a mid-day nadir and a nocturnal peak. Strikingly different 24-h patterns were observed in methionine, leucine, isoleucine and tyrosine. In all, the 24-h curves revealed a strong influence of both the sleep-wake cycle and the feeding schedule. Methionine loading resulted in increased plasma Hcy levels during both morning and evening experiments, which were not significantly different from each other. CONCLUSIONS: There is a daily rhythm in plasma concentration of the amino acid Hcy, and this rhythm is independent of sleep-wake and food consumption. In view of the fact that increased Hcy concentrations may be associated with increased cardiovascular risks, these findings may have clinical implications for the health of rotating shift workers.