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Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study.

Abstract

OBJECTIVE

Homocysteine is a sulfur-containing amino acid formed during the demethylation of methionine. Vitamin B12 and folate deficiency and therapy with antifolate drugs may predispose patients with inflammatory bowel disease (IBD) to hyperhomocysteinemia. The known associations between hyperhomocysteinemia and smoking, osteoporosis, and thrombosis make it an interesting candidate as a pathogenetic link in IBD. The aim of this study was to identify the prevalence and risk factors of hyperhomocysteinemia in patients with IBD.

METHODS

Sixty-five consecutive IBD patients were recruited from a tertiary outpatient gastroenterology practice. Fasting plasma homocysteine levels were measured, along with vitamin B12 and folate. Data regarding medication use, multivitamin use, disease location and severity, and extraintestinal manifestations of IBD were gathered. Homocysteine levels in 138 healthy control subjects were compared with the IBD cohort, and adjustments for age and sex were made using logistic regression. Multivariate analysis was performed to seek predictors of homocysteine levels.

RESULTS

The mean age in the IBD cohort was 42+/-13.4 yr (+/-SD), and 43% were male. The mean disease duration was 13.8+/-9.4 yr, and 32% had used steroids within the last 3 months. Immunomodulator therapy had been used in 32%, and 75% had had an intestinal resection. Osteoporosis was present in 33% of patients. Five patients had experienced venous thrombosis or stroke, but only one of these had hyperhomocysteinemia. Of the 10 IBD patients (15.4%) with hyperhomocysteinemia, only two had vitamin B12 deficiency. The homocysteine levels in the IBD cohort cases and controls were 8.7 and 6.6 micromol/L, respectively (p < 0.05). IBD significantly increased the risk of hyperhomocysteinemia (adjusted odds ratio = 5.9 [95% CI: 1.5-24]). Advanced age, male sex, vitamin B12 deficiency or lower vitamin B12 serum levels, and multivitamin therapy were independently associated with higher homocysteine levels in the multivariate analysis (R2 = 0.55; p = 0.001).

CONCLUSIONS

Hyperhomocysteinemia is significantly more common in patients with IBD compared with healthy controls, and is associated with lower (but not necessarily deficient) vitamin B12 levels.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, McGill University Health Centre, Montreal, Canada.

    , , ,

    Source

    MeSH

    Adult
    Cohort Studies
    Cross-Sectional Studies
    Female
    Homocysteine
    Humans
    Hyperhomocysteinemia
    Inflammatory Bowel Diseases
    Male
    Models, Chemical
    Prevalence
    Risk Factors
    Vitamin B 12

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11467646

    Citation

    Romagnuolo, J, et al. "Hyperhomocysteinemia and Inflammatory Bowel Disease: Prevalence and Predictors in a Cross-sectional Study." The American Journal of Gastroenterology, vol. 96, no. 7, 2001, pp. 2143-9.
    Romagnuolo J, Fedorak RN, Dias VC, et al. Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study. Am J Gastroenterol. 2001;96(7):2143-9.
    Romagnuolo, J., Fedorak, R. N., Dias, V. C., Bamforth, F., & Teltscher, M. (2001). Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study. The American Journal of Gastroenterology, 96(7), pp. 2143-9.
    Romagnuolo J, et al. Hyperhomocysteinemia and Inflammatory Bowel Disease: Prevalence and Predictors in a Cross-sectional Study. Am J Gastroenterol. 2001;96(7):2143-9. PubMed PMID: 11467646.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study. AU - Romagnuolo,J, AU - Fedorak,R N, AU - Dias,V C, AU - Bamforth,F, AU - Teltscher,M, PY - 2001/7/27/pubmed PY - 2001/8/31/medline PY - 2001/7/27/entrez SP - 2143 EP - 9 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 96 IS - 7 N2 - OBJECTIVE: Homocysteine is a sulfur-containing amino acid formed during the demethylation of methionine. Vitamin B12 and folate deficiency and therapy with antifolate drugs may predispose patients with inflammatory bowel disease (IBD) to hyperhomocysteinemia. The known associations between hyperhomocysteinemia and smoking, osteoporosis, and thrombosis make it an interesting candidate as a pathogenetic link in IBD. The aim of this study was to identify the prevalence and risk factors of hyperhomocysteinemia in patients with IBD. METHODS: Sixty-five consecutive IBD patients were recruited from a tertiary outpatient gastroenterology practice. Fasting plasma homocysteine levels were measured, along with vitamin B12 and folate. Data regarding medication use, multivitamin use, disease location and severity, and extraintestinal manifestations of IBD were gathered. Homocysteine levels in 138 healthy control subjects were compared with the IBD cohort, and adjustments for age and sex were made using logistic regression. Multivariate analysis was performed to seek predictors of homocysteine levels. RESULTS: The mean age in the IBD cohort was 42+/-13.4 yr (+/-SD), and 43% were male. The mean disease duration was 13.8+/-9.4 yr, and 32% had used steroids within the last 3 months. Immunomodulator therapy had been used in 32%, and 75% had had an intestinal resection. Osteoporosis was present in 33% of patients. Five patients had experienced venous thrombosis or stroke, but only one of these had hyperhomocysteinemia. Of the 10 IBD patients (15.4%) with hyperhomocysteinemia, only two had vitamin B12 deficiency. The homocysteine levels in the IBD cohort cases and controls were 8.7 and 6.6 micromol/L, respectively (p < 0.05). IBD significantly increased the risk of hyperhomocysteinemia (adjusted odds ratio = 5.9 [95% CI: 1.5-24]). Advanced age, male sex, vitamin B12 deficiency or lower vitamin B12 serum levels, and multivitamin therapy were independently associated with higher homocysteine levels in the multivariate analysis (R2 = 0.55; p = 0.001). CONCLUSIONS: Hyperhomocysteinemia is significantly more common in patients with IBD compared with healthy controls, and is associated with lower (but not necessarily deficient) vitamin B12 levels. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11467646/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=11467646 DB - PRIME DP - Unbound Medicine ER -