Associations among serum folate, waist-to-hip ratio, lipid profile, and eating habits with homocysteine in an elderly Thai population
Abstract
Abstract. A lower serum folate level is common in older populations and is associated with increased serum homocysteine concentration. In turn, an elevated homocysteine level is associated with increased risk of cardiovascular disease and age-related diseases. Contemporary studies of folate and dietary risk factors for cardiovascular disease among the elderly population in Thailand are lacking. This cross-sectional study aimed to investigate the relationships among serum folate, homocysteine level, and nutritional status in the elderly Thai. Three hundred individuals, aged 60 years and over, underwent anthropometric and physiological measurements, and biochemical parameters, and eating habits were also determined. Folate insufficiency was found in approximately 35% of subjects. Folate and homocysteine showed a significant inverse correlation. Serum homocysteine levels rose with increasing age. Folate deficiency and high waist-to-hip ratio were associated with 7-fold and 2.5-fold increased risk for hyperhomocysteinemia, respectively. There were positive correlations between homocysteine and waist-to-hip ratio and systolic blood pressure, but a negative correlation between homocysteine and high-density lipoprotein (r = −0.239, p < 0.01), which are markers for cardiovascular disease risk. Folate negatively correlated with body mass index, waist-to-hip ratio, and diastolic blood pressure, but positively with high-density lipoprotein (r = 0.162, p < 0.01). Investigation of eating habits showed that low consumption of green leafy vegetables and high consumption of sugary foods were associated with high homocysteine levels. Given associations between nutritional status and cardiovascular disease confirmed in this study, nutrition education, holistic health promotion, and appropriate behavioral modification of eating habits represent important measures for preventing premature cardiovascular disease in the elderly Thai population.
References
1 (1990) Methionine metabolism in mammals. J. Nutr. Biochem. 1, 228–237.
2 (1998) Can dietary supplements with folic acid or vitamin B6 reduce cardiovascular risk? Design or clinical trials to test the homocysteine hypothesis of vascular disease. J. Cardiovasc. Risk. 5, 249–255.
3 (2015) Folate and prevention of neural tube defects: new insights from a Bayesian model. Int. J. Vitam. Nutr. Res. 85, 109–111.
4 (1993) Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA. 270, 2693–2698.
5 (2014) Nutritional status of the elderly in rural north China: a cross-sectional study. J. Nutr. Health Aging. 18, 730–736.
6 (2005) Association of B vitamins status and homocysteine levels in elderly Taiwanese. Asia Pac. J. Clin. Nutr. 14, 250–255.
7 (2013) Relationship of serum homocysteine level with nutritional status and HbA1c level in elderly patients. Int. J. Clin. Exp. Med. 6, 779–784.
8 (1993) Total homocysteine in plasma or serum: methods and clinical applications. Clin. Chem. 39, 1764–1779.
9 (1999) Total homocysteine and cardiovascular disease. J. Intern. Med. 246, 425–454.
10 (2002) Folic acid and homocysteine in age-related disease. Ageing Res. Rev. 1, 95–111.
11 (2004) Serum total homocysteine concentrations and risk of stroke and its subtypes in Japanese. Circulation. 109, 2766–2772.
12 (2007) Homocysteine and cardiovascular disease: a review of the evidence. Diab. Vasc. Dis. Res. 4, 143–150.
13 (1991) Hyperhomocysteinemia: an independent risk factor for vascular disease. N. Engl. J. Med. 324, 1149–1155.
14 (1992) Hyperhomocysteinemia as a risk factor for occlusive vascular disease. Annu. Rev. Nutr. 12, 279–298.
15 (2006) The Hordaland Homocysteine Study: a community-based study of homocysteine, its determinants, and associations with disease. J. Nutr. 136, 1731–1740.
16 (2008) Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 117, 3031–3038.
17 (2001) Correlation between total homocysteine, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in serum of patients with myocardial infarction. Clin. Biochem. 34, 97–101.
18 (2010) Plasma folate levels are associated with the lipoprotein profile: a retrospective database analysis. Nutr. J. 9, 31.
19 (2010) Homocysteine lowering with folic acid supplements in children: effects on blood pressure. Int. J. Food Sci. Nutr. 61, 11–17.
20 (2002) The effect of folic acid supplementation on plasma homocysteine in an elderly population. Q. J. Med. 95, 27–35.
21 . (2016) Population aging in Thailand, 2016. [accessed Jan 12, 2016]. Available from: http://www.thailandometers.mahidol.ac.th/#elderly
22 (2016) Nutrition for older persons. [accessed Jan 12, 2016]. Available from: http://www.who.int/nutrition/topics/ageing/en/index1.html
23 (2007) Epidemiological survey of vitamin deficiencies in older Thai adults: implications for national policy planning. Public Health Nutr. 10, 65–70.
24 . Report of public health services system situation. The Third Trimester (April–June 2010), pp. 1–238.
25 . (2014) Population of Thailand, 2014. Mahidol Population Gazette. 23, 1–3.
26 . (2016) Serum and red blood cell folate concentrations for assessing folate status in populations. [accessed Jan 12, 2016]. Available from: http://www.who.int/vmnis/indicators/serum_RBC_folate/en/
27 (1995) Assessment of folate methodology used in the third National health and Nutrition Examination Survey (NHANES III, 1988–1994). J. Nutr. 125, 1371S–1398S.
28 (1961) Studies on the folic acid activity of human serum. J. Clin. Pathol. 14, 335–351.
29 (1999) Homocyst(e)ine, diet and cardiovascular diseases. A statement for health professionals from the Nutrition Committee, American Heart Association. Circulation. 99, 178–182.
30 (2004) Implication of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 110, 227–239.
31 . (2011) Report on food consumption survey in Thai population. Nonthaburi: Office of NHESO, 1–200.
32 (2005) Principles of Nutritional Assessment (2nd Edition). New York: Oxford University Press.
33 (2015) The relation between dark green leafy vegetables consumption and forearm bone mineral density in Thai menopausal women. J. Police Nurs. 7, 162–174.
34 (2012) Folate status and colorectal cancer in Thais. Master’s thesis. Bangkok: Mahidol University.
35 (2011) Trends in folate status in the Taiwanese population aged 19 years and older from the Nutrition and Health Survey in Taiwan 1993–1996 to 2005–2008. Asia Pac. J. Clin. Nutr. 20, 275–282.
36 (2008) Plasma homocysteine, but not folate or vitamin B-12, predicts mortality in older people in the United Kingdom. J. Nutr. 138, 1121–1128.
37 (2004) Folate, homocysteine, endothelial function and cardiovascular disease. J. Nutr. Biochem. 15, 64–79.
38 (1994) Influence of nutritional intake on 6-year mortality in an Italian elderly population. J. Nutr. Elder. 13, 25–34.
39 (1999) The role of diet, fruit and vegetables and antioxidants in the aetiology of stroke. J. Cardiovasc. Risk. 6, 229–234.
40 (2013) Obesity in the ageing man. Metabolism. 62, 1341–1349.
41 (2002) Fat-free mass index and fat mass index percentiles in Caucausians aged 18–98y. Int. J. Obes. Relat. Metab. Disord. 26, 953–960.
42 (2016) Prevalence of overweight and obesity among Chinese adults: role of adiposity indicators and age. Obes. Facts. 9, 17–28.
43 . (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 363, 157–163.
44 . (2008) Waist circumference and waist-hip ratio: report of a WHO expert consultation, 1–39.
45 (2011) Relation of body mass index to blood folate and total homocysteine concentrations in Japanese adults. Eur. J. Nutr. 50, 581–585.
46 (2003) Serum homocysteine, B12, and folic acid concentration in Thai obese and overweight subjects. Int. J. Vitam. Nutr. Res. 73, 8–14.
47 (2008) Waist-to-hip ratio correlates with homocysteine levels in male patients with coronary artery disease. Clin. Chem. Lab. Med. 46, 125–130.
48 (2015) Homocysteine levels show significant differences among Mediterranean dietary quality index variables compared to folate and Vitamin B(12) status in women. Int. J. Vitam. Nutr. Res. 85, 202–210.
49 (1997) High homocysteine levels are independently related to isolated systolic hypertension in older adults. Circulation. 96, 1745–1749.
50 (2003) Does homocysteine cause hypertension? Clin. Chem. Lab. Med. 41, 1408–1411.
51 (2006) Hyperhomocysteinemia decreases circulating HDL by inhibiting apoA-I protein synthesis and enhancing HDL-C clearance. Circ. Res. 99, 598–606.
52 (2014) High plasma homocysteine increases risk of metabolic syndrome in 6 to 8 year old children in rural Nepal. Nutrients. 6, 1649–1661.
53 (1981) Effect of chronological age on induction of cystathionine synthase, uroporphyrinogen I synthase, and glucose-6-phosphate dehydrogenase activities in lymphocytes. Proc. Natl. Acad. Sci. USA. 78, 1916–1919.
54 (2007) B-vitamins and homocysteine in Spanish institutionalized elderly. Int. J. Vitam. Nutr. Res. 77, 22–23.
55 . (2016) Understanding blood pressure readings. [accessed Jan 12, 2016]. Available from: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp