|Year : 2015 | Volume
| Issue : 2 | Page : 115-118
Correlation between homocysteine and Vitamin B12 levels: A post-hoc analysis from North-West India
Sunil Kumar Raina1, Jagjit Singh Chahal2, Navjot Kaur3
1 Department of Community Medicine, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India
2 Department of Biochemistry, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India
3 Department of Pathology, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India
|Date of Web Publication||10-Apr-2015|
Sunil Kumar Raina
Department of Community Medicine, Dr. RP Government Medical College, Tanda, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Homocysteine has been shown to be a risk factor for cardiovascular disease and is a degradation product of sulfur containing amino acids. The aim of this post-hoc analysis was aimed at arriving at homocysteine levels among voluntarily consenting healthy adults in the context of other hematological parameters. Methods: The data for this post-hoc analysis were derived from an observational study carried out at a medical college in rural North-west India. Results: About 77.42% of those participants enrolled in this study having serum homocysteine level more than 30 μmol/L were seen to possess suboptimal serum Vitamin B 12 (<200 pg/ml). On subjecting data to regression analysis, serum homocysteine was observed to possess an inverse correlation with serum level of Vitamin B 12, in general. Conclusions: Hyperhomocysteinemia observed in our study was sufficiently common and wholly ascribable to low Vitamin B 12 concentration as we did not find any case of subnormal serum folic acid level.
Keywords: Correlation, homocysteine, Vitamin B12
|How to cite this article:|
Raina SK, Chahal JS, Kaur N. Correlation between homocysteine and Vitamin B12 levels: A post-hoc analysis from North-West India. Int J Health Allied Sci 2015;4:115-8
|How to cite this URL:|
Raina SK, Chahal JS, Kaur N. Correlation between homocysteine and Vitamin B12 levels: A post-hoc analysis from North-West India. Int J Health Allied Sci [serial online] 2015 [cited 2019 Dec 15];4:115-8. Available from: http://www.ijhas.in/text.asp?2015/4/2/115/154915
| Introduction|| |
Homocysteine has been shown to be a risk factor for cardiovascular disease and is a degradation product of sulfur containing amino acids. , It gets converted into an essential amino acid methionine after undergoing "methylation" in the presence of Vitamin B 12 . This is the step in its metabolism, where Vitamin B 12 and folic acid are intricately involved.  Elevated serum homocysteine has also been implicated in the vascular changes compatible with atherosclerosis and endothelial dysfunction similar to the vascular changes of the placenta in preeclampsia. Homocysteine levels are too elevated significantly in patients with preeclampsia in the absence of Vitamin B 12 deficiency. 
Most of the analytical systems measure total homocysteine content after pretreatment with a reductant. Storage of whole blood at room temperature causes significant increases in the concentration of total homocysteine in serum of plasma.
The aim of this post-hoc analysis was aimed at arriving at homocysteine levels among voluntarily consenting healthy adults in the context of other hematological parameters.
| Methods|| |
The data for this post-hoc analysis were derived from an observational study carried out at a medical college in rural North-West India. A brief description of the original study is presented here.
A total of 153 study units voluntarily willing students and employees were picked by stratified random sampling method from the sampling frame that comprised of all students and employees of the medical college. The participants were subjected to general physical examination after having been interviewed using a structured questionnaire. Anthropometric measurements were taken on 1 st day of contact only. Height was measured to the nearest 1.0 cm, without shoes, with feet together, in Frankfurt's plane with measuring tape.  Weight was measured in light indoor clothes barefooted on adult weighing machine. Body mass index was calculated as weight in kilogram divided by height in meter square.
Blood sample was collected by following standardized procedure for the collection of blood sample, when the enrolled subject (with empty stomach after overnight fasting) came to the Department of Biochemistry next day after having got their clinical variables recorded the previous day.
Any voluntarily consenting adult subject (both male and female) aged from 18 to 62 years, student or employee of the medical college.
- Subject's refusal
- Subjects who were taking methylcobalamin or Vitamin B 12 or folic acid or iron, folic acid or have taken the same for more than 15 days during last 3 months
- Subjects who had received Vitamin B 12 or iron formulations as injectables during last 1-year
- Subjects on medication for hypertension or diabetes or on lipid-lowering drugs
- Those with chronic illness like tuberculosis, cancer or immunocompromised subjects
- Pregnant or lactating mothers
- Anyone who had either donated or received blood in last 3 months.
| Results|| |
A total of 153 subjects comprising 69 employees (group I) along with 84 students (group II) of the medical college were analyzed in this post-hoc study. Hyperhomocysteinemia (serum Hcy (t) >12 μmol/L), is found prevalent to the tune of 73.9% among participants of study population, and 20.3% of participants had serum homocysteine level even more than 30 μmol/L. Proportion of females with severe hyperhomocysteinemia (who had serum Hcy (t) more than 30 μmol/L) is less than that of males (17.9% vs. 22.61%) [Table 1]. An analysis [Table 2] of intergroup distribution of hematological and hematopoietic variables along with their deficiency markers among participants of study population reveals the relation between homocysteine levels, Vitamin B12 levels, and folic acid levels.
|Table 2: Intergroup distribution of hematological and hematopoietic variables along with their deficiency markers among participants of study population (n=153)|
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About 77.42% of those participants enrolled in this study having serum homocysteine level more than 30 μmol/L were seen to possess suboptimal serum Vitamin B 12 (<200 pg/ml). On subjecting data to regression analysis, serum homocysteine was observed to possess an inverse correlation with serum level of Vitamin B 12, in general. This inverse correlation (P = 0.005, r2 = 0.052) between serum level of Vitamin B 12 and serum level of homocysteine was statistically significant. We also found even stronger inverse correlation (P = 0.001, r2 = 0.187) between serum Vitamin B 12 and methylmalonic acid [Figure 1].
| Discussion|| |
Vitamin B 12 and folic acid, essential cofactors in homocysteine metabolism are known determinants of serum Hcy (t) concentrations. Deficiency of either Vitamin B 12 or folic acid can cause elevated levels of Hcy (t). , Determination of total homocysteine in serum has now become an important diagnostic procedure in clinical chemistry on account of accumulating evidence that a slightly increased concentration of Hcy (t) is a significant independent risk factor for atherosclerotic diseases. We found hyperhomocysteinemia (>12 μmol/L) prevalent to the tune of 73.9% among enrolled subjects and it was very much in agreement with similar high prevalence of 76% as reported by Refsum et al. from South India.  However, our finding of hyperhomocysteinemia was much higher than that reported by Pandey et al. who reported its prevalence to be 24.2% in their study population comprising exclusively of females. 
We had a particular finding to take note of; an inverse association existed between serum level of Vitamin B 12 and homocysteine. This correlation was more pronounced when participants had suboptimal vitamin B 12 because 77.42% of those subjects who had serum Hcy (t) more than 30 μmol/L, were having suboptimal serum Vitamin B 12 (<200 pg/ml) in our study. Results from our study confirmed the observed associations between Hcy (t), Vitamin B 12, and folic acid concentrations in a large population-based studies from India and abroad. ,
The occurrence of hyperhomocysteinemia has been very much discussed in recent literature, and we noted the mean level of serum total homocysteine in the instant study (21.53 ± 12.20 μmol/L) to be among the higher levels recorded in India. This observation of higher Hcy (t) was comparable to the highest reported level of homocysteine from India by Misra et al. who found a level of 23.2 ± 8.4 μmol/L among subjects in slums.  Reports of hyperhomocysteinemia were also released by many workers during the same period from different parts of the world as well as from country. ,, Gheye et al. compared the prevalence of hyperhomocysteinemia between original Bangladeshis migrated to United Kingdom and Caucasians and found it to higher among South Asians migrated to England.  Misra et al. mentioned poor economic condition of their subjects residing in slums as a coincidental factor, but this was contrasted by Chambers et al. as they enrolled a significant proportion of cases and controls from "nonmanual" class as was the case of our study, therefore hyperhomocysteinemia was not correlated to economic class of enrolled subjects. , Deepa et al. did not observe a significant difference between serum levels of Hcy (t) between cases and controls recruited for their study.  A difference in findings from different studies has been summarized in [Table 3].
| Conclusion|| |
Hyperhomocysteinemia observed in our study was sufficiently common and wholly ascribable to low Vitamin B 12 concentration as we did not find any case of subnormal serum folic acid level.
| References|| |
Ueland PM, Mansoor MA, Guttormsen AB, Müller F, Aukrust P, Refsum H, et al.
Reduced, oxidized and protein-bound forms of homocysteine and other aminothiols in plasma comprise the redox thiol status - A possible element of the extracellular antioxidant defense system. J Nutr 1996;126 4 Suppl: 1281S-4.
Yajnik CS, Deshpande SS, Lubree HG, Naik SS, Bhat DS, Uradey BS, et al.
Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India 2006;54:775-82.
Mayes PA. Structure and function of the water-soluble vitamins. In: Murray RK, Granner DK, Mayes PA, Rodwell VW, editors. Harper′s Biochemistry. 25 th
ed. Stamford: Appleton and Lange Publishers; 2000. p. 635-7.
Makedos G, Papanicolaou A, Hitoglou A, Kalogiannidis I, Makedos A, Vrazioti V, et al.
Homocysteine, folic acid and B12 serum levels in pregnancy complicated with preeclampsia. Arch Gynecol Obstet 2007;275:121-4.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al.
Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-70.
Klee GG. Cobalamin and folate evaluation: Measurement of methylmalonic acid and homocysteine vs vitamin B (12) and folate. Clin Chem 2000;46:1277-83.
Pandey SN, Vaidya AD, Vaidya RA, Talwalkar S. Hyperhomocysteinemia as a cardiovascular risk factor in Indian women: Determinants and directionality. J Assoc Physicians India 2006;54:769-74.
Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, et al.
Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr 2001;74:233-41.
Chacko KA. Plasma homocysteine levels in patients with coronary heart disease. Indian Heart J 1998;50:295-9.
Obeid OA, Mannan N, Perry G, Iles RA, Boucher BJ. Homocysteine and folate in healthy east London Bangladeshis. Lancet 1998;352:1829-30.
Gheye S, Lakshmi AV, Krishna TP, Krishnaswamy K. Fibrinogen and homocysteine levels in coronary artery disease. Indian Heart J 1999;51:499-502.
Chambers JC, Obeid OA, Refsum H, Ueland P, Hackett D, Hooper J, et al.
Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men. Lancet 2000;355:523-7.
Leowattana W, Mahanonda N, Bhuripunyo K, Pokum S. Association between serum homocysteine, vitamin B12, folate and Thai coronary artery disease patients. J Med Assoc Thai 2000;83:536-42.
Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K, et al.
Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India. Eur J Nutr 2002;41:68-77.
Deepa R, Velmurugan K, Saravanan G, Karkuzhali K, Dwarakanath V, Mohan V. Absence of association between serum homocysteine levels and coronary artery disease in south Indian males. Indian Heart J 2001;53:44-7.
Jacques PF, Bostom AG, Wilson PW, Rich S, Rosenberg IH, Selhub J. Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort. Am J Clin Nutr 2001;73:613-21.
[Table 1], [Table 2], [Table 3]