Hyperhomocysteinaemia is not related to risk of distal somatic polyneuropathy: The Hoorn Study

Objective. Distal somatic polyneuropathy is a major contributing factor in the pathogenesis of chronic foot infections and ulcers, and may lead to low er limb amputations. Both metabolic and vascular abnormalities may contribu te to the development of impaired nerve function. We therefore assessed the association between hyperhomocysteinaemia, a risk factor for cardiovascula r disease, and polyneuropathy. Design, setting and subjects. We studied an age-, sex- and glucose toleranc e-stratified random sample of a 50- to 75-year-old general Caucasian popula tion in the Hoorn Study (N = 629). Any polyneuropathy (N = 95) was defined as the absence of at least two of the three following sensory modalities or reflexes of either foot: light touch sense, ankle reflex and vibration sen sation. Definite polyneuropathy (N = 25) was present if, in addition, the v ibration perception threshold of the right big toe was abnormal. Results. The prevalence of any polyneuropathy was 12.4% (33 of 266) in subj ects with normal glucose tolerance (NGT), 12.6% (21 of 167) in those with i mpaired glucose tolerance (IGT), and 25.3% (41 of 162) in those with type 2 diabetes. The prevalence of definite polyneuropathy was 2.6% (7 of 266) in subjects with NGT, 2.4% (4 of 167) in those with IGT and 8.7% (14 of 161) in type 2 diabetic subjects. Polyneuropathy was associated with known risk factors such as diabetes, hyperglycaemia and body height. After adjustment for age, sex, HbA(1c) and hypertension, the odds ratio (95% CI) for any pol yneuropathy per 5 mu mol L-1 (about 1 SD) serum total homocysteine incremen t was 1.00 (0.72-1.39). After adjustment for age and sex, it was 0.62 (0.21 -1.89) for definite polyneuropathy. Conclusion. Although a weak relation (as judged from the confidence interva ls) cannot be excluded, we conclude that hyperhomocysteinaemia is probably not related to risk of distal somatic polyneuropathy.