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

OBJECTIVE: Homocysteine is a sulfur-containing amino acid formed during the demethylation of methionine. Vitamin B-12 and folate deficiency and therap y with antifolate drugs may predispose patients with inflammatory bowel dis ease (IBD) to hyperhomocysteinemia. The known associations between hyperhom ocysteinemia and smoking, osteoporosis, and thrombosis make it an interesti ng candidate as a pathogenetic link in IBD. The aim of this study was to id entify 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 w ere measured, along with vitamin B-12 and folate. Data regarding medication use, multivitamin use, disease location and severity, and extraintestinal manifestations of IBD were gathered. Homocysteine levels in 138 healthy con trol subjects were compared with the LED cohort, and adjustments for age an d sex were made using logistic regression. Multivariate analysis was perfor med 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 use d steroids within the last 3 months. Immunomodulator therapy had been used in 32%, and 75% had had an intestinal resection. Osteoporosis was present i n 33% of patients. Five patients had experienced venous thrombosis or strok e, but only one of these had hyperhomocysteinemia. Of the 10 IBD patients ( 15.4%) with hyperhomocysteinemia, only two had vitamin B-12 deficiency. The homocysteine levels in the IBD cohort cases and controls were 8.7 and 6.6 mu mol/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 B-12 deficiency or lower vitamin B-12 serum levels, and multivitamin therapy were independently associated with higher homocys teine levels in the multivariate analysis (R-2 = 0.55; p = 0.001). CONCLUSIONS: Hyperhomocysteinemia is significantly more common in patients with LED compared with healthy controls, and is associated with lower (but not necessarily deficient) vitamin B-12 levels. (C) 2001 by Am. Coll. of Ga stroenterology.