Correlations Between Folate, B₁₂, Homocysteine Levels, and Radiological Markers of Neuropathology in Elderly Post-Stroke Patients

• Published in: Journal of the American College of Nutrition Vol. 26; no. 3; pp. 272 - 278
• Main Authors: Yang, L.-K, Wong, K.-C, Wu, M.-Y, Liao, S.-L, Kuo, C.-S, Huang, R.-F.S
• Format: Journal Article
• Language: English
• Published: United States American College of Nutrition 01.06.2007
• Subjects: Aged; atrophy; Biomarkers - blood; blood chemistry; Brain - pathology; brain atrophy; Brain Infarction - blood; Brain Infarction - epidemiology; Brain Infarction - pathology; computed tomography; Cross-Sectional Studies; diet; dietary surveys; elderly; Female; folic acid; Folic Acid - administration & dosage; Folic Acid - blood; Folic Acid Deficiency - blood; Folic Acid Deficiency - complications; Folic Acid Deficiency - epidemiology; Folic Acid Deficiency - pathology; homocysteine; Homocysteine - administration & dosage; Homocysteine - blood; Humans; Hyperhomocysteinemia - blood; Hyperhomocysteinemia - complications; Hyperhomocysteinemia - epidemiology; Hyperhomocysteinemia - pathology; Magnetic Resonance Imaging; Male; Mental Recall; neuropathy; nutrient deficiencies; nutrient excess; nutrient intake; Nutrition Assessment; Nutrition Policy; nutritional status; patients; radiological markers; signs and symptoms (animals and humans); stroke; Stroke - blood; Surveys and Questionnaires; Vitamin B 12 - administration & dosage; Vitamin B 12 - blood; Vitamin B Complex - administration & dosage; Vitamin B Complex - blood; vitamin B12; Taiwan
• ISSN: 0731-5724; 1541-1087
• DOI: 10.1080/07315724.2007.10719611

OBJECTIVE: To investigate serum levels of folate, B₁₂, and total homocysteine (tHcy) in elderly post-stroke patients, and the possible correlations with radiological markers of neuropathology. DESIGN: Cross-sectional study. SETTING: Department of Neurology, Cardinal Tien Hospital. SUBJECTS: Eighty-nine elderly post-stroke patients were enrolled for dietary assessment and blood tests. Neuroradiological assessment was done in 62 of these patients. MAIN OUTCOME MEASURES: Dietary folate and vitamin B₁₂ intakes were evaluated by a 24-h recall system using a semi-quantitative questionnaire. Circulating levels of folate, B₁₂, and tHcy were measured. Magnetic resonance imaging (MRI) or computed tomography (CT) was used for evaluation of brain lesions including infarction and atrophy. RESULTS: Mean folate and B₁₂ intakes of these post-stroke patients were 69% and 261% of the recommended dietary allowances (RDA), respectively. Inadequate folate levels, defined as serum folate < 6 ng/mL, was noted in 68% of these patients. Hyperhomocysteinemia levels (tHcy >=15 μmol/L) were observed in 48%. According to tertiles of serum tHcy and folate levels, the rate of brain atrophy, but not brain infarctions, are significantly associated with elevated tHcy (P = 0.0126) and decreased folate levels (P = 0.0273). After adjustments for age, sex, disease status, brain infarctions and carotid stenosis, the odds ratio of brain atrophy was 9.8 (95% CI: 1.7-56.4, P = 0.0101) in the hyperhomocysteinemia group and 9.6 (95% CI: 1.1-81.3, P = 0.0377) in the low folate group (serum folate < 3.0 ng/mL) compared with the group with normal tHcy and folate levels. No significant association was noted between vitamin B₁₂ levels and brain lesions. CONCLUSIONS: Our data shows that folate deficiency and hyperhomocysteinemia are prevalent in elderly post-stroke patients. These two conditions are strongly and independently associated with the development of brain atrophy.