Homocysteine and the risk of nursing home admission and mortality in older persons

Background/Objectives: This study aimed to investigate whether higher homocysteine and lower vitamin B12 concentrations increase the risk of future nursing home (NH) admission and all-cause mortality in independently living older persons. Subjects/Methods: In total, 1117 independently living participants (mean age = 75.1, s.d. = 6.4) were included in this prospective sub-study of the Longitudinal Aging Study Amsterdam. EDTA plasma samples, collected in 1995-1996, were analysed for total homocysteine (umol/l). Time to NH admission was assessed using a follow-up until 2002-2003. In addition, we studied mortality until 1 June 2007. Cox proportional hazards models were used to examine the association between homocysteine in quartiles and risk of NH admission and mortality. Results: During follow-up, 126 persons (11.3%) were admitted to NHs, and 513 persons (45.9%) deceased. In men, no significant associations were observed. In women, after adjustment for confounding, the highest quartile of homocysteine was associated with a significantly higher risk of NH admission compared with the first quartile (hazard ratio (HR) = 2.97, 95% confidence interval (CI) = 1.36-6.49). Both women in the third and the fourth quartile of homocysteine had a significantly higher mortality risk (HR = 1.70, 95% CI = 1.08-2.65 and HR = 1.91, 95% CI = 1.22-3.00, respectively) compared with the first quartile. Vitamin B12 was not related to an increased risk of NH admission and mortality. Conclusions: Elevated plasma homocysteine is associated with an increased risk of NH admission and mortality in older women, but not in older men. European Journal of Clinical Nutrition (2012) 66, 188-195; doi: 10.1038/ejcn.2011.186; published online 9 November 2011 Keywords: homocysteine; vitamin B12; nursing homes; mortality; aged
Introduction In the older population, elevated plasma homocysteine concentrations are present in 30-50% of the persons (de Bree et al., 2005). Plasma homocysteine concentrations are influenced by a complex interaction [...]