TY - JOUR
T1 - Dietary diversity no longer offsets the mortality risk of hyperhomocysteinaemia in older adults with diabetes
T2 - A prospective cohort study
AU - Wahlqvist, Mark L.
AU - Xiu, Lili
AU - Lee, Meei-Shyuan
AU - Chen, Rosalind Chia Yu
AU - Chen, Kuan Ju
AU - Li, Duo
PY - 2016
Y1 - 2016
N2 - Background and Objective: The increased mortality risk of hyperhomocysteinaemia in diabetes may be mitigated by dietary quality. Methods and Study Design: The Nutrition and Health Survey in Taiwan of 1999-2000 for elders formed this prospective cohort. Baseline health status, diet and anthropometry were documented and plasma homocysteine and biomarkers for B vitamins measured. Participants without diabetes (n=985) were referent for those who had diabetes or developed diabetes until 2006 (n=427). The effect of homocysteine on mortality risk during 1999-2008 was evaluated. Results: Men, smokers and those with poorer physical function had higher homocysteine, but less so with diabetes. Diabetes incidence was unrelated to homocysteine. In hyperhomocysteinaemia (≥15 vs < 15 μmol/L), those with diabetes had an adjusted hazard ratio (HR) (95% CI) for mortality of 1.71 (1.18-2.46); p for interaction between homocysteine and diabetes was 0.005. Without diabetes, but with hyperhomocysteinaemia and a low dietary diversity score (DDS≤4 of 6), where the joint mortality hazard for the greater DDS, (> 4) and lower homocysteine (< 15) was referent, the HR was 1.80 (1.27-2.54) with significant interaction (p=0.008); by contrast, there was no joint effect with diabetes. The contribution of DDS to mortality mitigation in hyperhomocysteinaemia could not be explained by B group vitamins, even though plasma folate was low in hyperhomocysteinaemic participants. With hyperhomocysteinaemia, heart failure was a major cause of death. Conclusions: In non-diabetic hyperhomocysteinaemia, a more diverse diet increases survival prospects independent of B group vitamins, but not in hyperhomocysteinaemic diabetes where the cardiomyopathy may be less responsive.
AB - Background and Objective: The increased mortality risk of hyperhomocysteinaemia in diabetes may be mitigated by dietary quality. Methods and Study Design: The Nutrition and Health Survey in Taiwan of 1999-2000 for elders formed this prospective cohort. Baseline health status, diet and anthropometry were documented and plasma homocysteine and biomarkers for B vitamins measured. Participants without diabetes (n=985) were referent for those who had diabetes or developed diabetes until 2006 (n=427). The effect of homocysteine on mortality risk during 1999-2008 was evaluated. Results: Men, smokers and those with poorer physical function had higher homocysteine, but less so with diabetes. Diabetes incidence was unrelated to homocysteine. In hyperhomocysteinaemia (≥15 vs < 15 μmol/L), those with diabetes had an adjusted hazard ratio (HR) (95% CI) for mortality of 1.71 (1.18-2.46); p for interaction between homocysteine and diabetes was 0.005. Without diabetes, but with hyperhomocysteinaemia and a low dietary diversity score (DDS≤4 of 6), where the joint mortality hazard for the greater DDS, (> 4) and lower homocysteine (< 15) was referent, the HR was 1.80 (1.27-2.54) with significant interaction (p=0.008); by contrast, there was no joint effect with diabetes. The contribution of DDS to mortality mitigation in hyperhomocysteinaemia could not be explained by B group vitamins, even though plasma folate was low in hyperhomocysteinaemic participants. With hyperhomocysteinaemia, heart failure was a major cause of death. Conclusions: In non-diabetic hyperhomocysteinaemia, a more diverse diet increases survival prospects independent of B group vitamins, but not in hyperhomocysteinaemic diabetes where the cardiomyopathy may be less responsive.
KW - Dietary diversity
KW - Elderly
KW - Homocysteine
KW - Mortality
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84979093876&partnerID=8YFLogxK
U2 - 10.6133/apjcn.112015.06
DO - 10.6133/apjcn.112015.06
M3 - Article
C2 - 27222426
AN - SCOPUS:84979093876
SN - 0964-7058
VL - 25
SP - 414
EP - 423
JO - Asia Pacific Journal of Clinical Nutrition
JF - Asia Pacific Journal of Clinical Nutrition
IS - 2
ER -