Dietary diversity no longer offsets the mortality risk of hyperhomocysteinaemia in older adults with diabetes: A prospective cohort study

Mark L. Wahlqvist, Lili Xiu, Meei-Shyuan Lee, Rosalind Chia Yu Chen, Kuan Ju Chen, Duo Li

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    Abstract

    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.

    Original languageEnglish
    Pages (from-to)414-423
    Number of pages10
    JournalAsia Pacific Journal of Clinical Nutrition
    Volume25
    Issue number2
    DOIs
    Publication statusPublished - 2016

    Keywords

    • Dietary diversity
    • Elderly
    • Homocysteine
    • Mortality
    • Type 2 diabetes

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