Meta-analysis: hyperhomocysteinaemia in inflammatory bowel diseases
A Oussalah1, J-L Guéant, L Peyrin-Biroulet
1INSERM U954, Cellular and Molecular Pathology in Nutrition, Henri Poincaré University Nancy 1, and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
Insights
Patients with inflammatory bowel diseases (IBD) have significantly higher homocysteine levels and a greater risk of hyperhomocysteinaemia compared to healthy individuals. Further research is needed to clarify the link between hyperhomocysteinaemia and thrombosis in IBD patients.
Area of Science:
- Gastroenterology
- Metabolic Medicine
- Clinical Research
Background:
- The relationship between homocysteine metabolism and inflammatory bowel diseases (IBD) is not fully understood.
- The association between hyperhomocysteinaemia and thrombosis in IBD patients is debated.
Purpose of the Study:
- To systematically review and analyze the association between homocysteine levels and IBD.
- To investigate the risk of hyperhomocysteinaemia and its link to thrombosis in IBD.
Main Methods:
- A systematic literature search was conducted using MEDLINE and conference abstracts from January 1966 to April 2011.
- Included studies evaluated plasma homocysteine levels in IBD patients.
Main Results:
- IBD patients exhibited significantly higher plasma homocysteine levels (WMD=3.75 μmol/L) and increased risk of hyperhomocysteinaemia (OR=4.65) compared to controls.
- No significant difference in homocysteine levels was observed between ulcerative colitis and Crohn's disease.
- Hyperhomocysteinaemia risk was not elevated in IBD patients with thromboembolic complications (OR=1.97).
- Lower plasma folate levels correlated with increased IBD risk related to MTHFR C677T polymorphism.
Conclusions:
- Individuals with IBD have a substantially higher risk of hyperhomocysteinaemia.
- The role of hyperhomocysteinaemia in IBD-related thrombosis warrants additional investigation.
- Folate deficiency exacerbates the impact of MTHFR C677T polymorphism on IBD risk.
Background:
The magnitude of association between homocysteine metabolism and inflammatory bowel diseases (IBD) remains unknown, whereas the association between hyperhomocysteinaemia and thrombosis remains controversial in IBD.
Aim:
To conduct a systematic review and meta-analysis to examine these issues.
Methods:
The literature search was conducted using MEDLINE database and international conference abstracts from January 1966 to April 2011 and included all studies that evaluated plasma homocysteine level in IBD.
Results:
Twenty-eight studies evaluated the plasma homocysteine level and/or hyperhomocysteinaemia risk in IBD patients. Five studies assessed the association of hyperhomocysteinaemia with thrombosis. The mean plasma homocysteine level was significantly higher in IBD patients when compared with controls (weighted mean difference (WMD)=3.75 μmol/L; 95% CI, 2.23-5.26 μmol/L; P<0.0001; reference ranges for plasma homocysteine level: 5-12 μmol/L). The mean plasma homocysteine level did not differ between ulcerative colitis (UC) and Crohn's disease (CD) (WMD=0.41 μmol/L; 95% CI, -2.45 to 3.06 μmol/L; P=0.76). The risk of hyperhomocysteinaemia was significantly higher in IBD patients when compared with controls [odds ratio (OR)=4.65; 95% CI, 3.04-7.09; P<0.0001]. The risk of hyperhomocysteinaemia was not higher among IBD patients who experienced thromboembolic complications (OR=1.97; 95% CI, 0.83-4.67; P=0.12). Plasma folate level was inversely correlated with IBD risk associated with MTHFR C677T polymorphism (P=0.006).
Conclusions:
The risk of hyperhomocysteinaemia is significantly higher in IBD patients when compared with controls. The risk assessment of hyperhomocysteinaemia-related thrombosis in IBD requires further investigation. Deficient folate status is associated with a higher impact of MTHFR C677T polymorphism on IBD risk.
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