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Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 46-48

Effect of age on serum homocysteine level among adult urban population of Manipur

1 Department of Physiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication17-Aug-2013

Correspondence Address:
Kshetrimayum Lakshmikumar
Department of Physiology, Regional Institute of Medical Sciences, Imphal, Manipur
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Source of Support: Financial assistance provided partly by my Institution, Regional Institute of Medical Sciences, Imphal and partly by DBT Nodal Cell, Tezpur University, Assam., Conflict of Interest: None

DOI: 10.4103/0972-4958.116642

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Objective: To determine the effect of age on serum homocysteine (Hcy) level among adult urban population of Manipur. Materials and Methods: A total of 200 serum samples (98 males and 102 females) were taken from the adult urban population of Manipur within the age group 20-60 years. Estimation of serum Hcy level was carried out by enzyme linked immunosorbent assay method using axis Hcyenzyme immunoassay kit from Ranbaxy Diagnostic Ltd., India in the Department of Physiology, Regional Institute of Medical Sciences, Imphal. Results: The mean serum Hcy level was 14.62 ± 11.46 μmol/L. Serum Hcy level increases with age from 20 to 29 year age group till 40-49 year age group (P > 0.001). 37% of the subjects studied have normal serum Hcy level. Conclusion: Serum Hcy level was positively associated with age but the association was not linear.

Keywords: Homocysteineage, Healthy population, Hyperhomocysteinemia

How to cite this article:
Lakshmikumar K, Gomti KD, Shugeta ND, Arbind RS. Effect of age on serum homocysteine level among adult urban population of Manipur. J Med Soc 2013;27:46-8

How to cite this URL:
Lakshmikumar K, Gomti KD, Shugeta ND, Arbind RS. Effect of age on serum homocysteine level among adult urban population of Manipur. J Med Soc [serial online] 2013 [cited 2021 Jun 21];27:46-8. Available from:

  Introduction Top

Homocysteine (Hcy) is sulfur-containing non-essential amino acid exclusively formed as an intermediary product of methionine metabolism. It is not obtained from diet and is not incorporated into proteins. [1] The normal value of serum Hcy ranges from 5 to 15 μmol/L. Hyperhomocysteinemia is a term used to refer elevated level of Hcy in plasma generally >15 μmol/L. [1],[2]

Elevated Hcy is a marker of vitamin B 12 and folic acid deficiency especially, in cases of subtle or atypical deficiency, where the classical signs are lacking. It is also an independent risk-factor for various cardiovascular disease, stroke, diabetes mellitus, pregnancy associated complications such as Intrauterine growth retardation (IUGR), pre-eclampsia, and placental abortion. [3]

Difference in genetic, dietary, and life-style profile restricts the generalization of results from other ethnic groups to the Asian Indians and to be more specific to our state. Several studies have attempted to determine the factors involved in regulating Hcy; however, majority of previous reports are based on clinical studies and therefore may not represent community prevalence. This study is an attempt to document the reference level of serum Hcy level among the different age group of adults in the region.

  Materials and Methods Top

The study was a cross-sectional study type carried out in the Department of Physiology, Regional Institute of Medical Sciences, Imphal, during the period from November 2010 to August 2012 after getting approval from the Institutional Ethics Committee. A total of 200 serum samples were selected from the healthy adult urban population of Manipur from within the age group 20-60 years in both sexes. A detailed history and physical examination were taken. Twomilliliters of fasting venous blood was drawn after taking a written informed consent. Estimation of serum Hcy level was carried out by enzyme linked immunosorbent assay method using axis Hcyenzyme immunoassay kit from Ranbaxy Diagnostic Ltd., India. Comparison was done by dividing the subjects into four age groups: 20-29 years age group, 30-39 years age group, 40-49 years age group, and lastly 50-60 years age group, respectively. Descriptive statistical analysis, cross-tabulation, Spearman's correlation test were applied using statistical software. A P value of less than 0.005 was used to indicate statistical significance in all the analyses.

  Results Top

The mean age of the subjects was 37.95 ± 11.60 years. Highest percentage of subjects included in the sample belongs to the age group 20-29 years (32.5%) with female subject's preponderance (51%) [Table 1]. Serum Hcy level in the community ranges from 2 to 67 μmol/L with a mean concentration of 14.62 ± 11.46 μmol/L. The mean serum Hcy level in different age group and their patterns of distribution are shown in [Figure 1] and [Table 2]. The age group 40-49 years has the highest serum Hcy level (18.41 μmol/L). Hyperhomocysteinemia was most common in the oldest age group (63.4%).
Table 1: Distribution of subjects according to age and sex

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Table 2: Patterns of distribution of serum homocysteine level in different age group

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Figure 1: Mean serum Homocysteine levels in different age-group

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Hcy was positively correlated with age, weight, body mass index (BMI), systolic blood pressure, and diastolic blood pressure (DBP). However, the correlation between serum Hcy and BMI as well as Hcy with DBP were not statistically significant [Table 3].
Table 3: Correlation of serum homocysteine level with selected variables in subjects studied

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  Discussion Top

Any direct relation of Hcy with age is not observed in the present study. Serum Hcy increase with age from 20 to 29 year age group till 40-49 year age group. However, in the oldest age group of 50-60 years, there was a slight decline in serum Hcy level. These findings are somewhat different compare to studies done earlier. [4],[5],[6]

Changes in renal function, impaired renal metabolism of Hcy or vitamin status, or both [1] may be responsible in part for the age-related changes in Hcy concentration. Other factors such as fat free lean body mass, muscle mass and life-style factors, must have affected the age related changes in Hcy concentration. Smokers are mostly in the age group of 40-49 years (6 out of 9 smokers) in the present study. These may have confounded the effect of age on serum Hcy level as higher Hcy levels are observed in smokers. [1]

The mean serum Hcy level (14.62 ± 11.47 μmol/L) and hyperhomocysteinemia prevalence (43%) found in the present study are similar with other Indian studies. [7],[8] However, some Indian studies and many western and other European countries have reported much lower levels. [1],[4],[9] Several factors (methodology of the assay, definition of normal values, mean age, dietary factor, genetic factor, etc.) may explain markedly different mean levels of serum Hcy and variations in the prevalence rates of hyperhomocysteinemia in Asian Indians, other Indian states and the present study.

An important factor may be because of the inequalities in the dietary habits. The dietary vitamins B 6 , B 12 and folate and their synthetic oral counterparts, pyridoxine hydrochloride, cyanocobalamin and folic acid, serve as precursors of the cofactors for Hcy metabolism. Folate and vitamin B 12 deficiency may result in considerable hyperhomocysteinemia. [3] In a study done by Devi et al.[10] in Manipur, the incidence of megaloblastic anemia as a cause of pancytopenia was reported to be 18%. Unlike other Indian studies, most of the subjects in the present study except a single subject were non-vegetarian. Since, food habits and diet are different from rest of other Indian states, further research are needed to correlate vitamin status and serum Hcy level in order to document that the former is related to the prevalent hyperhomocysteinemia in the region.

Another factor that would have predisposed the subjects to hyperhomocysteinemia may be a genetic defect in the enzymes that metabolizes Hcy, especially, 5,10-methylenetetrahydrofolate reductase (MTHFR). MTHFR is an enzyme involved in the transmethylation of Hcy to methionine. Two polymorphisms of the MTHFR enzyme commonly exists amongst Indians viz. C677T and A1298C. [11] Compared to other factor, however, the effect of genetic factors in raising the Hcy level seems to be modest. Reference documented studies regarding MTHFR polymorphism in our region in particular, is limited.

  Conclusion Top

The present work established the reference intervals for serum Hcy for adult urban Manipuri subjects aged 20-60 years. The findings of this urban population based, 2 years study suggest that the prevalence of hyperhomocysteinemia is high in the population sample. Elderly group (50-60 years) are more affected.

Our understanding of factors that influence circulating Hcy concentrations are still incomplete. Dietary factor that is an important determinant needs to be further assessed, if possible through further studies in concluding the fact that aged population and others at risk can avoid the possible outcome through simple Hcy lowering measures as vitamin supplementation.

  References Top

1.Nygård O, Vollset SE, Refsum H, Brattström L, Ueland PM. Total homocysteine and cardiovascular disease. J Intern Med 1999;246:425-54.  Back to cited text no. 1
2.Ueland PM, Refsum H. Plasma homocysteine, a risk factor for vascular disease: Plasma levels in health, disease, and drug therapy. J Lab Clin Med 1989;114:473-501.  Back to cited text no. 2
3.Ueland PM, Refsum H, Stabler SP, Malinow MR, Andersson A, Allen RH. Total homocysteine in plasma or serum: Methods and clinical applications. Clin Chem 1993;39:1764-79.  Back to cited text no. 3
4.Ganji V, Kafai MR. Demographic, lifestyle, and health characteristics and serum B vitamin status are determinants of plasma total homocysteine concentration in the post-folic acid fortification period, 1999-2004. J Nutr 2009;139:345-52.  Back to cited text no. 4
5.Saw SM, Yuan JM, Ong CN, Arakawa K, Lee HP, Coetzee GA, et al. Genetic, dietary, and other lifestyle determinants of plasma homocysteine concentrations in middle-aged and older Chinese men and women in Singapore. Am J Clin Nutr 2001;73:232-9.  Back to cited text no. 5
6.Pfeiffer CM, Osterloh JD, Kennedy-Stephenson J, Picciano MF, Yetley EA, Rader JI, et al. Trends in circulating concentrations of total homocysteine among US adolescents and adults: Findings from the 1991-1994 and 1999-2004 National health and nutrition examination surveys. Clin Chem 2008;54:801-13.  Back to cited text no. 6
7.Puri A, Gupta OK, Dwivedi RN, Bharadwaj RP, Narain VS, Singh S. Homocysteine and lipid levels in young patients with coronary artery disease. J Assoc Physicians India 2003;51:681-5.  Back to cited text no. 7
8.Angeline T, Aruna RM, Ramadevi K, Mohan G, Jeyaraj N. Homocysteine status and acute myocardial infarction among Tamilians. Indian J Clin Biochem 2005;20:18-20.  Back to cited text no. 8
9.Deepa R, Velmurugan K, Saravanan G, Karkuzhali K, Dwarakanath V, Mohan V. Absence of association between serum homocysteine levels and coronary artery disease in south Indian males. Indian Heart J 2001;53:44-7.  Back to cited text no. 9
10.Devi PM, Laishram RS, Sharma PS, Ahongshangbam MS, Moirangthem KS, Yanglem MS. Clinico-hematological profile of pancytopenia in Manipur, India. Kuwait Med J 2008;40:221-4.  Back to cited text no. 10
11.Kalita J, Srivastava R, Bansal V, Agarwal S, Misra UK. Methylenetetrahydrofolate reductase gene polymorphism in Indian stroke patients. Neurol India 2006;54:260-3.  Back to cited text no. 11
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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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