Re: Re: MTFHR & low homocysteine (hypohomocysteinemia)

[Guest guest]

1: Am J Kidney Dis. 2003 Nov;42(5):864-81.

Malnutrition-inflammation complex syndrome in dialysis patients: causes and

consequences.

Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD.

Division of Nephrology and Hypertension, Geffen School of Medicine at UCLA,

Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA. kamkal@...

Protein-energy malnutrition (PEM) and inflammation are common and usually

concurrent in maintenance dialysis patients. Many factors that appear to lead to

these 2 conditions overlap, as do assessment tools and such criteria for

detecting them as hypoalbuminemia. Both these conditions are related to poor

dialysis outcome. Low appetite and a hypercatabolic state are among common

features. PEM in dialysis patients has been suggested to be secondary to

inflammation; however, the evidence is not conclusive, and an equicausal status

or even opposite causal direction is possible. Hence, malnutrition-inflammation

complex syndrome (MICS) is an appropriate term. Possible causes of MICS include

comorbid illnesses, oxidative and carbonyl stress, nutrient loss through

dialysis, anorexia and low nutrient intake, uremic toxins, decreased clearance

of inflammatory cytokines, volume overload, and dialysis-related factors. MICS

is believed to be the main cause of erythropoietin hyporesponsiveness, high rate

of cardiovascular atherosclerotic disease, decreased quality of life, and

increased mortality and hospitalization in dialysis patients. Because MICS leads

to a low body mass index, hypocholesterolemia, hypocreatininemia, and

hypohomocysteinemia, a " reverse epidemiology " of cardiovascular risks can occur

in dialysis patients. Therefore, obesity, hypercholesterolemia, and increased

blood levels of creatinine and homocysteine appear to be protective and

paradoxically associated with a better outcome. There is no consensus about how

to determine the degree of severity of MICS or how to manage it. Several

diagnostic tools and treatment modalities are discussed. Successful management

of MICS may ameliorate the cardiovascular epidemic and poor outcome in dialysis

patients. Clinical trials focusing on MICS and its possible causes and

consequences are urgently required to improve poor clinical outcome in dialysis

patients.

PMID: 14582032 [PubMed - in process]

2: J Nutr. 1996 Apr;126(4 Suppl):1244S-8S.

The Hordaland homocysteine study: the opposite tails odds ratios reveal

differential effects of gender and intake of vitamin supplements at high and low

plasma total homocysteine concentrations.

Refsum H, Nygard O, Kvale G, Ueland PM, Vollset SE.

Department of Clinical Biology, Division of Pharmacology, University of Bergen,

Bergen, Norway.

Both female sex and intake of vitamin supplements are known to be associated

with a low mean plasma homocysteine level. In the present study, we used

multiple logistic regression analyses to investigate the relation between these

two variables and plasma homocysteine at the extreme ends of the plasma

homocysteine distribution curve. We propose that the obtained set of odds ratios

for hyper- and hypohomocysteinemia, referred to as the opposite tails odds

ratios, may be an alternative approach to study determinants of plasma

homocysteine.

PMID: 8642464 [PubMed - indexed for MEDLINE]

Binstock wrote:

>There are probably several factors (biological substances, physiological

>pathways) whereby homocysteine might be low. Generally speaking, a child

>with chronically low homocysteine is probably less likely to have a weak

>MTHFR allele.

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>Kim Drummond wrote:

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>>, Just for clarification, if our child has chronically low

>>homocysteine, can we assume this test to be of no value? I am

>>struggling to get all this MTHFR stuff straight...Kim

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>Many frequently asked questions and answers can be found at

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