title: Hyperhomocysteinaemia is not related to risk of distal somatic polyneuropathy: the Hoorn Study.
abstract: OBJECTIVE
  Distal somatic polyneuropathy is a major contributing factor in the pathogenesis of chronic foot infections and ulcers, and may lead to lower limb amputations. Both metabolic and vascular abnormalities may contribute to the development of impaired nerve function. We therefore assessed the association between hyperhomocysteinaemia, a risk factor for cardiovascular disease, and polyneuropathy.
  
  
  METHODS
  We studied an age-, sex- and glucose-tolerance-stratified random sample of a 50- to 75-year-old general Caucasian population in the Hoorn Study (N = 629). Any polyneuropathy (N = 95) was defined as the absence of at least two of the three following sensory modalities or reflexes of either foot: light touch sense, ankle reflex and vibration sensation. Definite polyneuropathy (N = 25) was present if, in addition, the vibration perception threshold of the right big toe was abnormal.
  
  
  RESULTS
  The prevalence of any polyneuropathy was 12.4% (33 of 266) in subjects with normal glucose tolerance (NGT), 12.6% (21 of 167) in those with impaired glucose tolerance (IGT), and 25.3% (41 of 162) in those with type 2 diabetes. The prevalence of definite polyneuropathy was 2.6% (7 of 266) in subjects with NGT, 2.4% (4 of 167) in those with IGT and 8.7% (14 of 161) in type 2 diabetic subjects. Polyneuropathy was associated with known risk factors such as diabetes, hyperglycaemia and body height. After adjustment for age, sex, HbA1c and hypertension, the odds ratio (95% CI) for any polyneuropathy per 5 micromol L-1 (about 1 SD) serum total homocysteine increment was 1.00 (0.72-1.39). After adjustment for age and sex, it was 0.62 (0.21-1.89) for definite polyneuropathy.
  
  
  CONCLUSIONS
  Although a weak relation (as judged from the confidence intervals) cannot be excluded, we conclude that hyperhomocysteinaemia is probably not related to risk of distal somatic polyneuropathy.
authors.affiliation: Institute for Resaerch in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands. ellenhgv@casema.net
authors.forename: E K
authors.initials: EK
authors.lastname: Hoogeveen
authors.forename: P J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: G D
authors.initials: GD
authors.lastname: Valk
authors.forename: F W
authors.initials: FW
authors.lastname: Bertelsmann
authors.forename: C
authors.initials: C
authors.lastname: Jakobs
authors.forename: J M
authors.initials: JM
authors.lastname: Dekker
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: C D
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000368:Aged; D015897:Comorbidity; D003929:Diabetic Neuropathies / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010523:Peripheral Nervous System Diseases / Q000097:blood / Q000453:epidemiology*; D018570:Risk Assessment