Hyperhomocysteinaemia is not related to risk of distal somatic polyneuropathy: the Hoorn Study.
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.
Hoogeveen
E K
EK
Institute for Resaerch in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands. ellenhgv@casema.net
Kostense
P J
PJ
Valk
G D
GD
Bertelsmann
F W
FW
Jakobs
C
C
Dekker
J M
JM
Nijpels
G
G
Heine
R J
RJ
Bouter
L M
LM
Stehouwer
C D
CD
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