title: Subclinical protein malnutrition is a determinant of hyperhomocysteinemia.
abstract: OBJECTIVE
  Hyperhomocysteinemia is regarded as a public health problem of increasing importance likely to contribute to vascular disorders and premature mortality. Folate, cobalamin, pyridoxine, and riboflavin dietary deficiencies are currently regarded as causative factors. However, several investigations have indicated that the theory of vitamin B deprivation provides only a partial explanation for the observed abnormalities of sulfur-containing amino acids. We investigated the potential contributory role played by protein malnutrition.
  
  
  METHODS
  For that purpose, three cohorts of 20 adult patients presenting stage I, II, and III goiter underwent careful medical history, dietary inquiry, and clinical examination. Their overall health and nutrition states were assessed with classic anthropometry, measurement of vitamin B blood parameters, visceral protein markers, essential amino acids, total homocysteine, and cystathionine.
  
  
  RESULTS
  The concentrations of transthyretin, seven essential amino acids, and cystathionine progressively decreased as the thyroid gland increased. Methionine was the sole essential amino acid whose values did not change; total homocysteine was unique in that increased levels correlated negatively with transthyretin values. Taken together, the data point to a progressive deterioration of protein nutrition status impairing the transsulfuration pathway and is best explained by an acquired defect of cystathionine-beta-synthase activity.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia may arise from the shrinking of endogenous nitrogen pools as a result of decreased protein intake or stress-induced increased losses. Raised total homocysteine may result from the attempt of the malnourished and/or stressed body to preserve methionine homeostasis.
authors.affiliation: Laboratories of Nutrition Faculty of Pharmacy, University Louis Pasteur Strasbourg, Illkirch, France. ingen@pharma.u-strasbg.fr
authors.forename: Yves
authors.initials: Y
authors.lastname: Ingenbleek
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hardillier
authors.forename: Louis
authors.initials: L
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000601:Amino Acids, Essential / Q000097:blood / Q000378:metabolism; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D016000:Cluster Analysis; D015331:Cohort Studies; D003541:Cystathionine beta-Synthase / Q000378:metabolism; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D006042:Goiter / Q000150:complications* / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011228:Prealbumin / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000378:metabolism; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology / Q000378:metabolism; D014804:Vitamin B Deficiency / Q000150:complications
chemical_list: D000601:Amino Acids, Essential; D015415:Biomarkers; D004044:Dietary Proteins; D011228:Prealbumin; D003541:Cystathionine beta-Synthase