title: Biochemical risk indices, including plasma homocysteine, that prospectively predict mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over.
abstract: Predictive power, for total and vascular mortality, of selected indices measured at baseline in the British National Diet and Nutrition Survey (community-living subset) of People Aged 65 Years and Over was tested. Mortality status and its primary and underlying causes were recorded for 1100 (mean age 76.7 (sd 7.5) years, 50.2% females) respondents from the baseline survey in 1994-5 until September 2008. Follow-up data analyses focussed especially on known predictors of vascular disease risk, together with intakes and status indices of selected nutrients known to affect, or to be affected by, these predictors. Total mortality was significantly predicted by hazard ratios of baseline plasma concentrations (per sd) of total homocysteine (tHcy) (95% CI) 1.19 (1.11, 1.27), pyridoxal phosphate 0.90 (0.81, 1.00), pyridoxic acid 1.10 (1.03, 1.19), alpha1-antichymotrypsin 1.21 (1.13, 1.29), fibrinogen 1.14 (1.05, 1.23), creatinine 1.20 (1.10, 1.31) and glycosylated Hb 1.23 (1.14, 1.32), and by dietary intakes of energy 0.87 (0.80, 0.96) and protein 0.86 (0.77, 0.97). Prediction patterns and significance were similar for primary-cause vascular mortality. The traditional risk predictors plasma total and HDL cholesterol were not significant mortality predictors in this age group, nor were the known tHcy-regulating nutrients, folate and vitamin B12 (intakes and status indices). Model adjustment for known risk predictors resulted in the loss of significance for some of the afore-mentioned indices; however, tHcy 1.34 (1.04, 1.73) remained a significant predictor for vascular mortality. Thus, total and primary vascular mortality is predicted by energy and protein intakes, and by biochemical indices including tHcy, independent of serum folate or vitamin B12.
authors.affiliation: MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK. chris.bates@mrc-hnr.cam.ac.uk
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Bates
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Mansoor
authors.forename: Kristina D
authors.initials: KD
authors.lastname: Pentieva
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Gita D
authors.initials: GD
authors.lastname: Mishra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D002918:Chymotrypsin / Q000037:antagonists & inhibitors; D003404:Creatinine / Q000097:blood; D004034:Diet Surveys; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D009026:Mortality; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D006113:United Kingdom; D014652:Vascular Diseases / Q000097:blood* / Q000401:mortality; D014803:Vitamin B Complex / Q000097:blood
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D002918:Chymotrypsin; D003404:Creatinine; D004044:Dietary Proteins; D005340:Fibrinogen; D006442:Glycated Hemoglobin; D006710:Homocysteine; D014803:Vitamin B Complex
references.citation: Cardiology. 2007;107(1):52-6
references.pmid: 16763372
references.citation: Am J Clin Nutr. 1999 Mar;69(3):467-75
references.pmid: 10075332
references.citation: Am J Epidemiol. 1996 May 1;143(9):845-59
references.pmid: 8610698
references.citation: Br J Nutr. 1999 Mar;81(3):191-201
references.pmid: 10434845
references.citation: JAMA. 2002 Oct 23-30;288(16):2015-22
references.pmid: 12387654
references.citation: Arch Intern Med. 1999 May 24;159(10):1077-80
references.pmid: 10335684
references.citation: Ann Intern Med. 1999 Sep 7;131(5):321-30
references.pmid: 10475884
references.citation: Circulation. 2006 Mar 28;113(12):1572-7
references.pmid: 16549639
references.citation: Br J Nutr. 2007 Sep;98(3):593-9
references.pmid: 17442130
references.citation: Eur J Clin Nutr. 1997 Oct;51(10):691-7
references.pmid: 9347290
references.citation: J Nutr. 2006 Jun;136(6 Suppl):1731S-1740S
references.pmid: 16702348
references.citation: Clin Chim Acta. 1999 Feb;280(1-2):101-11
references.pmid: 10090528
references.citation: Nutr Metab Cardiovasc Dis. 2006 Mar;16(2):113-20
references.pmid: 16487911
references.citation: Circulation. 2004 Feb 10;109(5):601-6
references.pmid: 14769681
references.citation: J Nutr Health Aging. 2009 Aug;13(7):587-93
references.pmid: 19621193
references.citation: J Intern Med. 2005 Mar;257(3):255-62
references.pmid: 15715682
references.citation: Heart. 1999 Oct;82(4):448-54
references.pmid: 10490559
references.citation: N Engl J Med. 2004 Apr 1;350(14):1387-97
references.pmid: 15070788
references.citation: BMJ. 2002 Nov 23;325(7374):1202
references.pmid: 12446535
references.citation: Diabet Med. 2004 Jul;21(7):677-84
references.pmid: 15209758
references.citation: Anal Biochem. 1992 Feb 1;200(2):218-29
references.pmid: 1632485
references.citation: Am J Cardiol. 2002 Sep 15;90(6):591-5
references.pmid: 12231082
references.citation: Am J Clin Nutr. 2001 Jul;74(1):130-6
references.pmid: 11451728
references.citation: J Nutr. 2008 Jun;138(6):1121-8
references.pmid: 18492844
references.citation: J Nutr. 2006 Jun;136(6 Suppl):1726S-1730S
references.pmid: 16702347
references.citation: Br J Nutr. 2007 Jun;97(6):1138-43
references.pmid: 17367569
references.citation: N Engl J Med. 1997 Jul 24;337(4):230-6
references.pmid: 9227928
references.citation: Public Health Nutr. 1999 Dec;2(4):529-35
references.pmid: 10656472
references.citation: Am J Geriatr Cardiol. 2002 Mar-Apr;11(2):101-7
references.pmid: 11872968
references.citation: Arch Intern Med. 2000 Jun 26;160(12):1834-40
references.pmid: 10871978
references.citation: J Hypertens. 2006 May;24(5):851-9
references.pmid: 16612246
references.citation: BMJ. 1998 Mar 21;316(7135):894-8
references.pmid: 9569395
references.citation: Nutr Metab Cardiovasc Dis. 2010 Jan;20(1):15-21
references.pmid: 19364638
references.citation: Circulation. 2000 Sep 12;102(11):1227-32
references.pmid: 10982535
references.citation: BMJ. 2009 Jan 08;338:a3083
references.pmid: 19131384
references.citation: Br J Nutr. 2002 Jan;87(1):71-9
references.pmid: 11895315
references.citation: N Engl J Med. 2008 May 15;358(20):2107-16
references.pmid: 18480203
references.citation: Am J Geriatr Psychiatry. 2011 Jan;19(1):72-8
references.pmid: 20808095