title: Poor nutrition and alcohol consumption are related to high serum homocysteine level at post-stroke.
abstract: OBJECTIVE
  Increased serum homocysteine (Hcy) levels have been reported to be related to the occurrence of cardio- and cerebrovascular diseases. High serum Hcy levels are also related to the development of secondary stroke and all-cause mortality. The purpose of this study was to investigate the prevalence of high serum homocysteine level and relating factors, and the change over the 10 month period post-stroke.
  
  
  METHODS
  Consecutive stroke patients who were admitted to the Asan Medical Center were enrolled. Ten months after the onset of stroke, an interview with a structured questionnaire was performed and blood samples were obtained for the biochemical parameters. Nutritional status was determined using the mini nutritional assessment (MNA) score and dietary nutrient intakes were also obtained using a 24 hour recall method.
  
  
  RESULTS
  Out of 203 patients, 84% were malnourished or at risk of malnutrition, and 26% had high homocysteine levels at 10 months post-stroke. Using logistic regression, the factors related with high homocysteine levels at 10 months post-stroke included heavy alcohol consumption (P = 0.020), low MNA scores (P = 0.026), low serum vitamin B12 (P = 0.021) and low serum folate levels (P = 0.003). Of the 156 patients who had normal homocysteine levels at admission, 36 patients developed hyperhomocysteinemia 10 months post-stroke, which was related to heavy alcohol consumption (P = 0.013). Persistent hyperhomocysteinemia, observed in 22 patients (11%), was related to male sex (P = 0.031), old age (P = 0.042), low vitamin B6 intake (P = 0.029), and heavy alcohol consumption (P = 0.013).
  
  
  CONCLUSIONS
  Hyperhomocysteinemia is common in post-stroke, and is related to malnutrition, heavy alcohol drinking and low serum level of folate and vitamin B12. Strategies to prevent or manage high homocysteine levels should consider these factors.
authors.affiliation: Department of Nursing Science, Suwon University, Gyeonggi 447-743, Korea.
authors.forename: Seung-Hye
authors.initials: SH
authors.lastname: Choi
authors.affiliation: College of Nursing & Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongro-Gu, Seoul 110-799, Korea.
authors.forename: Smi
authors.initials: S
authors.lastname: Choi-Kwon
authors.affiliation: Nutritional Science, Department of Agriculture and Natural Resources, Michigan State University 48109, USA.
authors.forename: Min-Sun
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Jong-Sung
authors.initials: JS
authors.lastname: Kim
keywords: Homocysteine; alcohol consumption; nutritional status; stroke