Prevalence and Determinants of Hyperhomocysteinemia in School Aged Children in Rural Nepal

Limited data are available on hyperhomocysteinemia (HHcy) in school aged children in South Asia. We determined prevalence of HHcy (>;12μmol/l) and its association with vitamins B12, B6, and folate and dietary patterns in 6–8 y old children in rural Nepal. Homocysteine and B‐vitamins were assessed in plasma samples from 1000 children, randomly selected from a bioarchive of 3524 children born to mothers who had previously participated in an antenatal micronutrient supplementation trial. Prevalence of HHcy was 18.4%, and vitamin B12 deficiency (<150 pmol/L), low folate (<13.6 nmol/L), and vitamin B6 deficiency (pyridoxal phosphate < 20 nmol/L) occurred in 18%, 6%, and 43% of children, respectively. HHcy increased with vitamin B12 deficiency [OR=5.8, 95%CI=4.0–8.3; P<0.001] and low folate [OR=2.21, 95% CI=1.28–3.92, P=0.004] but not vitamin B6 deficiency [OR=0.73, 95% CI=0.52–1.01; P=0.06]. Food consumption data for the week prior to sample collection was assessed using factor analysis, revealing three distinct dietary patterns. Highest intakes of one pattern were protective against HHcy, while another conferred risk of HHcy. Dietary patterns and micronutrient deficiencies contribute to HHcy, which was unexpectedly high in these children, potentially signaling future cardiovascular disease risk. Support: Bill and Melinda Gates Foundation Grants 614 and 5241.