Background and objective: The increased mortality risk of hyperhomocysteinaemia in diabetes may be mitigated by dietary quality.
Methods and study design: The Nutrition and Health Survey in Taiwan of 1999-2000 for elders formed this prospective cohort. Baseline health status, diet and anthropometry were documented and plasma homocysteine and biomarkers for B vitamins measured. Participants without diabetes (n=985) were referent for those who had diabetes or developed diabetes until 2006 (n=427). The effect of homocysteine on mortality risk during 1999-2008 was evaluated.
Results: Men, smokers and those with poorer physical function had higher homocysteine, but less so with diabetes. Diabetes incidence was unrelated to homocysteine. In hyperhomocysteinaemia (>=15 vs <15 μmol/L), those with diabetes had an adjusted hazard ratio (HR) (95% CI) for mortality of 1.71 (1.18-2.46); p for interaction between homocysteine and diabetes was 0.005. Without diabetes, but with hyperhomocysteinaemia and a low dietary diversity score (DDS <=4 of 6), where the joint mortality hazard for the greater DDS, (>4) and lower homocysteine (<15) was referent, the HR was 1.80 (1.27-2.54) with significant interaction (p=0.008); by contrast, there was no joint effect with diabetes. The contribution of DDS to mortality mitigation in hyperhomocysteinaemia could not be explained by B group vitamins, even though plasma folate was low in hyperhomocysteinaemic participants. With hyperhomocysteinaemia, heart failure was a major cause of death.
Conclusions: In non-diabetic hyperhomocysteinaemia, a more diverse diet increases survival prospects independent of B group vitamins, but not in hyperhomocysteinaemic diabetes where the cardiomyopathy may be less responsive.
背景與目的：飲食品質可能減輕糖尿病患因高同半胱氨酸血症增加的死亡風 險。方法與研究設計：1999 - 2000 年臺灣老人營養健康狀況調查形成這個前瞻 世代。基線健康狀況、飲食和體位測量被記錄，血漿同半胱氨酸和B 群維生 素生物標記被測量。非糖尿病的參與者（n=985）當作那些已經有糖尿病或至 2006 年期間發生糖尿病者（n=427）之參考組，評估參與者於1999-2008 年間 同半胱氨酸對死亡風險的影響。結果：男性、吸菸者和那些身體生理功能較差 者，有較高的同半胱氨酸，但糖尿病患者並非如此。糖尿病發生率與同半胱氨 酸無關。在高同半胱氨酸寫症患者中（>=15 vs <15 mol/ L），患有糖尿病者， 其調整後之死亡危害比（HR）及95％信賴區間為1.71（1.18-2.46）；同半胱 氨酸與糖尿病之間的交互作用p 值0.005。非糖尿病患者，以有較高的飲食多 樣性得分（DDS >4）及較低的同半胱氨酸血症者為參考組，高同半胱氨酸血 症者加上較低的DDS（<=4）的聯合死亡風險更大HR 為1.80 （1.27-2.54）及 顯著的交互作用（p=0.008）；相較之下，對糖尿病並無聯合作用。儘管有高 同半胱氨酸血症的參與者其血漿葉酸濃度較低，DDS 減輕同半胱氨酸血症對 死亡的貢獻並無法被維生素B 群所解釋。心臟衰竭是高同半胱氨酸血症參與 者的主要死因。結論：在非糖尿病的高同半胱氨酸血症患者，無論維生素B 群的狀況，較多樣化的飲食可以增加存活率。但是，對高同半胱氨酸血症的糖 尿病患者，其心肌病變對飲食的反應可能較差。.