Homocysteine metabolism may be impaired in chronic liver disease. This may contribute to fibrogenesis and disease complications.
In this study, researchers investigated the prevalence and determinants of basal and postprandial hyperhomocysteinemia in patients with chronic liver disease and after orthotopic liver transplantation (OLT).
Their findings are published in the May issue of the American Journal of Clinical Nutrition.
|Basal hyperhomocysteinemia was observed in all patient groups.|
|American Journal of Clinical Nutrition|
The team performed a cross-sectional study, which included 323 patients with chronic liver disease and 25 healthy controls. The patient group included 93 with hepatitis, 8 with fatty liver, 168 with cirrhosis, and 54 after OLT.
The team assessed portohepatovenous gradients of total homocysteine (tHcy) and methionine, and postload methionine and tHcy kinetics. Gradients were measured both before and after 10 days of supplementation with folate plus vitamin B-6.
Basal hyperhomocysteinemia was observed in all patient groups. The team found this in 34% of patients with hepatitis, 50% with fatty liver, 54% with cirrhosis, and 52% after OLT. However, it was more frequently seen in patients with elevated plasma creatinine concentrations and advanced liver disease.
The researchers determined that mean plasma folate was normal in patients with liver disease, but vitamin B-12 was elevated in cirrhosis and vitamin B-6 was low after OLT.
In addition, there were significant negative associations between tHcy and folic acid or vitamin B-12 concentrations in the controls and in patients with hepatitis and after OLT.
The team was unable to identify any systematic association between portohepatovenous differences in tHcy and methionine concentrations.
However, cirrhosis was accompanied by impaired methionine clearance.
After vitamin supplementation, the area under the tHcy curve improved in cirrhosis at nearly unchanged basal tHcy concentrations.
Dr Anja Bosy-Westphal's team concluded, "Basal hyperhomocysteinemia is seen in 50% of patients with cirrhosis and after OLT".
"Basal tHcy concentrations do not change significantly after supplementation with folate and vitamin B-6, but postprandial tHcy metabolism improves".