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Original Contribution
April 7, 1999

Distribution of and Factors Associated With Serum Homocysteine Levels in Children: Child and Adolescent Trial for Cardiovascular Health

Author Affiliations

Author Affiliations: New England Research Institutes, Watertown, Mass (Drs Osganian and Feldman); Departments of Nutrition (Drs Stampfer and Rimm), Epidemiology (Drs Stampfer, Spiegelman, and Rimm), and Biostatistics (Dr Spiegelman), School of Public Health, Harvard University and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University (Drs Stampfer and Rimm), Boston, Mass; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Cutler); Departments of Biostatistics and Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La (Dr Webber); Center for Health Promotion Research and Development, University of Texas Health Science Center, Houston (Dr Montgomery); Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Lytle); Division of Community Pediatrics, University of California, San Diego (Dr Nader); and Lipoprotein Analysis Laboratory, Miriam Hospital and School of Medicine, Brown University, Providence, RI (Dr Bausserman).

JAMA. 1999;281(13):1189-1196. doi:10.1001/jama.281.13.1189

Context Although evidence suggests that homocysteine is a risk factor for cardiovascular disease in adults, little information exists on homocysteine levels in children.

Objectives To describe the distribution of serum homocysteine concentrations among children and to examine the association between homocysteine levels and several characteristics, including serum levels of folic acid and vitamins B12 and B6.

Design Cross-sectional analysis.

Setting School-based cohort from California, Louisiana, Minnesota, and Texas.

Participants A total of 3524 US schoolchildren, aged 13 and 14 years, from the Child and Adolescent Trial for Cardiovascular Health (completed in 1994). Measurement was conducted in 1997.

Main Outcome Measure Nonfasting serum total homocysteine concentration.

Results The distribution of homocysteine values ranged from 0.1 to 25.7 µmol/L (median, 4.9 µmol/L). Geometric mean homocysteine concentration was significantly higher in boys (5.22 µmol/L) than girls (4.84 µmol/L); blacks (5.51 µmol/L) than whites (4.96 µmol/L) or Hispanics (4.93 µmol/L); nonusers of multivitamins (5.09 µmol/L) than users (4.82 µmol/L); and smokers (5.19 µmol/L) than nonsmokers (5.00 µmol/L). Serum homocysteine was significantly inversely correlated with serum levels of folic acid (r=−0.36; P=.001), vitamin B12 (r=−0.21; P=.001), and vitamin B6 (r=−0.18; P=.001). Serum homocysteine was not significantly associated with serum lipid levels or family history of cardiovascular disease and was only weakly related to body mass index and systolic blood pressure. After multivariate adjustment, homocysteine remained independently associated with sex, race, serum folic acid and vitamin B12 levels, and systolic blood pressure.

Conclusions The distribution of homocysteine levels in children is substantially lower than that observed for adults; however, a small percentage of children are still potentially at elevated risk for future cardiovascular disease. Serum folic acid may be an important determinant of homocysteine levels in children.