Folic acid and vitamin B₆ deficiencies related hyperhomocysteinemia in apparently healthy pakistani adults; is mass micronutrient supplementation indicated in this population?

Objective: To determine the plasma/serum levels of homocysteine, and vitamins folate, B₈ and B₁₂, in Pakistani healthy adults. Study Design: Cross-sectional study. Place and Duration of Study: The Aga Khan University, from October 2006 to April 2008. Methodology: Fasting levels of plasma/serum folic acid, pyridoxal phosphate (PLP), vitamin B₁₂ and homocysteine were determined in 290 apparently healthy hospital personnel from institutions in two cities of Pakistan. Spearman correlation test and linear regression analysis was conducted. Results: There were 219 males and 71 females with mean age of 46±10.5 years and mean body mass index of 23.5 ±3.8. Mean plasma homocysteine levels in Pakistani normal adults were found to be 17.95±8.4 μmol/l. Mean concentrations of plasma/serum folate, vitamin B₁₂ and PLP were found to be 5±3.9 ng/ml, 522±296 pg/ml and 21.6±14 nmol/l, respectively. Serum/plasma levels of folate, vitamin B₁₂ and PLP were negatively correlated with plasma homocysteine (rho coefficient=-0.367, p<0.001; -0.173, p=0.004; -0.185, p=0.002, respectively). Serum folate and plasma PLP levels were inversely related with plasma homocysteine, adjusted for gender, age, smoking and body mass index (p<0.001 and p=0.003, respectively). Percent deficiency values of folate, vitamin B₆ and vitamin B₁₂ were 39.7%, 52.8% and 6.6% respectively. Conclusion: The high levels of plasma homocysteine could indicate a reason for mass micronutrient supplementation to prevent the high incidence of cardiovascular disease observed in Pakistani population.