Effect of multivitamin supplementation on the homocysteine and methylmalonic acid blood concentrations in women over the age of 60 years

Summary Background Deficiencyof folic acid, vitamin B₆and/or vitamin B₁₂ can result in elevatedtotal plasma homocysteineconcentrations (tHcy), which areconsidered to be a risk factor forvascular disease. Studies haveshown that supplementation of thethree vitamins can lower tHcyeven in subjects with tHcy in thenormal range. Aim of the study The aim of this study was to evaluate the effect of a 6 month supplementationwith vitamin B₆, B₁₂ andfolate on the concentrations of totalplasma homocysteine andserum methylmalonic acid (MMA)of elderly women. Methods Thestudy was designed as a randomizedplacebo controlled doubleblindtrial, and 220 healthy women(aged 60–91 years) were involved.The vitamin and mineral capsulecontained pyridoxine (3.4 mg),folic acid (400 µg) and cobalamin(9 µg) in addition to other micronutrients.Blood concentrationsof folate, cobalamin, tHcy, MMAand the activity coefficient of erythrocytealpha-aspartic aminotransferase(alpha-EAST) weremeasured at baseline and after 6months of supplementation. Dietaryintake was evaluated at thebeginning and the end of the interventionby two 3–day dietrecords. Results Median concentrationsof serum cobalamin, serumfolate and erythrocyte folate increasedsignificantly and tHcy andalpha–EAST activity (indicative ofimproved status of vitamin B₆) coefficientdecreased significantly inthe supplemented group. MedianMMA concentration of the supplementedgroup was significantlylower than that of the placebogroup after the intervention. Thevitamin supplementation had agreater decreasing effect on thetHcy concentration of volunteerswith lower vitamin and highertHcy initial concentrations. In alinear regression model, baselinetHcy, serum folate, age and alpha–EAST activity coefficient were significantlycorrelated with thechange in tHcy. The change inMMA in the supplement groupwas significantly associated to thebaseline MMA values. Conclusions Our results show that a 6 monthsupplementation including physiologicaldosages of B vitamins improvesthe status of these nutrientsand reduces tHcy in presumedhealthy elderly women.