Homocysteine, vitamin B12, and folate levels in patients with multiple sclerosis in Chinese population: A case-control study and meta-analysis

Pan, Lishou; Yin, Yanying; Chen, Jinying; Ma, Zhenyu; Chen, Yong; Deng, Xinbo; Zhang, Han‐Ting; Leng, Huilin; Wu, Kuaiying

doi:10.1016/j.msard.2019.101395

Cited by 17 publications

(15 citation statements)

References 32 publications

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“…However, our study found a trend that Vitamin B12 levels and MS may be associated, to some extent, but without significant (P=0.23). Some prior studies showed significant difference of Vitamin B12 levels between MS patients and controls [12,14,16], while the conclusion is not further confirmed by other studies [6,15,35] and our updated meta-analysis. Our metaanalysis of Vitamin B12 showed high heterogeneity of involved studies which could have a certain impact on the negative results.…”

Section: Discussioncontrasting

confidence: 97%

“…However, another study conducted in Greece inferred the opposite conclusion that circulating Hcy was not elevated in patients with MS [37]. Our results combining 17 studies for Hcy were in agreement with the earlier meta-analyses [14][15][16], showing that MS patients were associated with elevated Hcy levels. Increased Hcy plays a role in the myelin sheath degeneration through interfering methyl group donors, causing neuroinflammation, microglial activation and other biochemical reactions in the CNS [29,42,43].…”

Section: Discussionsupporting

confidence: 91%

“…Different results of these two studies may due to small sample sizes, genetic factors, and environmental factors. Besides, another subgroup analysis showed increased Hcy levels in relapsing or remitting MS patients, and decreased Vitamin B12 levels in relapsing MS patients compared with controls, while no difference for folate [16]. More randomized controlled trials with larger sample sizes are needed to validate the effects of Hcy on different MS clinical subtypes.…”

Section: Discussionmentioning

confidence: 98%

“…Twenty-nine articles were excluded because they did not include related information or were not written in English. Finally, a total of 17 studies were selected according to the predefined inclusion and exclusion criteria [6,11,12,16,[27][28][29][30][31][32][33][34][35][36][37][38][39]. The association between Vitamin B12 and MS has been investigated by 50 different studies.…”

Section: The Characteristics Of the Included Studiesmentioning

confidence: 99%

“…A recent meta-analysis indicated that MS patients have elevated Hcy levels compared to controls, and no significant difference of Vitamin B12 or folate was found between the two groups [15]. The latest meta-analysis published in 2019 mainly focused on Chinese population, suggesting that increased Hcy levels and reduced Vitamin B12 levels were found in Chinese MS patients [16]. However, the conclusion has not been further confirmed [6,17,18], showing that there were no significant differences of serum Hcy and Vitamin B12 levels between MS patients and controls [6].…”

Section: Introductionmentioning

confidence: 99%

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Serum levels of Homocysteine, Vitamin B12 and Folate in Patients with Multiple Sclerosis: an Updated Meta-Analysis

Li¹,

Yuan²,

Han³

et al. 2020

Int. J. Med. Sci.

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Background: Multiple sclerosis (MS) is a demyelinating and disabling inflammatory disease of the central nervous system. MS is triggered by complex environmental factors which mostly affect genetically the susceptible young people. Emerging data has suggested that changes of homocysteine (Hcy), Vitamin B12 and folate serum levels may be associated with MS. However, previous findings are not always consistent. Methods: In this study, we aimed to investigate the relationships between MS and Hcy, Vitamin B12 and folate with updated available data (until September, 2019). The diagnosis of MS was performed based on international criteria for the diagnosis of MS, including magnetic resonance imaging and cerebrospinal fluid tests. We searched the databases including PubMed, EMBASE, Cochrane Library and ScienceDirect. After data collection, separate analyses based on random-effect models were used to test for relationships between MS and Hcy, Vitamin B12 or folate blood levels. The effective sizes were estimated by the combined standardized mean difference (SMD) and associated 95% confidence interval (CI). Results: Based on the inclusion criteria, a total of 21 original studies with 1738 MS patients and 1424 controls were included in this study. There were 17 studies for measuring Hcy, 16 studies for measuring Vitamin B12 and 13 studies for measuring folate in patients with MS, respectively. Specifically, patients with MS had higher serum levels of Hcy (SMD: 0.64; 95% CI:0.33, 0.95; P <0.0001) compared with control groups. There were no significant differences of SMD for Vitamin B12 (SMD: -0.08; 95% CI: -0.35, 0.20; P=0.58) or folate (SMD: 0.07; 95% CI: -0.14, 0.28; P=0.52) between MS and controls. Subgroup analysis demonstrated that there was statistically significant difference for Hcy between relapsing-remitting MS (RRMS) patients and controls with a SMD of 0.67 (95% CI: 0.21, 1.13; P=0.004). However, no significant difference of Hcy serum levels between secondary progressive MS patients or primary progressive MS patients and controls was noted in this study. In addition, there was no significant difference of Hcy levels in females (SMD: 0.22; 95% CI: -0.16, 0.60; P=0.25) or males (SMD: 0.56; 95% CI: -0.13, 1.26; P=0.11) between MS patients and controls. Conclusions: Higher serum levels of Hcy were noted in patients with MS when compared with control groups. And the difference was especially significant between RRMS patients and controls. Hcy may play an important role in the pathogenesis of MS. Functional studies are required to assess the effects of Hcy on patients with MS at the molecular level.

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