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(Circulation. 2000;102:852.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Effect of Dietary Patterns on Serum Homocysteine

Results of a Randomized, Controlled Feeding Study

Lawrence J. Appel, MD, MPH; Edgar R. Miller, III, MD, PhD; Sun Ha Jee, PhD; Rachael Stolzenberg-Solomon, PhD, MPH; RD; Pao-Hwa Lin, PhD; Thomas Erlinger, MD, MPH; Marie R. Nadeau, MS; Jacob Selhub, PhD

From Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md (L.J.A., E.R.M., T.E.); the Department of Epidemiology and Disease Control, Graduate School of Health Science and Management, Yonsei University, Seoul, Korea (S.H.J.); Cancer Prevention Studies Branch, National Cancer Institute, Bethesda, Md (R.S.-S.); Sarah W. Stedman Center for Nutritional Studies, Duke University Medical Center, Durham, NC (P.-H.L.); and the US Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University, Boston, Mass (M.R.N., J.S.).

Correspondence to Lawrence J. Appel, MD, MPH, Johns Hopkins University, 2024 E Monument St, Suite 2-645, Baltimore, MD 21205-2223. E-mail lappel{at}welch.jhu.edu

Background—Elevated blood levels of homocysteine are associated with an increased risk of atherosclerotic cardiovascular disease. Although numerous studies have assessed the impact of vitamin supplements on homocysteine, the effect of dietary patterns on homocysteine has not been well studied.

Methods and Results—During a 3-week run-in, 118 participants were fed a control diet, low in fruits, vegetables, and dairy products, with a fat content typical of US consumption. During an 8-week intervention phase, participants were then fed 1 of 3 randomly assigned diets: the control diet, a diet rich in fruits and vegetables but otherwise similar to control, or a combination diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat. Between the end of run-in and intervention periods, mean change in homocysteine was +0.46 µmol/L in the control diet, +0.21 µmol/L in the fruits and vegetables diet (P=0.47 compared with control), and -0.34 µmol/L in the combination diet (P=0.03 compared with control, P=0.12 compared with the fruits and vegetables diet). In multivariable regression models, change in homocysteine was significantly and inversely associated with change in serum folate (P=0.03) but not with change in serum vitamin B₁₂ (P=0.64) or pyridoxal 5' phosphate, the coenzyme form of vitamin B₆ (P=0.83).

Conclusions—Modification of dietary patterns can have substantial effects on fasting levels of total serum homocysteine. These results provide additional insights into the mechanisms by which diet might influence the occurrence of atherosclerotic cardiovascular disease.

Key Words: nutrition • risk factors • metabolism

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