Jacob Selhub, PhD; Paul F. Jacques, ScD; Irwin H. Rosenberg, MD; Gail Rogers, BA; Barbara A. Bowman, PhD; Elaine W. Gunter, MT; Jacqueline D. Wright, MPH; Clifford L. Johnson, MSPH
Acknowledgments: The authors thank Marie Nadeau and Gayle Petty for technical assistance and the NHANES III Surplus Sera Bank Steering Committee for support.
Grant Support: By the U.S. Department of Agriculture (agreement no. 58-1950-9-001) and the National Institutes of Health, National Heart, Lung, and Blood Institute (grant no. R01 HL52630). Any opinions, findings, conclusion, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Department of Agriculture.
Requests for Reprints: Jacob Selhub, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.
Current Author Addresses: Drs. Selhub, Jacques, and Rosenberg and Ms. Rogers: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.
Dr. Bowman: Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K261, Atlanta, GA 30341.
Ms. Gunter: Division of Environmental Health Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341.
Ms. Wright and Mr. Johnson: Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Road, Hyattsville, MD 20782.
The concentration of circulating total homocysteine is a sensitive marker of inadequate folate and vitamin B12 status. Elevated homocysteine concentrations are associated with an increased risk for vascular disease.
To identify reference ranges for serum total homocysteine concentration in U.S. residents and quantify the contribution of circulating vitamin concentrations to high homocysteine concentrations.
Cross-sectional prevalence study.
A nationally representative sample of 3563 male participants and 4523 female participants 12 years of age or older who participated in the third National Health and Nutrition Examination Survey.
Reference ranges (5th and 95th percentiles) for the total homocysteine concentration were defined among participants who were folate- and vitamin B12-replete and had normal creatinine concentrations. A high total homocysteine concentration was defined as one that exceeded the sex-specific 95th percentile for the reference sample (participants 20 to 39 years of age). The population attributable risk percentage was calculated to determine the contribution of low folate (<11 nmol/L) and vitamin B12 (<185 pmol/L) concentrations to a high homocysteine concentration.
Reference ranges for serum total homocysteine concentration increased with age; these ranges were 4.3 to 9.9 µmol/L for male participants and 3.3 to 7.2 µmol/L for female participants 12 to 19 years of age and from 5.9 to 15.3 µmol/L for men and 4.9 to 11.6 µmol/L for women 60 years of age or older. A high homocysteine concentration was defined as at least 11.4 µmol/L for male participants and at least 10.4 µmol/L for female participants. Approximately two thirds of the cases of high homocysteine concentrations were associated with low vitamin concentrations.
Upper reference limits for the serum total homocysteine concentration increased with age and were higher for male participants than for female participants at all ages. In most cases, high homocysteine concentrations were associated with low serum vitamin concentrations.
Table 1. Selected Characteristics of Participants in the Third National Health and Nutrition Examination Survey Homocysteine Sample by Sex and Ethnicity
Table 2. Percentile Values Used To Define Decile Categories of Serum Folate and Vitamin B12 Concentrations
Geometric mean serum total homocysteine concentrations by decile category of serum folate concentration for male participants (circles) and female participants (squares) 12 to 19 years of age (top left), 20 to 39 years of age (top right), 40 to 59 years of age (bottom left), and 60 years of age or older (bottom right).
Geometric mean serum total homocysteine concentrations by decile category of serum vitamin Bconcentration for male participants (circles) and female participants (squares) 12 to 19 years of age (top left), 20 to 39 years of age (top right), 40 to 59 years of age (bottom left), and 60 years of age or older (bottom right).
Table 3. Serum Total Homocysteine Concentrations for Selected Percentiles in a Vitamin-Replete Reference Sample by Sex and Age
Table 4. Prevalence of High Serum Total Homocysteine Concentration by Sex and Age
Table 5. Mean and Prevalence of High Serum Total Homocysteine Concentrations Associated with Low Serum Vitamin Status
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Selhub J, Jacques PF, Rosenberg IH, Rogers G, Bowman BA, Gunter EW, et al. Serum Total Homocysteine Concentrations in the Third National Health and Nutrition Examination Survey (1991–1994): Population Reference Ranges and Contribution of Vitamin Status to High Serum Concentrations. Ann Intern Med. ;131:331–339. doi: 10.7326/0003-4819-131-5-199909070-00003
Download citation file:
Published: Ann Intern Med. 1999;131(5):331-339.
Education and Training, Endocrine and Metabolism.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use