Homocysteinemia and B vitamin status among adult patients with inflammatory bowel disease: A one-year prospective follow-up study

Background: The aim of this study was to longitudinally study serum homocysteine levels in patients with Crohn's disease (CD) and ulcerative colitis (UC) in relation to disease activity and B vitamin status. Methods: In all, 98 consecutive adult patients (age 25-55 years) with CD (n =70) and UC (n = 28) were enrolled and assessed at three timepoints over 1 year. Results: There were no significant differences in levels of homocysteine, B vitamins, or dietary intake by disease type, disease activity, or across visits. 13% of all inflammatory bowel disease (IBD) patients had elevated homocysteine at least once during the study. Nine patients with CD had fluctuating homocysteine levels during the study but these were inconsistent, ranging from within normal range to elevated levels in any individual. Six of these nine patients were persistently in remission. 30% of all IBD patients had vitamin B6 deficiency, 11% had vitamin B12 deficiency, and one patient (CD) had folate deficiency. All vitamins showed a significant correlation between intake and serum levels (B6; r 0.46, P < 0.001, B12; r = 0.42, P < 0.001, and folate; r = 0.26, P = 0.008). There was an inverse relationship between serum homocysteine in the blood and serum vitamin B12 (r = -0.241, P = 0.017). Conclusions: Serum homocysteine was mostly normal in patients with IBD and changed minimally over time. There was no association between disease activity and elevation of serum homocysteine. 30% of patients have vitamin B6 deficiency but vitamin B6 is not associated with elevated homocysteine. The routine measurement of homocysteine is not warranted.