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Nutritional Epidemiology

A Homocysteine Metabolism–Related Dietary Pattern and the Risk of Coronary Heart Disease in Two Independent German Study Populations¹

Cornelia Weikert², Kurt Hoffmann, Jutta Dierkes^*, Birgit-Christiane Zyriax, Kerstin Klipstein-Grobusch, Matthias B. Schulze, Roman Jung^**, Eberhard Windler and Heiner Boeing

Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany; ^* Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University, Magdeburg, Germany; and Department of Internal Medicine and ^** Institute of Clinical Chemistry, University Hospital, Hamburg-Eppendorf, Germany

²To whom correspondence should be addressed. E-mail: Weikert{at}mail.dife.de.

A biomarker profile of high folate and vitamin B-12 and low plasma homocysteine concentrations reduces the risk of coronary heart disease (CHD) and may be linked to diet. The objectives of the present study were to identify a food pattern related to these biomarkers and to examine its association with CHD risk. Dietary patterns related to biomarker plasma concentrations were constructed from data obtained in the Coronary Risk Factors for Atherosclerosis in Women (CORA) Study (200 cases; 255 controls) using the reduced rank regression statistical method. Risks for CHD with relation to the identified pattern were estimated in the CORA study and in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study with 157 cases of incident myocardial infarction among 26,795 participants. In these 2 German study populations, whole-grain bread, fresh fruit, olive oil, mushrooms, cruciferous vegetables, wine, and nuts contributed the most positively and fried potatoes the most negatively to a dietary pattern that was directly associated with both plasma folate and vitamin B-12 concentrations, but inversely with plasma homocysteine. Multivariate-adjusted relative risks for CHD across increasing quintiles of the food pattern score were 1.0, 0.55, 0.52, 0.58, 0.39 (P for trend = 0.05) in the case-control sample and 1.0, 0.95, 0.75, 0.56, 0.72 (P for trend = 0.041) in the prospective study. The combination of a high intake of whole-grain bread, fresh fruit, olive oil, mushrooms, cruciferous vegetables, wine, and nuts with a low intake of fried potatoes was associated with a favorable biomarker profile of homocysteine metabolism and reduced risk of CHD.

KEY WORDS: • coronary heart disease • nutrition • folate • homocysteine • vitamin B-12

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