Prudent dietary pattern influences homocysteine level more than folate, vitamin B12, and docosahexaenoic acid: a structural equation model approach
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A structural equation model (SEM) was used to test multiple and simultaneous relationships between socio-demographic factors, dietary patterns, biochemical levels of folate, vitamin B12, docosahexaenoic acid (DHA), and its effects on homocysteine (Hcy) level.
Socio-demographic and lifestyle characteristics, blood sample, anthropometric measurements, and a food-frequency questionnaire (FFQ) were obtained from 281 individuals of ISA-Capital study (Sao Paulo, Brazil). The dietary patterns (DP) were estimated using factor analysis with principal component’s estimation based on the frequency of daily intake derived from the 38-item FFQ. The SEM considered a theoretical model where the DP were expected to be directly associated with Hcy level, and indirectly via biochemical levels of folate, vitamin B12, and DHA. The variables sex, age, ethnicity, and MTHFR C677T polymorphism were included in the model.
The Prudent DP (− 0.12, p = 0.04) had a negative effect, while MTHFR C677T polymorphism (0.16, p = 0.01), age (0.22, p < 0.01), and being man (0.16, p = 0.01) had a positive effect on Hcy level. There were no indirect effects of any dietary patterns on Hcy level, neither via folate, vitamin B12, nor DHA. DHA was negatively associated with the Modern DP (− 0.12, p = 0.04) and positively associated with the Prudent DP (0.19, p < 0.01).
The DP mainly composed of fruits and vegetables, natural juices, potato/cassava/cooked cornmeal, fish, and chicken, which was negatively associated with the Hcy level in this population. These findings support the role of a healthy dietary pattern in health outcomes, rather than promoting specific foods or nutrients, for policy-based health promotion strategies.
KeywordsOne-carbon metabolism Folate Homocysteine MTHFR Structural equation model
We would like to acknowledge the participants and all the members of the ISA-Capital study. In addition, we acknowledge the Sao Paulo Research Foundation (FAPESP) for the doctoral scholarship granted to Juliana Araujo Teixeira (2014/12647-1).
Compliance with ethical standards
This study was approved by the Ethical Committee of School of Public Health, University of São Paulo (nº 2001, 275/09 and nº 1.501.677/16) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Participants provided written consent in each stage of the study to be involved.
Conflict of interest
The authors declare that they have no conflict of interest.
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