Food Nutr Bull. 2016 Dec;37(4):517-528.

Dietary B Vitamins and Serum C-Reactive Protein in Persons With Human Immunodeficiency Virus Infection: The Positive Living With HIV (POLH) Study.

Poudel-Tandukar K1, Chandyo RK2,3.

1. College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
2. Centre for International Health, University of Bergen, Norway.
3. Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.




B vitamins may have beneficial roles in reducing inflammation; however, research on the role of B vitamins in inflammation among HIV-infected persons is lacking.


This study assessed the association between B vitamins and serum C-reactive protein (CRP) concentrations in HIV-infected persons.


A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 years residing in the Kathmandu, Nepal. High-sensitive and regular serum CRP concentrations were measured by the latex agglutination nephelometry and latex agglutination turbidimetric method, respectively. Dietary intake was assessed using 2 nonconsecutive 24-hour dietary recalls. The relationships between B vitamins and serum CRP concentrations were assessed using multiple regression analysis.


The multivariate-adjusted geometric mean of serum CRP concentrations was significantly decreased with an increasing B vitamins intake across quartiles of niacin (P for trend = .007), pyridoxine (P for trend = .042), and cobalamin (P for trend = .037) in men. In men, the mean serum CRP concentrations in the highest quartiles of niacin, pyridoxine, and cobalamin were 63%, 38%, and 58%, respectively, lower than that in the lowest quartile. In women, the mean serum CRP concentrations in the highest quartiles of riboflavin (P for trend = .084) and pyridoxine (P for trend = .093) were 37% and 47%, respectively, lower than that in the lowest quartile.


High intake of niacin, pyridoxine, or cobalamin was independently associated with decreased serum CRP concentrations among HIV-infected men. Further prospective studies are warranted to confirm the role of B vitamins in inflammation among HIV-infected persons.

KEYWORDS: B vitamins; C-reactive protein; HIV; developing country; dietary assessment

PMID: 27370977;



This is the first study assessing the relationship between dietary B vitamins and serum C-reactive Protein (CRP) concentrations in HIV-infected persons while accounting for important HIV-related clinical and other confounders including age, smoking, alcohol, physical activity, body mass index, history of any disease in past twelve months, CD4+ T-cell count, and anti-retroviral therapy. This study provided special emphasis on B vitamins among micronutrients as emerging evidence suggests the protective role of B vitamins to reduce inflammation among general populations1,2 and patients with inflammatory diseases.3,4  The deficiency of B vitamins is common in HIV-infected persons due to malabsorption, diarrhea, impaired storage, and altered metabolism.5,6  Besides, the metabolic turnover of B vitamins may be increased in HIV-infection due to its chronic inflammatory process.7,8

This study found that the mean serum CRP concentrations was lower among HIV-infected persons in the highest intake of dietary B vitamins than that in the lowest intake. This inverse relationship between dietary B vitamins intake and serum CRP concentrations remained significant for niacin, pyridoxine, and cobalamin in men but not in women. This could be due to very low intake of dietary B vitamins in women as compared to men, which might be below the threshold levels where an effect of B vitamins on inflammation could be observed. For example, the proportion of participants with dietary B vitamins intake below the estimated average requirements level9 was higher in women than in men; 88% versus 65% for niacin (<12 mg/day vs (<11 mg/day), 54% versus 24% for pyridoxine (<1.1 mg/day), and 88% versus 78% for cobalamin (<2.0 ug/day). Overall, dietary B vitamins were correlated among each other except between folic acid and cobalamin, and niacin and folic acid.

The common sources of B vitamins in Nepalese diet are rice (B1, B2), wheat bread (B1, B9), pulse/lentils (B1, B6, B9), navy beans (B1), black eyed beans (B9), green peas (B1, B3), mushrooms (B2, B3), spinach (B2, B6, B9), broccoli (B9), lettuce (B9), dried fruits (B6), bananas (B6), mango (B9), oranges (B9), tofu (B12), low fat dairy products and cheese (B2, B12), egg (B2, B12), chicken (B3, B6), liver (B3), red meat (B2, B12), tuna fish (B6), and trout fish (B1).10 The mean daily consumption of food averaged 458 ± 107 g of cereals, 436 ± 97 g of rice, 173 ± 127 g of colored vegetables, 101 ± 191 g of milk and dairy products, and 60 ± 86 g of potatoes.10 These items constituted more than three-fourths of the total food weight, whereas the amounts and frequency of the consumption of meats (19 ± 43 g), fish (13 ± 32 g) and eggs (2 ± 14 g) were very low.

The anti-inflammatory role of B vitamins can be explained through its enzymatic reactions in metabolizing amino acids, neurotransmitters, nucleic acids, and lipids including homocysteine referring to mechanistic studies.11-14 For example, B vitamins enzymes, such as coenzymes of riboflavin and pyridoxine are involved in the conversion of homocysteine to methionine and cysteine.12 The accumulation of homocysteine may occur due to decrease intake of B vitamins.11,13,14 An increasing level of homocysteine may promote inflammation by producing interleukin-6 by monocytes and endothelial cells.15,16 The active form of pyridoxine, pyridoxal 5’-phosphate, functions as a cofactor involved in several metabolic processes including immune and inflammatory responses in the body.17

This study suggests a beneficial effect of increased intake of B vitamins such as riboflavin, niacin, or cobalamin to reduce serum CRP concentrations among HIV-infected persons with poor nutritional and immunity status. This novel finding adds an importance of B vitamins to the inflammation research among HIV-infected persons. This finding is important in that this may lead to clinical trials of B vitamin supplementation as a simple low-cost intervention to improve the health and quality of life among HIV-infected persons in resource poor settings.



  1. Morris MS, Sakakeeny L, Jacques PF, Picciano MF, Selhub J. Vitamin B-6 intake is inversely related to, and the requirement is affected by, inflammation status. J Nutr 2010;140:103-10.
  2. Friso S, Jacques PF, Wilson PW, Rosenberg IH, Selhub J. Low circulating vitamin B(6) is associated with elevation of the inflammation marker C-reactive protein independently of plasma homocysteine levels. Circulation 2001;103:2788-91.
  3. Friedman AN, Hunsicker LG, Selhub J, Bostom AG. Clinical and nutritional correlates of C-reactive protein in type 2 diabetic nephropathy. Atherosclerosis 2004;172:121-5.
  4. Chiang EP, Bagley PJ, Roubenoff R, Nadeau M, Selhub J. Plasma pyridoxal 5′-phosphate concentration is correlated with functional vitamin B-6 indices in patients with rheumatoid arthritis and marginal vitamin B-6 status. J Nutr 2003;133:1056-9.
  5. Tang AM, Smit E. Selected vitamins in HIV infection: a review. AIDS Patient Care STDS 1998;12:263-73.
  6. Drain PK, Kupka R, Mugusi F, Fawzi WW. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr 2007;85:333-45.
  7. Gerhard GT, Malinow MR, DeLoughery TG, et al. Higher total homocysteine concentrations and lower folate concentrations in premenopausal black women than in premenopausal white women. Am J Clin Nutr 1999;70:252-60.
  8. McCormick DB. Two interconnected B vitamins: riboflavin and pyridoxine. Physiol Rev 1989;69:1170-98.
  9. IOM. Dietary reference intakes (DRIs): estimated average requirements for groups. Washington D.C.: Food and Nutrition Board, Institute of Medicine, National Academies. Washington D.C.: Food and Nutrition Board, Institute of Medicine, National Academies; 2004.
  10. Ohno Y, Hirai K, Sato N, Ito M, Yamamoto T, Tamura T, Shrestha MP. Food consumption patterns and nutrient intake among Nepalese living in the southern rural Terai region. Asia Pac J Clin Nutr. Dec 1997;6(4):251-255.
  11. Jacques PF, Bostom AG, Wilson PW, Rich S, Rosenberg IH, Selhub J. Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort. Am J Clin Nutr 2001;73:613-21.
  12. McCormick DB. Two interconnected B vitamins: riboflavin and pyridoxine. Physiol Rev 1989;69:1170-98.
  13. Pancharuniti N, Lewis CA, Sauberlich HE, et al. Plasma homocyst(e)ine, folate, and vitamin B-12 concentrations and risk for early-onset coronary artery disease. Am J Clin Nutr 1994;59:940-8.
  14. Ganji V, Kafai MR. Demographic, health, lifestyle, and blood vitamin determinants of serum total homocysteine concentrations in the third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2003;77:826-33.
  15. van Aken BE, Jansen J, van Deventer SJ, Reitsma PH. Elevated levels of homocysteine increase IL-6 production in monocytic Mono Mac 6 cells. Blood Coagul Fibrinolysis 2000;11:159-64.
  16. Dalal S, Parkin SM, Homer-Vanniasinkam S, Nicolaou A. Effect of homocysteine on cytokine production by human endothelial cells and monocytes. Ann Clin Biochem 2003;40:534-41.
  17. Paul L, Ueland PM, Selhub J. Mechanistic perspective on the relationship between pyridoxal 5′-phosphate and inflammation. Nutr Rev 2014;71:239-44. 



This study was partially supported by the Grant-in-Aid for Young Scientists (B) (22790581), Japan Society for the Promotion of Science, The Ministry of Education, Culture, Sports, Science and Technology, Japan; Waseda University Grants for Special Research Projects, General Grant/Ippan Josei, Japan, (2012A-101); and by the Grant for Research on Global Health and Medicine (No. 21A-2) from the National Center for Global Health and Medicine, Japan. Authors would like to thank Dr. Krishna C Poudel, Associate Professor, School of Public Health and Health Sciences, University of Massachusetts Amherst, for his support in the conception and design of the main study cohort and overall management of the study.



Kalpana Poudel-Tandukar, PhD, MPH, MPHC

Assistant Professor

College of Nursing

University of Massachusetts Amherst

220 Skinner Hall, 651 North Pleasant St, Amherst, MA 01003-9299, USA