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 kalpana@nursing.umass.edu.
2. Centre for International Health, University of Bergen, Norway.
3. Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.

 

Abstract

BACKGROUND:

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.

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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;

 

Supplement

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.

 

References

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Acknowledgements

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.

 

Contact

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

Email: kalpana@nursing.umass.edu