Serum homocysteine level and protein intake are related to risk of microalbuminuria: the Hoorn Study

Kidney Int. 1998 Jul;54(1):203-9. doi: 10.1038/


Background: Microalbuminuria (MA) is a strong predictor of cardiovascular disease, but its causes are incompletely understood. Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease independent of established risk factors. It is not known whether hyperhomocysteinemia is associated with MA, and thus could be a possible cause of microalbuminuria.

Methods: We studied an age-, sex- and glucose-tolerance-stratified random sample of a 50- to 75-year old general Caucasian population (N = 680). The urinary albumin-to-creatinine ratio (ACR) was measured in an early morning spot urine sample. MA was defined as an ACR > 3.0 mg/mmol.

Results: The prevalence of MA was 4.3% (13 of 304) in subjects with normal glucose tolerance, 9.2% (17 of 185) in impaired glucose tolerance and 18.3% (30 of 164) in non-insulin-dependent diabetes mellitus (NIDDM); it was 3.7% (15 of 402) in subjects without hypertension and 17.9% (45 of 251) in those with hypertension. After adjusting for age, sex, glucose tolerance category, hypertension, dyslipidemia and smoking, the odds ratio [OR; 95% confidence interval (95%CI)] for MA per 5 mumol/liter total homocysteine increment was 1.33 (1.08 to 1.63). Additional adjustment for HbA1c, waist-hip ratio, protein intake and serum creatinine did not attenuate the association between MA and total homocysteine. A 0.1 g/ increment of protein intake was also associated with an increased risk for MA after adjustment for age, sex, classical risk factors and serum total homocysteine [OR (95% CI); 1.20 (1.08 to 1.32)].

Conclusion: Both hyperhomocysteinemia and protein intake are related to microalbuminuria independent of NIDDM and hypertension. Hyperhomocysteinemia may partly explain the link between MA and increased risk of cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / blood*
  • Albuminuria / diet therapy
  • Albuminuria / epidemiology*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / urine
  • Dietary Proteins / administration & dosage*
  • Female
  • Glucose Tolerance Test
  • Homocysteine / blood*
  • Humans
  • Hypertension, Renal / blood
  • Hypertension, Renal / etiology
  • Hypertension, Renal / urine
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors


  • Dietary Proteins
  • Homocysteine