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Biomedical subjects

M J Müller

Publications and source records attributed to M J Müller.

At least 37 records · Page 2Linked to original sources
PubMed2004

Subchronic effects of olanzapine on sleep EEG in schizophrenic patients with predominantly negative symptoms.

BACKGROUND: It is well known that sleep disturbance is an integral symptom of schizophrenia. In recent studies, a deficit of delta sleep has been observed in schizophrenic patients. Antipsychotic drugs with serotonin (5-HT2) receptor-antagonistic properties are considered to have delta sleep promoting effects. We have investigated the effects of subchronic olanzapine treatment on sleep EEG in schizophrenic patients. METHODS: The effects of administration of olanzapine (15 to 20 mg) on sleep were studied for four weeks in 10 male, drug-free patients suffering from schizophrenia with predominantly negative symptoms. Conventional sleep EEG parameters were investigated at baseline and after treatment with olanzapine for four weeks. Additionally, spectral power analysis of the EEG signal in distinct frequency bands was computed for different sleep stages. Psychopathology (PANSS, HAMD-17, HAMA) and side effects were assessed weekly. RESULTS: All patients improved, as measured by PANSS global scores. Compared to baseline, there was a significant improvement of parameters of sleep efficiency and an increase of delta sleep as well as REM sleep. Regarding spectral power values, no significant differences between baseline and treatment conditions were found. CONCLUSIONS: Sleep improvement was due to parameters of sleep efficiency and delta sleep, which may be related to serotonin antagonistic properties of olanzapine.

Adolescent↗
PubMed2003

[Standardized documentation procedure as a basis for improvement of process quality of treatment in psychiatric hospitals].

A standardized documentation system is presented for detailed description and analysis of treatment procedure for psychiatric inpatients. In the first step of a pilot study limited to patients with depressive syndromes at the Department of Psychiatry, University of Mainz, for each subject the clinical status was assessed weekly using psychopathological ratings and depicted in its temporal course along with therapeutic activities. Visualization of the treatment process turned out to be useful for everyday work by supporting the application of practice guidelines for clinical decisions. Beyond optimization of the individual treatment process, aggregation of the data also allows global assessment of treatment processes in the clinic. Thus, in addition to established basic documentation, the presented documentation procedure allows the development of a powerful quality management system in psychiatric clinics, due to its process orientation. Moreover, in psychiatric care research, it is an adequate basis for evaluating the effectiveness and efficiency of treatment procedures.

Adult↗
PubMed2003

Validation of air-displacement plethysmography for estimation of body fat mass in healthy elderly subjects.

BACKGROUND: Air-displacement plethysmography (ADP) is a non-invasive method for body composition analysis that divides the body into fat-free mass (FFM) and fat mass (FM) (= 2 compartment model, 2C). It places low demands on subject performance and is therefore most convenient in the elderly. OBJECTIVE: To validate ADP against dual energy X-ray absorptiometry (DEXA) and to compare it to a four-compartment model of body composition (4C; fat mass, total body water, bone mineral content and residual mass) in the elderly. METHODS: Body composition was assessed by ADP, DEXA and bioelectrical impedance analysis (BIA) in 26 healthy elderly subjects (15 women, 11 men) aged 60-82 years. RESULTS: Despite a high correlation of %FM assessed by ADP and DEXA we observed significant differences between the results of these methods for both sexes (2.5 +/-3.4%; bias +/- SD). Deviations of %FM(ADP) from %FM(DEXA) were dependent on bone mineral content (BMC(DEXA)) fraction of FFM. A low BMC(DEXA) was related to an overestimation of DEXA-derived %FM by ADP. There was a systematic bias between results from ADP and the 4C model. 76% of its variance was explained by the assumption of a fixed density of FFM. 96% of the variance in the density of FFM was explained by water content and only 4% by BMC(DEXA) of FFM. When compared to a 4C model, overestimation of %FM(ADP) increases with increasing water fraction of FFM. CONCLUSION: Although there is a tendency for overestimation of %FM(ADP),ADP is a valid method for body composition measurement in the elderly. The bias in %FM(ADP) is mainly related to water content of FFM and indicates that a correction factor for TBW may improve the accuracy of the ADP measurements in the elderly.

Absorptiometry, Photon↗
PubMed2003

Melperone is an inhibitor of the CYP2D6 catalyzed O-demethylation of venlafaxine.

INTRODUCTION: Melperone, a butyrophenone neuroleptic, is frequently used for its sleep-inducing properties. Despite its common use for more than 30 years, it is not yet characterized regarding its effects on cytochrome P450 s (CYPs). In an open pilot study, effects of melperone on the steady-state blood levels of venlafaxine, a recently introduced serotonin- and noradrenaline reuptake inhibiting antidepressant, were assessed. METHODS: The dose-corrected serum concentrations of venlafaxine and O-desmethylvenlafaxine were analyzed retrospectively in a therapeutic drug-monitoring (TDM) database comprising 94 patients. In addition, three patients received venlafaxine and melperone concomitantly and the serum concentrations of venlafaxine and O-desmethylvenlafaxine were analyzed before, during, and after melperone co-medication. The effect of melperone on CYP2D6 was further assessed in seven patients by means of the dextromethorphan O-demethylation, which serves as a CYP2D6 probe reaction. RESULTS: Patients treated concomitantly with venlafaxine and melperone had significantly higher (mean +/- SD) venlafaxine (3.27 +/- 2.9 vs. 0.97 +/- 0.99 ng/ml per mg/d; p < 0.05) and lower O-desmethylvenlafaxine serum concentrations (0.69 +/- 0.35 vs. 1.51 +/- 0.9 ng/ml per mg/d; p < 0.01) compared to patients without melperone comedication. In the three patients, venlafaxine serum concentrations increased, on average by 52 % during melperone co-medication, whereas O-desmethylvenlafaxine was decreased, on average by 29 %. Administration of melperone over three days elevated the ratio of dextromethorphan to dextrorphan from 0.044 +/- 0.04 to 0.09 +/- 0.083 (p < 0.05). DISCUSSION: This study pointed to an inhibitory effect of melperone on the O-demethylation of venlafaxine. Because the O-demethylation of venlafaxine is almost exclusively catalyzed by CYP2D6 it is concluded that melperone is an inhibitor of CYP2D6. The hypothesis was further corroborated by the inhibitory effect of melperone on the dextromethorphan O-demethylation.

Adult↗
PubMed2003

Therapeutic drug monitoring of tricyclic antidepressants: how does it work under clinical conditions?

Therapeutic drug monitoring (TDM) of tricyclic antidepressants (TCA) is established in the treatment of depression to optimize outcome and safety. However, there are few reports on TDM under naturalistic clinical conditions. In the present study, we investigated a TDM group (TDM) and a randomly assigned parallel group without TDM (no-TDM) while on TCA treatment. Serum levels were analyzed in both cohorts, but feedback and dose recommendation were only provided for the TDM group. Serum levels of TCA were assessed by high-performance liquid chromatography (HPLC). The outcome was measured weekly using the Hamilton Depression Rating Scale (HAMD), the Clinical Global Impressions Scale (CGI), and the UKU side-effect scale. 84 patients with depressive disorder according to DSM-IV were recruited in three centers (TDM, n = 43; no-TDM, n = 41; mean age 49.9 +/- 13.2 years, 63.1 % female). Patients were treated with either amitriptyline (n = 69) or doxepin (n = 15); the mean dosage at endpoint was 126 +/- 35 mg and 155 +/- 47 mg, respectively. The mean study duration was 21 +/- 8 days. Both groups improved according to HAMD (from 25.2 +/- 8.4 at baseline to 12.0 +/- 7.4 at endpoint) and CGI scores (68 % responders). Moderately severe or severe side effects occurred in 16 % of patients. Adequate dose adjustment was significantly higher in the TDM group (60 % vs. 46 %, p < 0.05); this led to a significantly higher rate of therapeutic serum levels in the TDM group (58 % vs. 44 %, p < 0.05). Direct effects of TDM were not found for effectiveness. Therapeutic TCA serum levels over weeks one to three, however, were associated with significantly better outcome at endpoint (p < 0.05) as measured with changes in the HAMD or CGI response rates from baseline to endpoint. Finally, considerable side effects occurred significantly more often when serum levels were above the therapeutic range (27 % vs. 11 %; p < 0.01). We conclude that treating depression with TCA can be optimized by early TDM, which is superior to clinical judgment on its own. Since the psychiatrists in charge were less than completely "compliant" to the recommendations provided together with serum levels, the effect could be more pronounced than this study shows. The results encourage further studies in order to optimize antidepressant pharmacotherapy when using TDM appropriately.

Amitriptyline↗
PubMed2002

Use of BMI as a measure of overweight and obesity in a field study on 5-7 year old children.

OBJECTIVE: The present field study examines the use of BMI in comparison with estimates of percent fat mass to screen for overweight and obesity in children. DESIGN: Cross-sectional field study. SETTING: Four waves of children 1996-1999 at Kiel, North West Germany. SUBJECTS: A representative large sample of 2,286 5-7 year old children representing 40% of the total child population examined by school physicians within the same period in Kiel. MAIN OUTCOME MEASURES: BMI was compared with anthropometric measures (TSF, BSF, SIF, SSF) and bioelectrical impedance analysis (BIA). The 90th and 97th BMI percentiles were used as cut offs for overweight and obesity, respectively. RESULTS: BMI reached a low sensitivity to identify overweight children when compared with the two estimates of % FM (0.60 to 0.78 for girls, 0.71 to 0.82 for boys, respectively). The specificity of BMI was 93 to 95 %. By contrast, BMI reached higher sensitivity to screen for obese children of 0.83 to 0.85 for boys and 0.62 to 0.80 for girls at a concomitant specificity of 0.95 to 0.98 for boys and 0.96 to 0.97 for girls as defined by assessment of body fat mass. Comparing nutritional status of overweight children classified as overweight or non overweight by BMI shows that BMI only identified obese but not-overweight children. CONCLUSION: BMI can be used to screen for obese children. In contrast BMI has a poor sensitivity to screen for overweight children. Body composition analysis should be used to screen for children at risk of becoming obese.

Adipose Tissue↗
PubMed2002

Narcoleptic and schizophrenic hallucinations. Implications for differential diagnosis and pathophysiology.

The differential diagnosis of narcolepsy versus schizophrenia is sometimes complicated by similar phenomenology, particularly when hallucinations predominate. REM sleep disturbances seem fundamental in the pathophysiology of narcolepsy, and REM sleep intrusions during periods of wakefulness are often associated with hallucinations also in healthy controls and in patients with other brain disorders including schizophrenia. This study used a semistructured interview to investigate different aspects of hallucinations (frequency, modality, content, and dependence on body posture) in 148 patients with narcolepsy, 21 patients with acute exacerbation of a schizophrenic disorder, and 128 healthy subjects. About 80% of patients with narcolepsy, 81% of schizophrenics, and 37% of healthy subjects reported lifetime occurrence of hallucinations (at least once). Auditory hallucinations were reported by 81% of schizophrenic patients (narcoleptics 45%, healthy controls 9%), whereas 83% of narcoleptic patients reported visual hallucinations (schizophrenics 29%, healthy controls 19%). Kinetic hallucinations were experienced by 71% of patients with narcolepsy and 53% of healthy controls in contrast to only 5% of schizophrenics. Accordingly, the content of hallucinations differed substantially between the groups. Most hallucinations in narcoleptics but not in schizophrenics, were sleep-related and dependent on body posture. Taken together, the qualitative aspects of hallucinations in narcolepsy and schizophrenia were so different that a common underlying mechanism of hallucinations in the two conditions is unlikely. Although the clinical separation of patients with narcolepsy and schizophrenia with predominant hallucinations is sometimes difficult, clinical features including the patient's illness history, and careful psychopathological assessments can help to avoid misdiagnoses and treatment failures.

Journal Article↗
PubMed2002

Depression, emotional blunting, and akinesia in schizophrenia. Overlap and differentiation.

Depression, negative symptoms, and extrapyramidal signs (EPS) frequently occur together in schizophrenia. Their overlap is due partly to the lack of specificity of assessment instruments. However, to disentangle the three syndromes is clinically important as treatment of schizophrenia requires a differentiated approach. This study investigated the overlap between depression, emotional blunting as a core part of the negative syndrome, and akinesia as manifestation of EPS, using the Calgary Depression Rating Scale (CDSS), the Rating Scale for Emotional Blunting (SEB), and the akinesia score of the Simpson-Angus Scale (SAS) as the most specific assessment instruments presently available. We investigated 57 medicated schizophrenic patients before discharge from hospitalization. Mutual relationships were assessed with linear and partial correlations. Substantial linear associations emerged between SEB and SAS scores. The correlation between CDSS and SAS scores was significantly lower, but also different from zero. When SEB scores were statistically controlled, the association between CDSS and SAS scores dropped to nonsignificance; the correlation between SEB and SAS scores remained nearly unchanged when controlling for depression. The correlation between CDSS and SEB scores decreased to nonsignificance when controlling for SAS scores. Neither gender, age, illness duration, nor type of medication had an influence on the findings. High levels of akinesia were related to emotional blunting but not independently to depressive symptoms in medicated schizophrenic patients. Although the results cannot be assumed to be specific for schizophrenia, they corroborate the partial independence of depression and affective blunting in schizophrenia and the relationship of negative symptoms to EPS.

Journal Article↗
PubMed2002

Social class differences in overweight of prepubertal children in northwest Germany.

OBJECTIVES: To assess social class differences in overweight and health-related behaviours in 5-7-y-old German children. DESIGN: Cross-sectional study. SETTING: Twenty-nine primary schools in Kiel (inhabitants: 248000), northwest Germany. SUBJECTS: A total of 1350 German 5-7-y-old children and their parents. MAIN OUTCOME MEASURES: Body mass index (BMI), fat mass and health-related behaviours of the children. Self-reported height and weight of their parents, parental school education as a measure of social class. RESULTS: The prevalence of overweight (> or = 90th percentile of reference) was 18.5%. There was an inverse social gradient (P < 0.01): the highest fat mass was observed in children from low social class. The odds ratios for overweight reached 3.1 (CI 1.7-5.4) in boys and 2.3 (CI 1.2-4.3) in girls, respectively (low vs high social class). Overweight parents (BMI > or = 25 kg/m2) were more likely to have overweight children. Parental overweight enhanced the inverse social gradient. The prevalence of overweight was 37.5% (low social class) vs 22.9% (high social class) in children from overweight parents, respectively. There was an inverse social gradient in unhealthy behaviours. Parental BMI and physical inactivity were independent risk factors of overweight in children. CONCLUSIONS: In 5 to 7-y-old children overweight and health-related behaviours are inversely related to social class. Parental overweight enhanced the risk of childhood overweight. The familial effect on body weight is most pronounced in children with low social class. Preventive measures should specifically tackle 'overweight families' from low social class.

Behavior↗
PubMed2002

Metabolically active components of fat-free mass and resting energy expenditure in humans: recent lessons from imaging technologies.

Imaging technologies, i.e. magnetic resonance imaging (MRI), computer tomography (CT) and dual-energy X-ray absorptiometry (DEXA), are precise and accurate techniques used to study lean body mass and adipose tissue distribution. CT and MRI can also be used to assess metabolically active components of fat-free mass (FFM). (Throughout this article, metabolic activity is defined with respect to oxidative metabolism.) To date a total of 116 in vivo measurements of organ masses (OM), in combination with the measurement of resting energy expenditure (REE), have been reported. These data suggest that MRI- or CT-derived OM explains part (approximately 5-10%) of the interindividual variance in REE. The data also suggest that REE can be reconstructed from detailed body composition analysis. Calculating REE from the sum of individual OM multiplied by a constant organ tissue-respiration rate showed a high correlation between calculated and measured REE, with only small and non-significant differences of 83-96 kJ d-1. In addition to CT- and MRI-derived OM, data are available of 244 obese and non-obese subjects regarding the association between regional components of lean body mass (LBM, assessed by DEXA) and REE. These results suggest that measurement of LBM distribution also provides the opportunity to adjust for the non-linearity of REE on body mass. Assessment of metabolically active components of FFM or LBM may also add to our understanding of malnutrition-, obesity- and disease states-related variance in REE. There is need for (1) standardization of imaging technology in body composition research; (2) reference data on detailed body composition, also including more recent autopsy data; (3) reducing the number of assumptions in model-based predictions; and (4) a combination of imaging technologies with in vivo measurements of individual OM respiration.

Absorptiometry, Photon↗
PubMed2002

[Problems in defining obesity in prepubescent children: consequences for assessing the requirements for medical rehabilitation].

INTRODUCTION: Prevalence of obesity has been on the increase in recent years. In contrast to obesity in adulthood, childhood obesity is still not uniformly defined. This results in problems to determine the need for medical rehabilitation. METHODS: The Kiel Obesity Prevention Study (KOPS) is a cross-sectional study assessing the nutritional status of 5-7 year-old German children. Three different definitions of overweight and obesity (German reference data for triceps skinfold thickness [90(th) percentile] and BMI [90(th)/97(th) percentile] as well as an international standard for BMI [extrapolated to levels of adults]) were applied to 1,643 children of KOPS enrolled between 1996 and 2000 (19 % of all first-graders in Kiel in this period). RESULTS: The prevalence of overweight varies from 9 to 21 % depending on the applied definition. With the definitions of overweight and obesity based on newer BMI percentiles a part of overweight children are not classified as such. The present state of art is that there is only a need for obese children for medical rehabilitation: these are 3.3 and 3.5 % of 5-7 year-old children in Kiel, respectively. CONCLUSIONS: Experts should work out an agreement concerning a uniform definition of childhood obesity. Currently, medical rehabilitation services are offered only to extremely obese children. There is a need for more and earlier preventive measures.

Body Mass Index↗
PubMed2002

[For what we need clinical nutrition].

Clinical nutrition covers a wide range of specialties of medicine. There is a need for better nutritional support in prevention of chronic diseases, investigations to assess malnutrition, dietetics including artificial nutrition and rehabilitation as well as supportive care for the severely and terminally ill patients. Clinical nutrition follows the principles of evidence-based medicine. In future the training of doctors in human nutrition has to be further improved. Since nothing works well in isolation an integration of clinical nutrition into gastroenterology is recommended.

Education, Medical↗
PubMed2002

Determinants of fat mass in prepubertal children.

The aim of the present study was to compare variables of metabolism, physical activity and fitness to body composition in normal and overweight children in a cross-sectional study design. Body composition was assessed by anthropometric measurements and bioelectrical impedance analysis in forty-eight prepubertal children (age 5-11 years, thirteen normal-weight, thirty-five overweight). Total energy expenditure (EE) was measured by combination of indirect calorimetry (for measurement of resting EE) and individually calibrated 24 h heart-rate (HR) monitoring. Activity-related EE and physical activity level (PAL) were calculated. Time spent with min-by-min HR>FLEX HR was also used as a marker of moderate habitual and vigorous activities. Aerobic fitness (O2 pulse (O2 consumption:HR at submaximal steady-state heart rate), submaximal O2 consumption (VO2submaximal), RER at a HR of 170 beats per min) was determined by bicycle ergometry. Muscle strength of the legs (maximal isometric strength of musculus quadriceps and of musculus ischiocruralis (Fa max and Fb max respectively)) was measured by computer tensiometry. When compared with normal children, overweight children had higher skinfold thicknesses (sum of skinfold thicknesses at four sites +160 %), fat mass (+142 %), waist (+24 %) and hip circumferences (+14 %), resting EE (+13 %) and RER (+5 %). No significant group differences were found for fat-free mass, muscle mass, total EE, activity-related EE, PAL, HR>FLEX HR, VO2submaximal, O2 pulse, Fa max and Fb max as well as the fat-free mass- or muscle mass-adjusted values for resting EE, aerobic fitness and muscle strength. When compared with normal children, overweight children had a lower measured v. estimated resting EE (Delta resting EE) and spent more time watching television. There were positive relationships between fat-free mass(x) and resting EE(x), total EE(y), aerobic fitness(y) and muscle strength(y), but only Delta resting EE(x) and HR>FLEX HR(x) correlated with fat mass(y). In a stepwise multivariate regression analysis resting EE adjusted for fat-free mass and Delta resting EE were significant determinants of % fat mass and explained 29.7 % of its variance. Thus, in the present cross-sectional study, resting EE was the most important determinant of fat mass.

Analysis of Variance↗
PubMed2002

Severe underreporting of energy intake in normal weight subjects: use of an appropriate standard and relation to restrained eating.

OBJECTIVE: To assess the influence of different standards and restrained eating on underreporting in healthy, non-obese, weight-stable young subjects. DESIGN AND SUBJECTS: Eighty-three young adults (20-38 years, 55 women, 28 men) were assessed under weight-stable conditions with a 7-day dietary record and the three-factor eating questionnaire by Stunkard and Messick. Resting energy expenditure (REE; indirect calorimetry) plus data derived from physical activity records (PA) (Standard 1) or REE times an activity factor (AF) (Standard 2) was used as standard for total energy expenditure (TEE). For comparison, doubly labelled water (DLW) was used to measure TEE in a subgroup of subjects. RESULTS: There was an association between self-reported energy intake and Standard 2 but not with Standard 1. When compared with DLW both calculated standards were inaccurate, but Standard 2 avoided high levels of overreporting. Using Standard 2 to identify 'severe' underreporting (SU; as defined by a deviation of energy intake (EI) and TEE of >20%), SU was seen in 37% of all subjects. It was more frequently found in women than in men (49% of women, 14.3% of men, ). Underreporting subjects had a reduced EI but there were no significant differences in nutritional status (body weight and height, body mass index, fat mass and fat-free mass), energy expenditure and the proportion of energy from macronutrients between normal and underreporting subjects. However, high restraint was associated with a higher degree of underreporting in the total group, whereas disinhibition had an influence only in men. CONCLUSIONS: A high prevalence of SU is seen in non-obese subjects. Characteristics of eating behaviour (restraint and disinhibition) were associated with underreporting but seemed to have a different influence in men and women.

Adult↗
PubMed2002

Differential effects of high-dose amisulpride versus flupentixol on latent dimensions of depressive and negative symptomatology in acute schizophrenia: an evaluation using confirmatory factor analysis.

While many acutely ill schizophrenic patients suffer from depressive symptoms, most studies on the efficacy of antipsychotic drugs focus on positive and negative symptoms. Dimensional models of schizophrenic symptoms, based on confirmatory factor analysis (CFA) using structural equation modelling, offer a methodological alternative to compare antipsychotics on empirically justified latent factors. The present report is a refined analysis of a published double-blind study on the D2/D3-selective antagonist amisulpride (ASP) versus the mixed D1-5/5-HT2 antagonist flupentixol (FPX). CFA was applied to Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Bech-Rafaelsen Melancholia Scale and Simpson-Angus Scale subscores to examine differential effects of high doses of ASP and FPX on negative and depressive symptom dimensions in 126 acutely ill schizophrenic patients. A four-factor model comprising the full spectrum of acute symptomatology and a three-factor model ('negative', 'anhedonia-apathy', 'depressive') restricted to negative and depressive symptoms were yielded with an identical 'depressive' dimension in both models. Analyses of CFA-derived factor scores showed that ASP was significantly superior to FPX regarding the latent 'depressive' dimension, independent of baseline scores, dosage and changes in akinesia. Neither the negative' dimension nor 'anhedonia-apathy' showed significantly different treatment effects. CFA-based analyses appear to be suitable for psychotropic drug evaluation when more refined and data-related information on drug efficacy profiles are required.

Adolescent↗
PubMed2001

[WHO warns of obesity epidemic. Are we becoming a society of obese persons?].

Overweight and obesity, together with their concomitant diseases and sequelae, have reached epidemic proportions. The problem is therefore not merely personal, but also societal. We have become an overweight society on its way to obesity. What we need is effective treatment over the long-term and a public health strategy to combat the condition. These two strategies are complementary, not in competition with each other. Without the latter, the successes of the former remain limited. We require national campaigns involving various aspects of our society aimed at promoting health and preventing disease. This makes necessary the involvement of politicians and representatives of various interested groups with appropriate responsibility. Members of health-related occupations should take the lead in initiating and maintaining such action.

Adolescent↗
PubMed2001

Increased plasma homocysteine in liver cirrhosis.

Background: Homocysteine (Hcy), is an atherogenic and thrombogenic risk factor which has also been proposed to be involved in hepatic fibrinogenesis. Hcy metabolism, depends on the cofactors folate, vit. B12, and the vit. B6 vitamer pyridoxalphosphate (PLP). Metabolism of these vitamins is frequently disturbed in cirrhotics, but little is known about plasma Hcy levels in these patients. Methods: Plasma levels of Hcy, methionine, serine, cysteine, PLP, vit. B12 and folate, and standard clinical/biochemical parameters of liver disease were measured in 43 postabsorptive patients with biopsy proven cirrhosis of different origin. Results: 74% of the patients had elevated plasma Hcy levels defined as >13.4 µmol/l (mean+2SD of healthy age matched controls). Increased plasma Hcy concentrations were seen in alcoholic as well as in non-alcoholic cirrhosis. Excluding patients with impaired renal function (n=7), Hcy concentrations remained elevated in 69% of the patients. We found a high prevalence of pathological plasma vitamin concentrations of 33% for increased vit. B12 levels and 5% and 80% for decreased folate and vit. B6 levels, respectively. Mean plasma vitamin B12 concentrations increased, folate remained unchanged and PLP concentrations decreased with deteriorating liver function. Hcy concentrations were correlated with levels of creatinine (r=0.44, P<0.01), serine (r=-0.46, P<0.01), and cysteine (r=0.38, P<0.05), but showed no association with parameters of liver function and with plasma levels of folate, vit. B12 und vit. B6. This was contrary to data obtained in healthy individuals. In a stepwise multiple regression serine and cysteine best explained the variance in Hcy levels. Conclusions: Elevated basal Hcy-plasma levels are frequently seen cirrhotic patients. Variations of Hcy concentration in liver cirrhosis are not explained by plasma levels of cofactors of Hcy metabolism.

Journal Article↗