Homocysteine blood level in long-term care residents with oropharyngeal dysphagia: Comparison of hand-oral and tube-enteral-fed patients

Background: Levels of homocysteine, methylmalonic acid, and relevant vitamins were measured and evaluated in patients with oral dysphagia (OD) receiving long-term care (LTC). Methods: Group A was composed of 26 orally fed patients, and group B was composed of 25 patients who were fed by nasogastric tube. All patients were hospitalized in the LTC departments of the Geriatric Medical Center, Shmuel Harofe. General and nutritional status were assessed, and levels of vitamins including B₁₂, folate, and B₆ were measured along with serum homocysteine and urine methylmalonic acid levels. Results: Homocysteine levels were significantly higher in the orally fed patients (p <.001); 92% had higher-than-normal homocysteine levels. The levels of vitamins B₁₂, folate, and B₆ were significantly lower in the orally fed patients (p <.001), although in most patients levels were in the normal range. Notably, the levels of homocysteine were significantly correlated with the levels of all vitamins but not with the albumin or hemoglobin values. Levels of methylmalonic acid were also higher in the orally fed patients, but the difference was not statistically significant, and there was no correlation between vitamin level and methylmalonic acid level. Conclusions: Orally fed patients with OD have substantially higher homocysteine levels and appreciably lower levels of the relevant vitamins than patients with OD who receive tube feeding. Therefore, homocysteine measurement may be the preferred indicator of vitamin intake in orally fed patients with OD.