Homocysteine levels and cardiovascular risk factors in children and adolescents: systematic review and meta-analysis

Context Studies have indicated that homocysteine levels are nontraditional markers for cardiovascular disease. The onset of atherosclerotic disease begins in childhood and adolescence; thus, prevention of its risk factors should occur early. Objective This systematic review and meta-analysis was conducted to summarize the association between high homocysteine levels and traditional cardiovascular risk factors in children and adolescents. Data Sources This systematic review and meta-analysis were developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the protocol was submitted to PROSPERO. Only observational studies in children and adolescents with homocysteine levels as an exposure variable and cardiovascular risk factors as outcome variables were included and searched in the following electronic bibliographic databases: PubMed/MEDLINE, Web of Science, Embase, Latin American and Caribbean Literature in Health Sciences, Ovid and Scopus. Data Extraction Two authors independently extracted data from eligible studies. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale. Data Analysis Seven studies were included in the systematic review; they were published from 1999 to 2017, predominantly were of a cross-sectional design, and mainly evaluated adolescents. In the meta-analysis (n = 6), cross-sectional studies (n = 3) identified that high homocysteine levels were positive and weakly correlated with overweight in children and adolescents (odds ratio, 1.08; 95%CI, 1.04–1.11). Conclusion High homocysteine levels were weakly associated with overweight in children and adolescents in the reviewed cross-sectional studies. However, for the other traditional cardiovascular risk factors, the findings, although important, were inconclusive. Additional robust longitudinal studies are recommended to be conducted to better identify these associations. Systematic Review Registration: PROSPERO registration no. CRD42018086252.