Facts and recommendations about total homocysteine determinations: an expert opinion
Open accessAbstract
BACKGROUND: Measurement of plasma total homocysteine has become common as new methods have been introduced. A wide range of disorders are associated with increased concentrations of total homocysteine. The purpose of this review is to provide an international expert opinion on the practical aspects of total homocysteine determinations in clinical practice and in the research setting and on the relevance of total homocysteine measurements as diagnostic or screening tests in several target populations. METHODS: Published data available on Medline were used as the basis for the recommendations. Drafts of the recommendations were critically discussed at meetings over a period of 3 years. OUTCOME: This review is divided into two sections: (a) determination of homocysteine (methods and their performance, sample collection and handling, biological determinants, reference intervals, within-person variability, and methionine loading test); and (b) risk assessment and disease diagnosis (homocystinuria, folate and cobalamin deficiencies, cardiovascular disease, renal failure, psychiatric disorders and cognitive impairment, pregnancy complications and birth defects, and screening of elderly and newborns). Each of these subsections concludes with a separate series of recommendations to assist the clinician and the research scientist in making informed decisions. The review concludes with a list of unresolved questions.
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The functional markers tHcy and MMA have been established as useful indicators of vitamin B-12 status and may be more sensitive indicators of mild vitamin B-12 deficiency.
“However, the functional markers total homocysteine (tHcy) 13 and methylmalonic acid (MMA) have been established as useful indicators of vitamin B-12 status (13) and may be more sensitive indicators of mild vitamin B-12 deficiency (14,15).”
From Vitamin B-12 status in infancy is positively associated with development and cognitive functioning 5 y later in Nepalese children (2017) · cites this paper as [13]
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- Authors
- Refsum, H., Smith, A. D., Ueland, P. M., Nexo, E., Clarke, R., McPartlin, J., Johnston, C., Engbaek, F., Schneede, J., McPartlin, C., & Scott, J. M.
- Affiliations
- University of Oxford (GB)
- University of Bergen (NO)
- Department of Clinical Biochemistry AKH, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
- Trinity College Dublin (IE)
- Aarhus University Hospital (DK)
- Corresponding author
- Refsum, Helga
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-01-01
- Volume
- 50
- Issue
- 1
- Pages
- 3-32
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- OpenAlex
- W2165313350
- Cited by
- 1,056
- References
- 298
- Citations by year
- 2026: 19 · 2025: 28 · 2024: 33 · 2023: 23 · 2022: 39 · 2021: 32 · 2020: 35 · 2019: 51 · 2018: 44 · 2017: 46 · 2016: 44 · 2015: 51 · 2014: 51 · 2013: 62 · 2012: 55
- FWCI
- 11.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
- Funders
- U.S. Department of Agriculture
- University of Oxford
- Universitetet i Bergen
- Medical Research Council
- Topics
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- total homocysteine, sample collection and handling, reference values, within-person variability, methionine loading test, homocystinuria, folate deficiency, vitamin B12 deficiency, cardiovascular disease, renal failure, cognitive impairment, pregnancy complications, congenital malformations, newborn screening
- MeSH terms
- Blood Specimen Collection, Homocysteine, Humans, Mass Screening, Reference Values, Risk Assessment, Evidence-Based Medicine, Clinical Laboratory Techniques
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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