Nutritional Deficiency as a Risk Factor for Cerebral Venous Thrombosis in Parts of Southern India: A Case‐Control Study

The incidence of cerebral venous thrombosis (CVT) is anecdotally considered to be higher in parts of South India as compared with the West. The higher prevalence of CVT in this population is not accounted for by genetic thrombophilias, implicating acquired risk factors. As hyperhomocysteinemia and vitamin B12 deficiency are common in this population, we expected unique risk factors related to the diet. This case‐control study was done to examine the acquired risk factors and dietary patterns in these patients. Patients with CVT admitted from June 2021 to January 2023 were included in the study. Healthy attendants of other patients attending the emergency department for other neurological illnesses were recruited as controls. Clinical and biochemical data of patients were collected. Diet was assessed using a food frequency questionnaire. The contribution of food items to various nutrients (calories, protein, methionine, vitamin B12, folate, pyridoxine, and riboflavin) was calculated and compared with the recommended dietary allowance (RDA) and controls. The study enrolled 104 patients and 109 controls. The mean age of patients was 34.9 years (SD = 13.4). Hyperhomocysteinemia, anemia, alcohol consumption, folate deficiency, and vitamin B12 deficiency were observed in 63.5%, 46.2%, 45.2%, 37.5%, and 26%, respectively. Patients with a history of alcohol consumption had significantly higher homocysteine and lower folate. The diet of the patients had significantly higher odds of being protein‐deficient and folate‐deficient as compared with controls on multiple linear regression analysis. Poor nutrition, in the form of hyperhomocysteinemia and anemia, was the most common risk factor in the study population. Crucially, these risk factors are modifiable. Further large‐scale studies are needed to determine the incidence of CVT in this area and to evaluate the role of dietary interventions for risk modification.