Metabolic and Nutritional Biomarkers for Cardiovascular Risk Stratification in Beninese Taxi-Motorbike Drivers: Interrelationships Between Homocysteine, Folate, Vitamin B12, TyG Index, and Framingham Risk Score

Background: Higher Framingham Risk Score (FRS) and elevated triglyceride-glucose (TyG) index are well-established markers of cardiovascular disease (CVD) risk. Given the high prevalence of insulin resistance (IR) and dyslipidemia among taxi-motorbike drivers (TMDs) in Cotonou, it is plausible that hyperhomocysteinemia (HHcy) or suboptimal folate and vitamin B12 status may further amplify their cardiovascular risk. However, the relationships between folate, vitamin B12, and homocysteine and established CVD risk markers like the TyG index and FRS have not been systematically investigated within this high-risk occupational group. Therefore, this study aimed to examine the associations of these key nutritional determinants with both the TyG index and FRS among TMDs. Methods: In this cross-sectional study of 137 TMDs (mean age 39.2 ± 7.7 years), we collected comprehensive demographic and lifestyle data alongside standardized anthropometric measurements, including BMI and blood pressure. Biochemical assessments encompassed glucose, lipid profiles, creatinine, vitamin B12, folate, and homocysteine levels. Cardiovascular risk was evaluated using risk stratification tools such as the FRS and TyG index. Participants were stratified by TyG cut-off (TyG ≤ 7.73 vs. TyG > 7.73) and by FRS category (Results: The cohort exhibited a high prevalence of hypertension (47.4%) and markedly elevated homocysteine levels (mean 30.5 ± 18.8 µmol/L), with 88.3% of participants showing HHcy. Plasma folate concentrations declined significantly with increasing homocysteine (p = 0.006), strongly linking low folate status to exacerbated HHcy. Participants with elevated FRS were older, hypertensive, and presented with significantly increased triglycerides, TyG index, and homocysteine. Conversely, high TyG index correlated with greater BMI (24.8 vs. 21.9 kg/m2, p Conclusion: TMDs in Cotonou face a high burden of hypertension, metabolic dysfunction, and HHcy, with substantial links between adiposity, insulin resistance, and predicted cardiovascular risk. While FRS predominantly reflects age and hypertension-related risk, the TyG index captures modifiable metabolic dysfunction closely linked with adiposity, dyslipidemia, and vitamin B12 status. The TyG index complements traditional risk scores by identifying modifiable metabolic dysfunction and nutritional imbalances, especially in younger individuals. Vitamin B12 offers modest metabolic protection, whereas low folate exacerbates HHcy. Integrating TyG and nutritional biomarkers into occupational health screening could guide targeted interventions to reduce CVD burden in high-risk resource-limited settings.