Serum homocysteine and folate concentrations among a US cohort of adolescents before and after folic acid fortification

Abstract

AbstractObjectiveWe assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors.DesignObservational study conducted among participants of a randomized trial.SettingThe Child and Adolescent Trial for Cardiovascular Health (CATCH) study.SubjectsAdolescents (n2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years).ResultsAverage serum concentrations of tHcy, folate and vitamin B6increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 μg folate/d. Male sex (P< 0·0001) and white race (P= 0·0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P= 0·006) and serum folate concentration (P< 0·0001) were associated with significant decreases in tHcy concentration. Female sex (P< 0·0001), non-smoking (P< 0·0001), use of multivitamins (P< 0·0001) and higher dietary intake of folate (P= 0·001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P> 0·50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher;P< 0·0001) with fortification. These trends differed significantly for malesv. females (P< 0·001 for interaction).ConclusionsFortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.