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Original Research Communications |
1 From the Departments of Human Nutrition and Preventive and Social Medicine, the University of Otago, Dunedin, New Zealand.
Background: Elevated plasma total homocysteine (tHcy) concentrations are associated with increased risk of vascular disease, and there is a strong inverse association between dietary and blood folate and blood tHcy concentrations. Increased folate consumption may lower the risk of tHcy-mediated cardiovascular disease.
Objectives: The objective was to determine the most appropriate means of increasing dietary folate to reduce plasma tHcy.
Design: Sixty-five free-living subjects aged 36–71 y with tHcy concentrations 
9 µmol/L participated in a randomized, controlled trial to compare 3 approaches for increasing dietary folate to 
600 µg/d: folic acid supplementation, consumption of folic acid–fortified breakfast cereals, and increased consumption of folate-rich foods.
Results: An intake of 437 µg folic acid/d from supplements resulted in a 27-nmol/L increase in serum folate and a 21% reduction in tHcy, relative to the change in a control group. In subjects who consumed folic acid–fortified breakfast cereal, folate intake increased by an average of 298 µg, serum folate increased by 21 nmol/L, and tHcy concentrations decreased by 24%. Increased intakes of folate-rich foods resulted in a 418-µg increase in dietary folate, a 7-nmol/L increase in serum folate, and a 9% reduction in tHcy concentrations. The decrease in tHcy was negatively correlated (r = -0.66) with the increase in serum folate.
Conclusions: Daily consumption of folic acid–fortified breakfast cereals and the use of folic acid supplements appear to be the most effective means of reducing tHcy concentrations. The reduction in tHcy was significantly negatively correlated with the increase in serum folate, which may be a useful marker for measuring dietary change.
Key Words: Homocysteine • dietary folate • folic acid • fortified breakfast cereals • serum folate • free-living subjects • cardiovascular disease
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