REDUCTION OF PLASMA HOMOCYST(E)INE LEVELS BY BREAKFAST CEREAL FORTIFIED WITH FOLIC-ACID IN PATIENTS WITH CORONARY HEART-DISEASE

Background The Food and Drug Administration (FDA) has recommended that cereal-grain products be fortified with folic acid to prevent congeni tal neural-tube defects. Since folic acid supplementation reduces leve ls of plasma homocyst(e)ine, or plasma total homocysteine, which are f requently elevated in arterial occlusive disease, we hypothesized that folic acid fortification might reduce plasma homocyst(e)ine levels. M ethods To test this hypothesis, we assessed the effects of breakfast c ereals fortified with three levels of folic acid, and also containing the recommended dietary allowances of vitamins B-6 and B-12, in a rand omized, double-blind, placebo-controlled, crossover trial in 75 men an d women with coronary artery disease. Results Plasma folic acid increa sed and plasma homocyst(e)ine decreased proportionately with the folic acid content of the breakfast cereal. Cereal providing 127 mu g of fo lic acid daily, approximating the increased daily intake that may resu lt from the FDA's enrichment policy, increased plasma folic acid by 30 .8 percent (P = 0.045) but decreased plasma homocyst(e)ine by only 3.7 percent (P = 0.24). However, cereals providing 499 and 665 mu g of fo lic acid daily increased plasma folic acid by 64.8 percent (P < 0.001) and 105.7 percent (P = 0.001), respectively, and decreased plasma hom ocyst(e)ine by 11.0 percent (P < 0.001) and 14.0 percent (P = 0.001), respectively. Conclusions Cereal fortified with folic acid has the pot ential to increase plasma folic acid levels and reduce plasma homocyst (e)ine levels. Further clinical trials are required to determine wheth er folic acid fortification may prevent vascular disease. Until then, our results suggest that folic acid fortification at levels higher tha n that recommended by the FDA may be warranted. (C) 1998, Massachusett s Medical Society.