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

Objective: We 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. Design: Observational study conducted among participants of a randomized trial. Setting: The Child and Adolescent Trial for Cardiovascular Health (CATCH) study. Subjects: Adolescents (n 2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years). Results: Average serum concentrations of tHcy, folate and vitamin B-6 increased by 17%, 16% and 14%, respectively, while serum concentrations of vitamin B-12 decreased by 11% post-fortification. Folic acid fortification provided, on average, an additional intake of 118 mu g 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 males v. females (P < 0.001 for interaction). Conclusions: Fortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.