Folic Acid Fortification

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Abstract
Jacques and colleagues (May 13 issue)1 report data showing that the 30 percent of the Framingham Offspring Study cohort who took B vitamin supplements had a substantially lower mean plasma homocysteine concentration that the members of the cohort who did not take such vitamins, even after the fortification of grain products with folic acid was introduced by the Food and Drug Administration (FDA). Furthermore, the upper tail of the distribution of homocysteine concentrations remained skewed in those who did not take supplements after fortification as compared with those who did take them. This distribution suggests that the homocysteine concentration remains too high in those who do not take supplements. Thus, approximately 70 percent of the adult population in the United States is exposed to a risk factor for cardiovascular disease — an elevated plasma homocysteine concentration — that can be easily avoided simply by consuming a B vitamin supplement. It seems strange that the authors suggest neither supplements nor increased fortification of food.