Homocysteine and Folate Status in an Era of Folic Acid Fortification: Balancing Benefits, Risks, And B-Vitamins (Editorial‪)‬

Mandatory folic acid (vitamin [B.sub.9]) fortification of flour products to a level of 140-150 [micro]g/100g was implemented in the US and Canada in 1998. The rationale was to improve folate status in women of childbearing age and thereby decrease the incidence of neural tube defects (NTDs). Studies with complete ascertainment of prenatally diagnosed NTD cases indicate that fortification has prevented up to 50% of NTDs (1). Fortification has therefore been highly successful in achieving its primary objective. Folate concentration in serum and erythrocytes is a marker of folate status, which is inversely associated with the plasma concentration of total homocysteine (tHcy). Cobalamin (vitamin B12) status and renal function are also strong determinants of plasma tHcy (2), and moderate hyperhomocysteinemia is associated with an increased risk of chronic diseases, including cardiovascular disease, dementia, and impaired cognition (3).