In their recent study of the effects of folic acid on reduction in homocysteine concentrations, Wald et al1 randomized 151 patients with ischemic heart disease to dosages of folic acid of 0.2 to 0.8 mg/d or placebo and measured serum homocysteine levels at baseline, after 3 months of supplementation, and 3 months after folic acid use was discontinued. Median serum homocysteine levels decreased with increasing folic acid dosage to a maximum of 0.8 mg/d of folic acid, at which point a 23% reduction in homocysteine level was observed. Wald et al1 concluded that a dosage of 0.8 mg/d of folic acid was necessary to achieve the maximum reduction in serum homocysteine level. Wald et al further stated that current US food fortification levels (0.14 mg of folic acid/100 g of cereal-grain product) will achieve only a small proportion of the achievable homocysteine-lowering effect and that the higher level of fortification recommended in England (0.24 mg of folic acid/100 g of flour) will likewise have only a partial effect in lowering serum homocysteine levels. Wald et al inappropriately generalize their study results regarding folic acid fortification levels in enriched cereal-grain products to the United States, which warrants our response.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 12
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.