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March 6, 1996

Folic Acid Fortification of Food-Reply

Author Affiliations

University of Washington Seattle

JAMA. 1996;275(9):682-683. doi:10.1001/jama.1996.03530330025015

In Reply.  —In response to Dr Bostom, we did state that vitamins B12, B6, and folic acid regulate plasma homocysteine levels, and we summarized and included PML studies in our meta-analysis. Although the ORs for elevated PML homocysteine tended to be higher than those for elevated fasting homocysteine, our analysis (p 1050, Table 1, and Figure 1) showed little difference in the pooled ORs for coronary and cerebrovascular diseases with inclusion or omission of the PML data (OR, 1.7 vs 1.8 for coronary artery disease; OR, 2.5 vs 2.3 for cerebrovascular disease). Increasing folic acid intake directly and independently reduces fasting plasma total homocysteine; such folic acid effects are stronger and more consistent than those of vitamin B12 or vitamin B6.1 We stated that vitamin B6 can reduce elevated homocysteine PML. Different treatment for different patterns of elevated homocysteine deserves further investigation. On a