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Nutritional Epidemiology

Demographic, Lifestyle, and Health Characteristic and Serum B Vitamin Status Determinants of Plasma Total Homocysteine Concentration in the Post-Folic Acid Fortification Period, 1999–2004¹

² Division of Nutrition, School of Health Professions, College of Health and Human Sciences, Georgia State University, Atlanta, GA 30303 ³ Department of Mathematics, San Francisco State University, San Francisco, CA 94132

Elevated circulating total homocysteine (tHcy) concentrations are related to increased risk for cardiovascular disease. Folic acid fortification resulted in a significant decrease in circulating tHcy in the United States. In the post-folic acid fortification period, association between plasma tHcy and demographic, health, and lifestyle factors and B vitamin status was investigated. Data from the 3 recent NHANES cycles (1999–2004) were used to study the association among plasma tHcy and sex, race/ethnicity, age, BMI, blood pressure (BP), serum creatinine, serum cotinine, vitamin/mineral supplement use, and folate and cobalamin status in 16,254 persons (8329 men, 7925 women). Multivariate-adjusted plasma tHcy was 9.7% higher in men than in women (P < 0.0001), 5.3% higher in non-Hispanic whites than in non-Hispanic blacks (P < 0.0001), 64.5% higher in individuals aged 60 y than in individuals aged <20 y (P < 0.0001), and 5% higher in nonsupplement users than in supplement users (P < 0.0001). Persons in the 4th quartile for serum creatinine, serum cotinine, systolic BP, and serum methylmalonic acid (MMA) had 36.1, 13.4, 5.6, and 16.2%, respectively, higher tHcy than those in the 1st quartile (P < 0.0001). Plasma tHcy was inversely associated with serum folate (P < 0.0001), RBC folate (P < 0.0001), and serum cobalamin (P < 0.0001). In the post-folic acid fortification period, sex, race/ethnicity, age, systolic BP, supplement use, RBC folate, and serum creatinine, cotinine, folate, and cobalamin are significant determinants of plasma tHcy. Serum MMA was strongly associated with plasma tHcy.

^* To whom correspondence should be addressed. E-mail: vganji{at}gsu.edu.

Manuscript received 30 June 2008. Initial review completed 28 July 2008. Revision accepted 1 December 2008.