title: Bread cofortified with folic acid and vitamin B-12 improves the folate and vitamin B-12 status of healthy older people: a randomized controlled trial.
abstract: BACKGROUND
  Mandatory fortification of flour with folic acid has reduced the number of neural tube defects in North America. Concerns that high intakes of folic acid might mask vitamin B-12 deficiency in older persons have delayed the introduction of fortification in many European countries. Cofortification of flour with folic acid and vitamin B-12 could simultaneously improve folate and vitamin B-12 status.
  
  
  OBJECTIVE
  The objective was to estimate the effect of the consumption of bread fortified with modest amounts of folic acid and vitamin B-12 on folate and vitamin B-12 status in healthy older persons living in the Netherlands, where folic acid fortification is not taking place.
  
  
  METHODS
  Men and women aged 50-75 y were randomly assigned in this 12-wk double-blind, placebo-controlled trial to consume bread fortified with 138 mug folic acid and 9.6 mug vitamin B-12 daily (n = 72) or unfortified bread (n = 70).
  
  
  RESULTS
  The consumption of fortified bread increased serum folate concentrations by 45% (mean: 6.3 nmol/L; 95% CI: 4.5, 8.1 nmol/L) and serum vitamin B-12 concentrations by 49% (mean: 102 pmol/L; 95% CI: 82, 122 pmol/L) relative to the placebo group. Fortified bread increased erythrocyte folate concentrations by 22% and holotranscobalamin concentrations by 35%; it decreased homocysteine concentrations by 13% and methylmalonic acid concentrations by 10%. Consumption of fortified bread decreased the proportion of individuals with marginal serum vitamin B-12 concentrations (<133 pmol/L) from 8% at enrollment to 0% after 12 wk.
  
  
  CONCLUSIONS
  Bread fortified with modest amounts of folic acid and vitamin B-12 will improve folate and vitamin B-12 status and a considerable proportion of vitamin B-12 deficiency in older people. This trial was registered at clinicaltrials.gov as NCT00353353.
authors.affiliation: Top Institute of Food & Nutrition, Wageningen, Netherlands.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Winkels
authors.forename: Ingeborg A
authors.initials: IA
authors.lastname: Brouwer
authors.forename: Robert
authors.initials: R
authors.lastname: Clarke
authors.forename: Martijn B
authors.initials: MB
authors.lastname: Katan
authors.forename: Petra
authors.initials: P
authors.lastname: Verhoef
mesh_terms: D000368:Aged; D000375:Aging / Q000097:blood / Q000378:metabolism; D001939:Bread / Q000032:analysis; D004311:Double-Blind Method; D004912:Erythrocytes / Q000737:chemistry / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood*; D005527:Food, Fortified; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood; D008875:Middle Aged; D009436:Neural Tube Defects / Q000517:prevention & control; D009751:Nutritional Requirements; D009752:Nutritional Status; D014805:Vitamin B 12 / Q000008:administration & dosage* / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis / Q000517:prevention & control
chemical_list: D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12