In a population that consumes folic acid supplements or has a diet fortified with this vitamin, the upper reference limit of Hcy is usually 20% to 25% lower than in unfortified populations. A study investigating the association between hyperhomocysteinemia and cardiovascular disease (CVD), serum folate, and cobalamin should also be analyzed [11]. The effectiveness of folic acid fortification in improving folate status has already been shown to be quite striking, with a dramatic increase BI 2536 concentration in blood measurements of folate and a substantial decrease in plasma Hcy levels in the United States [12]. In

Brazil, no study has been conducted comparing the plasma concentrations of Hcy before and after the fortification of flour with folic acid in women with metabolic syndrome (MS). Thus, the hypothesis of this research is that the fortification of flour with folic acid contributes to the reduction of plasma Hcy levels. Therefore, the objective of this study is to assess the effect of the consumption of corn and wheat flours fortified with

folic acid on Hcy levels and other biomarkers in women by a cross-sectional study covering 2 periods, prefortification and postfortification in Brazil. A cross-sectional study was conducted in which participants were recruited from 2 different stages: prefortification (2002-2003) and postfortification (2008-2009) of flours with folic acid. The study was performed with patients of the Nutritional Ambulatory Care of the Trichostatin A research buy Federal University of Rio de Janeiro, Brazil, where overweight patients with chronic diseases were being treated. They belonged to the lowest social classes and were residents in several cities in the state of Rio de Janeiro. Only women with MS were selected for this study because they surpassed men in rates of cardiovascular mortality in Brazil. The 38 volunteers from the prefortification stage were selected from a study with 93 individuals, which were designed to assess the factors associated with Hcy levels in individuals with and without MS [13]. From this study, only women who met the inclusion criteria were included in this

research. The 55 volunteers from the postfortification stage were selected from a study of 133 women. This study was designed to assess the association between concentrations of Hcy and biomarkers Uroporphyrinogen III synthase of MS. Included were those who filled out a food frequency questionnaire (FFQ) [14]; the others were excluded. In both studies, after the screening, the explanation of the research was given to the patients who met the eligibility criteria. They signed a statement of consent and filled out a general information questionnaire. Subsequently, blood draw and anthropometric measurements were performed. Lastly, the FFQ was applied. Inclusion criteria were the following: women nutritionally diagnosed as overweight, obesity classes 1 and 2, with body mass index (BMI) from 25.0 to 39.