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Objective: To determine the effect of folic acid, vitamin B 6 and B 12 fortified spreads on the blood concentrations of these vitamins and homocysteine. Design and setting: A 6-week randomized, double-blinded, placebo-controlled, parallel trial carried out in a clinical research center. Subjects: One hundred and fifty healthy volunteers (50% males). Interventions: For 6 weeks, the subjects consumed the test spreads (20 g/day): containing per 20 g (1) 200 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 , or (2) 400 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 or (3) no B-vitamins (control spread). Results: The B-vitamin status increased on using the test spreads, with the largest effect on the serum folate concentration: 48% in men and 58% in women on spread 1 and 92 and 146%, respectively, on spread 2 (P-values all o0.05). The plasma homocysteine decreased in the groups treated with the fortified spreads as compared to the control group. Average decreases were for males: 0.771.5 mmol/l (6.8%) on spread 1 and 1.771.7 mmol/l (17.6%) on spread 2 and for females: 1.471.2 mmol/l (14.2%) and 2.472.0 mmol/l (23.3%), respectively (P-values all o0.05). Conclusions: Consumption of a spread fortified with folic acid, vitamin B 6 and vitamin B 12 for 6 weeks significantly increases the blood concentrations of these vitamins and significantly decreases the plasma concentration of homocysteine. Fortified staple foods like spreads can contribute to the lowering of homocysteine concentrations.

Objective: To explore the feasibility of low-fat spreads as vehicles for folic acid (FA) fortification by determining the acute absorption of FA from a fortified spread. Design: Double blind, crossover study to test each of the following treatments administered at 1-weekly intervals: (A) 20 g lowfat (40%) spread fortified with 200 mg FA and a placebo tablet; (B) 20 g low-fat placebo spread and a 200 mg FA tablet; (C) 20 g low-fat placebo spread and a placebo tablet. Subjects: A total of 13 male volunteers, aged 31.8713.2 y. Main outcome measures: Plasma total folate concentrations, measured before and up to 10 h after each treatment (n ¼ 10 samples per treatment). Results: Plasma folate concentrations were significantly increased compared with baseline values 1 h after administration of the FA tablet, and 1.5 h after the FA spread, and remained significantly higher than the baseline values for up to 7 h after both treatments. The maximum plasma folate response (R max ), corrected for baseline values and 'placebo response', was established between 1 and 3 h postprandially in response to both FA spread and FA tablet, and no significant difference in R max was found between the two treatments (13.4 vs 14.4 nmol/l, P ¼ 0.9). The acute absorption of FA from fortified spread relative to that from the tablet, calculated on the basis of area under the plasma folate response curve, was 67% (P ¼ 0.04). Conclusion: The absorption of FA from fortified low-fat spread, although lower than from a tablet, is effective. These results suggest that low-fat spreads, typically associated with fat-soluble vitamin fortification, may also be considered feasible as vehicles for FA fortification.

Bleeding from the small intestine is still a very difficult diagnostic problem, even with the most advanced diagnostic procedures. This report suggests the use of intraoperative endoscopy of the small intestine by the introduction of a colonoscope through the mouth. The whole length of the small intestine can be invaginated on the advancing colonoscope and even intramural lesions can be identified and treated accordingly.

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