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Prevalence rates for folate deficiency and hyperhomocysteinemia have been markedly reduced following the introduction of folic acid fortification in the United States. We report the prevalence of hyperhomocysteinemia in a population of community-dwelling elderly Latinos in the post-folic acid fortification era. We measured homocysteine, total vitamin B 12 , holotranscobalamin, red blood cell folate, and serum creatinine in 1096 subjects aged ≥60years. Hyperhomocysteinemia (&gt;13μmol/L) was observed in 16.5% of the subjects. The population attributable risk percentages for hyperhomocysteinemia were 29.7% for total B 12  &lt;148pmol/L, 36.4% for holotranscobalamin &lt;35pmol/L, and 41.4% for creatinine &gt;115μmol/L. In contrast, the population attributable risk percentage for hyperhomocysteinemia was only 0.3% for red blood cell folate &lt;365nmol/L. We conclude that in the post-folic acid fortification era, low vitamin B 12  status has become the dominant nutritional determinant of hyperhomocysteinemia. Steps to either reduce the prevalence of vitamin B 12  deficiency or to identify and treat individuals with vitamin B 12  deficiency could further reduce the prevalence of hyperhomocysteinemia.

Vitamin B 12 deficiency is the dominant nutritional cause of hyperhomocysteinemia in a folic acid-fortified population