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Health effects of trans-fatty acids: experimental and observational evidence

Abstract

Background/Objectives:

Growing evidence indicates that trans-fatty acids (TFA) adversely affect cardiovascular health. As part of the World Health Organization (WHO) Scientific Update on TFA, we reviewed the evidence for effects of TFA consumption on coronary heart disease (CHD).

Subjects/Methods:

We searched Medline publications examining TFA consumption and CHD risk factors or outcomes, emphasizing results of studies in humans. We evaluated and synthesized evidence from both controlled feeding trials evaluating risk factors and long-term observational studies evaluating risk factors or clinical outcomes, each of which have complementary strengths and limitations, to enable the most robust and reliable inferences of effects.

Results:

The effects of TFA consumption on risk factors most consistently seen in both controlled trials and observational studies included adverse lipid effects (for example ↑low-density lipoprotein cholesterol, ↓high-density lipoprotein cholesterol (HDL-C), ↑total/HDL-C ratio), proinflammatory effects (for example ↑tumor necrosis factor-α activity, ↑interleukin-6, ↑C-reactive protein) and endothelial dysfunction. These effects were most prominent in comparison with cis unsaturated fats; adverse effects on total/HDL-C and endothelial function were also seen in comparison with saturated fatty acids (SFA). TFA may also worsen insulin sensitivity, particularly among individuals predisposed to insulin resistance; possible effects on weight gain and diabetes incidence require further confirmation. Five retrospective case–control studies and four prospective cohort studies demonstrated positive associations between TFA consumption and CHD events. A meta-analysis of prospective studies indicated 24, 20, 27 and 32% higher risk of myocardial infarction (MI) or CHD death for every 2% energy of TFA consumption isocalorically replacing carbohydrate, SFA, cis monounsaturated fatty acids and cis polyunsaturated fatty acids, respectively. The differential effects of specific TFA isomers may be important but are less well established. The available evidence indicates that trans-18:1 and particularly trans-18:2 isomers have stronger CHD effects than trans-16:1 isomers. The limited data suggest that the experimental effects of ruminant and industrial TFA are similar when consumed in similar quantities, but very few persons consume such high levels of ruminant TFA, and observational studies do not support adverse CHD effects of ruminant TFA in amounts actually consumed.

Conclusions:

Controlled trials and observational studies provide concordant evidence that consumption of TFA from partially hydrogenated oils adversely affects multiple cardiovascular risk factors and contributes significantly to increased risk of CHD events. The public health implications of ruminant TFA consumption appear much more limited. The effects of specific TFA isomers require further investigation.

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Acknowledgements

We thank Dr Robert Clarke, Dr Richard Deckelbaum, Dr Ghafoorunissa, Dr Martijn B Katan, Professor Jim Mann, Dr Ulf Risérus, Dr Thomas Sanders, Professor Ricardo Uauy and Dr Bengt Vessby for their helpful comments during the preparation of this paper. We also acknowledge the helpful comments received from Panel on Dietetic Products, Nutrition and Allergies (NDA), European Food Safety Authority (EFSA), in particular, Dr Silvia Valtueña Martinez, Dr Pilar Rodríguez Iglesias, Dr Wolfgang Gelbman and Dr Leng Heng. Dr Mozaffarian was supported by a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health (K08-HL-075628). We thank Jemma Hopewell and Paul Sherliker for their assistance in statistical analyses and figure production.

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Mozaffarian, D., Aro, A. & Willett, W. Health effects of trans-fatty acids: experimental and observational evidence. Eur J Clin Nutr 63 (Suppl 2), S5–S21 (2009). https://doi.org/10.1038/sj.ejcn.1602973

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