Abstract
Objective:
To investigate the consumption of industrial trans-fatty acids (TFAs) in Iranian homes and the proportion of coronary heart disease (CHD) events in Iran attributable to such intake.
Design, setting and participants:
The consumption of industrial TFAs was determined using (1) detailed in-home assessments of dietary intake among 7158 urban and rural households containing 35 924 individuals and (2) gas chromatography to determine TFA contents of the most commonly consumed partially hydrogenated oils. The population-attributable risk for CHD owing to TFA consumption was calculated on the basis of (1) documented effects of TFAs on total:high-density lipoprotein (HDL) cholesterol in randomized controlled dietary trials and (2) relationships of TFA intake with incidence of CHD in prospective observational studies.
Results:
Partially hydrogenated oils were used extensively for cooking in Iranian homes with average per-person intake of 14 g/1000 kcal. TFAs accounted for 33% of fatty acids in these products, or 4.2% of all calories consumed (12.3 g/day). On the basis of total:HDL cholesterol effects alone, 9% of CHD events would be prevented by replacement of TFA in Iranian homes with cis-unsaturated fats (8% by replacement with saturated fats). On the basis of relationships of TFA intake with CHD incidence in prospective studies, 39% of CHD events would be prevented by replacement of TFA with cis-unsaturated fats (31% by replacement with saturated fats). These population-attributable risks may be overestimates owing to competing risks and because not all the fat used for cooking might actually be consumed. If actual TFA consumption were only half as large, the estimated proportion of CHD events prevented by TFA elimination would be 5% on the basis of total:HDL cholesterol effects and replacement with cis-unsaturated (4% for replacement with saturated fats), and 22% on the basis of prospective studies and replacement with cis-unsaturated fats (17% for replacement with saturated fats). These estimates do not include possible additional benefits derived from replacing TFAs with vegetable oils containing n-3 fatty acids.
Conclusions:
Intake of TFAs is high in Iranian homes and contributes to a sizeable proportion of CHD events. Replacement of partially hydrogenated oils with unhydrogenated oils would likely produce substantial reductions in CHD incidence.
Sponsorship:
National Heart, Lung and Blood Institute, National Institutes of Health, USA. National Nutrition & Food Technology Research Institute, Tehran, Iran.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Allison DB, Egan SK, Barraj LM, Caughman C, Infante M, Heimbach JT (1999). Estimated intakes of trans fatty and other fatty acids in the US population. J Am Diet Assoc 99, 166–174.
Aro A (2006). The scientific basis for trans fatty acid regulations – is it sufficient? Eur Perspect Atheroscler Suppl 7, 67–68.
Ascherio A, Katan MB, Zock PL, Stampfer MJ, Willett WC (1999). Trans fatty acids and coronary heart disease. N Engl J Med 340, 1994–1998.
Baer DJ, Judd JT, Clevidence BA, Tracy RP (2004). Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. Am J Clin Nutr 79, 969–973.
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C et al. (2005). Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 366, 1267–1278.
Baylin A, Kabagambe EK, Siles X, Campos H (2002). Adipose tissue biomarkers of fatty acid intake. Am J Clin Nutr 76, 750–757.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N (1999). Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99, 779–785.
de Roos NM, Bots ML, Katan MB (2001). Replacement of dietary saturated fatty acids by trans fatty acids lowers serum HDL cholesterol and impairs endothelial function in healthy men and women. Arterioscler Thromb Vasc Biol 21, 1233–1237.
Dietary Guidelines Advisory Committee (2005). 2005 Dietary Guidelines Advisory Committee Report. US Department of Health and Human Services. US Department of Agriculture.
Han SN, Leka LS, Lichtenstein AH, Ausman LM, Schaefer EJ, Meydani SN (2002). Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. J Lipid Res 43, 445–452.
Health Canada (2005). Government response to the interim recommendations of the trans fat task force.
Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG et al. (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345, 790–797.
Hulshof KF, van Erp-Baart MA, Anttolainen M, Becker W, Church SM, Couet C et al. (1999). Intake of fatty acids in western Europe with emphasis on trans fatty acids: the TRANSFAIR Study. Eur J Clin Nutr 53, 143–157.
James WPT, Schofield EC (1990). Human Energy Requirements: a Manual for Planners and Nutritionists. Food and Agriculture Organization of the United Nations Oxford University Press: Oxford, England.
Jensen HG (2005). Labelling of trans fatty acid content in food, regulations, and what limits pros et cons – the Danish view (abst.). First International Symposium on Trans Fatty Acids and Health September 13, Rungstedgaard: Denmark.
Kavanagh K, Jones K, Sawyer J, Kelly K, Wagner JD, Rudel LL (2006). Trans fat diet induces insulin resistance in monkeys. American Diabetes Association Scientific Sessions June 12, Washington, DC.
Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W et al. (2003). Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men. Am J Clin Nutr 78, 719–727.
Kummerow FA, Zhou Q, Mahfouz MM (1999). Effect of trans fatty acids on calcium influx into human arterial endothelial cells. Am J Clin Nutr 70, 832–838.
Lemaitre RN, King I, Mozaffarian D, Siscovick DS (2005). Plasmaphospholipid trans fatty acids and fatal ischemic heart disease in older adults. The Cardiovascular Health Study (abst.). American Heart Association Conference on Cardiovascular Disease Epidemiology and Prevention May 1, Washington DC.
Lemaitre RN, King IB, Raghunathan TE, Pearce RM, Weinmann S, Knopp RH et al. (2002). Cell membrane trans-fatty acids and the risk of primary cardiac arrest. Circulation 105, 697–701.
Leth T, Bysted A, Erendah-Mikkelsen A (2005). The effect of the regulation on trans fatty acid content in Danish food (abst.). First International Symposium on Trans Fatty Acids and Health September 13, Rungstedgaard: Denmark.
Leth T, Jensen HG, Mikkelsen AA, Bysted A (2006). The effect of the regulation on trans fatty acid content in Danish food. Atheroscler Suppl 7, 53–56.
Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ et al. (2005). Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J Nutr 135, 562–566.
Mauger JF, Lichtenstein AH, Ausman LM, Jalbert SM, Jauhiainen M, Ehnholm C et al. (2003). Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr 78, 370–375.
Mensink RP, Zock PL, Kester AD, Katan MB (2003). Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77, 1146–1155.
Mozaffarian D (2005). Does alpha-linolenic acid intake reduce the risk of coronary heart disease? A review of the evidence. Altern Ther Health Med 11, 24–30. quiz 31, 79.
Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC (2006). Trans fatty acids and cardiovascular disease. N Engl J Med 354, 1601–1613.
Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC et al. (2004a). Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr 79, 606–612.
Mozaffarian D, Rimm EB, King IB, Lawler RL, McDonald GB, Levy WC (2004b). Trans fatty acids and systemic inflammation in heart failure. Am J Clin Nutr 80, 1521–1525.
New York City Department of Health and Mental Hygiene (2005). Press release: Health department asks restaurateurs and food suppliers to voluntarily make an oil change and eliminate artificial trans fat.
Nielsen K (2006). Is the quality and cost of food affected if industrially produced trans fatty acids are removed? Atheroscler Suppl 7, 61–62.
Nowrouzi F, Samimi B (2002). The food balance sheet of Iran, 1989–2001. Agricultural Planning and Economic Research Institute: Tehran.
Robins SJ, Collins D, Wittes JT, Papademetriou V, Deedwania PC, Schaefer EJ et al. (2001). Relation of gemfibrozil treatment and lipid levels with major coronary events: VA-HIT: a randomized controlled trial. JAMA 285, 1585–1591.
Schofield WN (1985). Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39 (Suppl 1), 5–41.
Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH (1991). A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med 325, 373–381.
UNICEF (2005). At a glance: islamic republic of iran statistics. At:http://www.unicef.org/infobycountry/iran_statistics.html.
US Food and Drug Administration (2005). FDA acts to provide better information to consumers on trans fats.
Willett WC, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, Rosner BA et al. (1993). Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 341, 581–585.
Zandi P, Coordinator of Research Committee and Oil Technology Working Group (2004). Report on the Status of Edible Oils in Iran. The Secretariat of the National Food and Nutrition Council: Tehran.
Zatonski WA, McMichael AJ, Powles JW (1998). Ecological study of reasons for sharp decline in mortality from ischaemic heart disease in Poland since 1991. BMJ 316, 1047–1051.
Acknowledgements
Dr Mozaffarian was supported by funding from the National Heart, Lung and Blood Institute, National Institutes of Health (K08-HL-075628). We thank Dr Mohsen Janghorbani for providing cause-specific mortality data from Iran and the investigators of the Nutrition Research Department, National Nutrition & Food Technology Research Institute, who collaborated in the conduction of the Iranian Food Consumption Survey.
Author information
Authors and Affiliations
Corresponding author
Additional information
Guarantor: D Mozaffarian.
Contributors: DM participated in the conception and design, statistical analysis and data interpretation, manuscript drafting, critical revision of the manuscript for important intellectual content and approval of the final manuscript for submission.MA participated in the collection of data, critical revision of the manuscript for important intellectual content, and approval of the final manuscript for submission.HC participated in the collection of data, critical revision of the manuscript for important intellectual content, and approval of the final manuscript for submission.AH participated in the collection of data, critical revision of the manuscript for important intellectual content, and approval of the final manuscript for submission.WW participated in the conception and design, data collection and interpretation, critical revision of the manuscript for important intellectual content, and approval of the final manuscript for submission.
Rights and permissions
About this article
Cite this article
Mozaffarian, D., Abdollahi, M., Campos, H. et al. Consumption of trans fats and estimated effects on coronary heart disease in Iran. Eur J Clin Nutr 61, 1004–1010 (2007). https://doi.org/10.1038/sj.ejcn.1602608
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ejcn.1602608
Keywords
This article is cited by
-
Association between dietary phytochemical index and breast cancer: a case–control study
Breast Cancer (2021)
-
Higher dietary fat quality is associated with lower anxiety score in women: a cross-sectional study
Annals of General Psychiatry (2020)
-
Ethnic Variation in Lipid Profile and Its Associations with Body Composition and Diet: Differences Between Iranians, Indians and Caucasians Living in Australia
Journal of Immigrant and Minority Health (2017)
-
Effect of a trans fatty acid-enriched diet on biochemical and inflammatory parameters in Wistar rats
European Journal of Nutrition (2017)
-
Effect of trans fatty acid intake on abdominal and liver fat deposition and blood lipids: a randomized trial in overweight postmenopausal women
Nutrition & Diabetes (2011)