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Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies


The aim of this systematic review and meta-analysis was to summarize the evidence from observational studies assessing the association between intake of trans fatty acids (TFA) and the risk of coronary heart disease (CHD), with a specific emphasis on distinguishing between TFA of industrial and ruminant origin. By searching five bibliographic databases, analyses from six published and two unpublished prospective cohort studies, assessing the association of intake of TFA with fatal and/or non-fatal CHD, were identified. Four and three studies reported separate associations for intake of ruminant or industrial-TFA, respectively. The pooled relative risk estimates for comparison of extreme quintiles of total-TFA intake (corresponding to intake increments ranging from 2.8 to 10 g/day) were 1.22 (95% confidence interval: 1.08–1.38; P=0.002) for CHD events and 1.24 (1.07–1.43; P=0.003) for fatal CHD. Ruminant-TFA intake (increments ranging from 0.5 to 1.9 g/day) was not significantly associated with risk of CHD (risk ratio (RR)=0.92 (0.76–1.11); P=0.36), and neither was industrial-TFA intake, although there was a trend towards a positive association (RR=1.21 (0.97–1.50); P=0.09). In conclusion, our analysis suggests that industrial-TFA may be positively related to CHD, whereas ruminant-TFA is not, but the limited number of available studies prohibits any firm conclusions concerning whether the source of TFA is important. The null association of ruminant-TFA with CHD risk may be due to lower intake levels.

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We thank the investigators of Finnish Mobile Clinic Health Examination Survey who shared unpublished data with us: P Knekt, A Reunanen, R Seppänen, R Järvinen and A Aromaa, and K Robien and S Motzinger from the Iowa Womens’ Health Study for performing data analyses on our request and sharing the data with us. Arla Food Amba provided financial support for the execution of this review. The Parker Institute, Musculoskeletal Statistics Unit is sponsored by the Oak Foundation.

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Correspondence to A Astrup.

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AA is a member of Communications and Scientific Advisory Board of The Global Dairy Platform, Chicago, IL, USA and has received research grants from Arla Foods Amba and the Danish Dairy Foundation. NTB, RC and EMB have no conflict of interest.

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Bendsen, N., Christensen, R., Bartels, E. et al. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr 65, 773–783 (2011).

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  • trans fatty acids
  • systematic review
  • meta-analysis
  • coronary heart disease
  • cohort studies

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