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Trans fatty acids: effects on metabolic syndrome, heart disease and diabetes

Nature Reviews Endocrinology volume 5, pages 335–344 (2009)Cite this article

Abstract

The major dietary sources of trans fatty acids (TFAs) in most countries are partially hydrogenated vegetable oils. TFA consumption is a modifiable dietary risk factor for metabolic syndrome, diabetes mellitus, and coronary heart disease. Here, we review the available data on various effects of TFAs, including metabolic and signaling pathways that mediate these effects, affected tissues, and relationships with clinical end points. TFA consumption causes metabolic dysfunction: it adversely affects circulating lipid levels, triggers systemic inflammation, induces endothelial dysfunction, and, according to some studies, increases visceral adiposity, body weight, and insulin resistance. Dietary TFAs influence the function of multiple cell types, including hepatocytes, adipocytes, macrophages and endothelial cells. Among dietary fats and nutrients, TFAs seem to have a unique cardiometabolic imprint that is linked to insulin-resistance and metabolic-syndrome pathways. Consistent with these adverse physiological effects, consumption of even small amounts of TFAs (2% of total energy intake) is consistently associated with a markedly increased incidence of coronary heart disease. Relationships between TFA consumption and diabetes mellitus have been less consistent, possibly owing to differences in study designs. Nevertheless, the documented adverse effects of TFAs underscore their potential to cause harm and the importance of policy measures to minimize consumption of industrially produced TFAs.

Key Points

  • Dietary trans fatty acids (TFAs) derive from industrial, partial hydrogenation of vegetable oils or from ruminant products

  • Dietary TFAs influence the function of multiple cell types, including hepatocytes, adipocytes, macrophages and endothelial cells

  • TFA consumption affects multiple metabolic risk factors, including lipid and lipoprotein levels, systemic inflammation, endothelial function, adiposity, and glucose–insulin homeostasis

  • TFA consumption increases risk of clinical coronary heart disease and likelihood of development of diabetes mellitus

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Figure 1: Changes in lipid and lipoprotein levels associated with consumption of SFAs, MUFAs or PUFAs isocalorically replaced with TFAs.
Figure 2: Changes in relative risk of coronary heart disease for each 1% energy from carbohydrate that is isocalorically replaced with TFAs, SFAs, MUFAs or PUFAs.

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References

  1. National Institute of Diabetes and Digestive and Kidney Diseases, NIH. Incidence of diagnosed diabetes among people aged 20 years or older, United States, 2007. National Diabetes Statistics [online] (2008).

  2. American Heart Association. Heart Disease and Stroke Statistics—Update 2008. [online] (2008).

  3. WHO. Obesity and Overweight. Fact Sheet No 311. [online] (2006).

  4. Allison, D. B. et al. Estimated intakes of trans fatty and other fatty acids in the US population. J. Am. Diet. Assoc. 99, 166–174 (1999).

    Article  CAS  Google Scholar 

  5. Mozaffarian, D., Abdollahi, M., Campos, H., Houshiarrad, A. & Willett, W. C. Consumption of trans fats and estimated effects on coronary heart disease in Iran. Eur. J. Clin. Nutr. 61, 1004–1010 (2007).

    Article  CAS  Google Scholar 

  6. Stender, S., Dyerberg, J. & Astrup, A. High levels of industrially produced trans fat in popular fast foods. N. Engl. J. Med. 354, 1650–1652 (2006).

    Article  CAS  Google Scholar 

  7. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans. US Department of Health Services Website [online] (2005).

  8. Lock, A. L. & Bauman, D. E. Modifying milk fat composition of dairy cows to enhance fatty acids beneficial to human health. Lipids 39, 1197–1206 (2004).

    Article  CAS  Google Scholar 

  9. Risérus, U., Vessby, B., Arnlöv, J. & Basu, S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am. J. Clin. Nutr. 80, 279–283 (2004).

    Article  Google Scholar 

  10. Moloney, F., Yeow, T. P., Mullen, A., Nolan, J. J. & Roche, H. M. Conjugated linoleic acid supplementation, insulin sensitivity, and lipoprotein metabolism in patients with type 2 diabetes mellitus. Am. J. Clin. Nutr. 80, 887–895 (2004).

    Article  CAS  Google Scholar 

  11. Smedman, A., Vessby, B. & Basu, S. Isomer-specific effects of conjugated linoleic acid on lipid peroxidation in humans: regulation by α-tocopherol and cyclo-oxygenase-2 inhibitor. Clin. Sci. (Lond.) 106, 67–73 (2004).

    Article  CAS  Google Scholar 

  12. Nugent, A. P. et al. The effects of conjugated linoleic acid supplementation on immune function in healthy volunteers. Eur. J. Clin. Nutr. 59, 742–750 (2005).

    Article  CAS  Google Scholar 

  13. Chardigny, J. M. et al. Do trans fatty acids from industrially produced sources and from natural sources have the same effect on cardiovascular disease risk factors in healthy subjects? Results of the Trans Fatty Acids Collaboration (TRANSFACT) study. Am. J. Clin. Nutr. 87, 558–566 (2008).

    Article  CAS  Google Scholar 

  14. Motard-Belanger, A. et al. Study of the effect of trans fatty acids from ruminants on blood lipids and other risk factors for cardiovascular disease. Am. J. Clin. Nutr. 87, 593–599 (2008).

    Article  CAS  Google Scholar 

  15. Willett, W. & Mozaffarian, D. Ruminant or industrial sources of trans fatty acids: public health issue or food label skirmish? Am. J. Clin. Nutr. 87, 515–516 (2008).

    Article  CAS  Google Scholar 

  16. Oomen, C. M. et al. Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study. Lancet 357, 746–751 (2001).

    Article  CAS  Google Scholar 

  17. Pietinen, P. et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The α-tocopherol, β-carotene cancer prevention study. Am. J. Epidemiol. 145, 876–887 (1997).

    Article  CAS  Google Scholar 

  18. Willett, W. C. et al. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet 341, 581–585 (1993).

    Article  CAS  Google Scholar 

  19. Jakobsen, M. U. et al. Intake of ruminant trans fatty acids and risk of coronary heart disease—an overview. Atheroscler. Suppl. 7, 9–11 (2006).

    Article  CAS  Google Scholar 

  20. Jakobsen, M. U., Overvad, K., Dyerberg, J. & Heitmann, B. L. Intake of ruminant trans fatty acids and risk of coronary heart disease. Int. J. Epidemiol. 37, 173–182 (2008).

    Article  Google Scholar 

  21. Mozaffarian, D. & Clarke, R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur. J. Clin. Nutr. (in press).

  22. Mauger, J. F. et al. Effect of different forms of dietary hydrogenated fats on LDL particle size. Am. J. Clin. Nutr. 78, 370–375 (2003).

    Article  CAS  Google Scholar 

  23. Mozaffarian, D., Aro, A. & Willett, W. C. Health effects of trans-fatty acids: experimental and observational evidence. Eur. J. Clin. Nutr. (in press).

  24. Baer, D. J., Judd, J. T., Clevidende, B. A. & Tracy, R. P. 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 (2004).

    Article  CAS  Google Scholar 

  25. Han, S. N. et al. 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 (2002).

    CAS  PubMed  Google Scholar 

  26. Mozaffarian, D. et al. Dietary intake of trans fatty acids and systemic inflammation in women. Am. J. Clin. Nutr. 79, 606–612 (2004).

    Article  CAS  Google Scholar 

  27. Lopez-Garcia, E. et al. Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J. Nutr. 135, 562–566 (2005).

    Article  CAS  Google Scholar 

  28. Ridker, P. M., Hennekens, C. H., Buring, J. E. & Rifai, N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N. Engl. J. Med. 342, 836–843 (2000).

    Article  CAS  Google Scholar 

  29. de Roos, N. M., Bots, M. L. & Katan, M. B. 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 (2001).

    Article  CAS  Google Scholar 

  30. Dyerberg, J. et al. Effects of trans- and n-3 unsaturated fatty acids on cardiovascular risk markers in healthy males. An 8 weeks dietary intervention study. Eur. J. Clin. Nutr. 58, 1062–1070 (2004).

    Article  CAS  Google Scholar 

  31. Kavanagh, K. et al. Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys. Obesity (Silver Spring) 15, 1675–1684 (2007).

    Article  CAS  Google Scholar 

  32. Koh-Banerjee, P. et al. 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 (2003).

    Article  CAS  Google Scholar 

  33. Field, A. E., Willett, W. C., Lissner, L. & Colditz, G. A. Dietary fat and weight gain among women in the Nurses' Health Study. Obesity (Silver Spring) 15, 967–976 (2007).

    Article  Google Scholar 

  34. Christiansen, E., Schnider, S., Palmvig, B., Tauber-Lassen, E. & Pedersen, O. Intake of a diet high in trans monounsaturated fatty acids or saturated fatty acids. Effects on postprandial insulinemia and glycemia in obese patients with NIDDM. Diabetes Care 20, 881–887 (1997).

    Article  CAS  Google Scholar 

  35. Vega-Lopez, S., Ausman, L. M., Jalbert, S. M., Erkkilä, A. T & Lichtenstein, A. H. Palm and partially hydrogenated soybean oils adversely alter lipoprotein profiles compared with soybean and canola oils in moderately hyperlipidemic subjects. Am. J. Clin. Nutr. 84, 54–62 (2006).

    Article  CAS  Google Scholar 

  36. Lefevre, M. et al. Comparison of the acute response to meals enriched with cis- or trans-fatty acids on glucose and lipids in overweight individuals with differing FABP2 genotypes. Metabolism 54, 1652–1658 (2005).

    Article  CAS  Google Scholar 

  37. Lovejoy, J. C. et al. Effects of diets enriched in saturated (palmitic), monounsaturated (oleic), or trans (elaidic) fatty acids on insulin sensitivity and substrate oxidation in healthy adults. Diabetes Care 25, 1283–1288 (2002).

    Article  CAS  Google Scholar 

  38. Louheranta, A. M., Turpeinen, A. K., Vidgren, H. M, Schwab, U. S. & Uusitupa, M. I. A high-trans fatty acid diet and insulin sensitivity in young healthy women. Metabolism 48, 870–875 (1999).

    Article  CAS  Google Scholar 

  39. Axen, K. V., Dikeakos, A. & Sclafani, A. High dietary fat promotes syndrome X in nonobese rats. J. Nutr. 133, 2244–2249 (2003).

    Article  CAS  Google Scholar 

  40. Ibrahim, A., Natrajan, S. & Ghafoorunissa, R. Dietary trans-fatty acids alter adipocyte plasma membrane fatty acid composition and insulin sensitivity in rats. Metabolism 54, 240–246 (2005).

    Article  CAS  Google Scholar 

  41. Natarajan, S., Ghafoorunissa, R. & Ibrahim, A. Dietary trans fatty acids alter diaphragm phospholipid fatty acid composition, triacylglycerol content and glucose transport in rats. Br. J. Nutr. 93, 829–833 (2005).

    Article  CAS  Google Scholar 

  42. Albuquerque, K. T. et al. Intake of trans fatty acid-rich hydrogenated fat during pregnancy and lactation inhibits the hypophagic effect of central insulin in the adult offspring. Nutrition 22, 820–829 (2006).

    Article  CAS  Google Scholar 

  43. Pisani, L. P. et al. Hydrogenated fat diet intake during pregnancy and lactation modifies the PAI-1 gene expression in white adipose tissue of offspring in adult life. Lipids Health Dis. 7, 13 (2008).

    Article  Google Scholar 

  44. Osso, F. S. et al. Trans fatty acids in maternal milk lead to cardiac insulin resistance in adult offspring. Nutrition 24, 727–732 (2008).

    Article  CAS  Google Scholar 

  45. Assumpcão, R. P., dos Santos, F. D., de Mattos Machado Andrade, P., Barreto, G. F. & das Graças Tavares do Carmo, M. Effect of variation of trans-fatty acid in lactating rats' diet on lipoprotein lipase activity in mammary gland, liver, and adipose tissue. Nutrition 20, 806–811 (2004).

    Article  Google Scholar 

  46. Innis, S. M. & King, D. J. Trans fatty acids in human milk are inversely associated with concentrations of essential all-cis n-6 and n-3 fatty acids and determine trans, but not n-6 and n-3, fatty acids in plasma lipids of breast-fed infants. Am. J. Clin. Nutr. 70, 383–390 (1999).

    Article  CAS  Google Scholar 

  47. Mozaffarian, D. & Willett, W. C. Trans fatty acids and cardiovascular risk: a unique cardiometabolic imprint? Curr. Atheroscler. Rep. 9, 486–493 (2007).

    Article  CAS  Google Scholar 

  48. Dashti, N., Feng, Q., Freeman, M. R., Gandhi, M. & Franklin, F. A. Trans polyunsaturated fatty acids have more adverse effects than saturated fatty acids on the concentration and composition of lipoproteins secreted by human hepatoma HepG2 cells. J. Nutr. 132, 2651–2659 (2002).

    Article  CAS  Google Scholar 

  49. Mitmesser, S. H. & Carr, T. P. Trans fatty acids alter the lipid composition and size of apo-B100-containing lipoproteins secreted by HepG2 cells. J. Nutr. Biochem. 16, 178–183 (2005).

    Article  CAS  Google Scholar 

  50. Matthan, N. R. et al. Hydrogenated fat consumption affects acylation-stimulating protein levels and cholesterol esterification rates in moderately hypercholesterolemic women. J. Lipid Res. 42, 1841–1848 (2001).

    CAS  PubMed  Google Scholar 

  51. Abbey, M. & Nestel, P. J. Plasma cholesteryl ester transfer protein activity is increased when trans-elaidic acid is substituted for cis-oleic acid in the diet. Atherosclerosis 106, 99–107 (1994).

    Article  CAS  Google Scholar 

  52. Lee, J. Y. & Carr, T. P. Dietary fatty acids regulate acyl-CoA:cholesterol acyltransferase and cytosolic cholesteryl ester hydrolase in hamsters. J. Nutr. 134, 3239–3244 (2004).

    Article  CAS  Google Scholar 

  53. Kummerow, F. A., Mahfouz, M. M. & Zhou, Q. Trans fatty acids in partially hydrogenated soybean oil inhibit prostacyclin release by endothelial cells in presence of high level of linoleic acid. Prostaglandins Other Lipid Mediat. 84, 138–153 (2007).

    Article  CAS  Google Scholar 

  54. Diamond, F. B. Jr & Eichler, D. C. Leptin and the adipocyte endocrine system. Crit. Rev. Clin. Lab. Sci. 39, 499–525 (2002).

    Article  CAS  Google Scholar 

  55. Niu, S. L. et al. Reduced G protein-coupled signaling efficiency in retinal rod outer segments in response to n-3 fatty acid deficiency. J. Biol. Chem. 279, 31098–31104 (2004).

    Article  CAS  Google Scholar 

  56. Niu, S. L., Mitchell, D. C. & Litman, B. J. Trans fatty acid derived phospholipids show increased membrane cholesterol and reduced receptor activation as compared to their cis analogs. Biochemistry 44, 4458–4465 (2005).

    Article  CAS  Google Scholar 

  57. Saravanan, N., Haseeb, A., Ehtesham, N. Z. & Ghafoorunissa, R. Differential effects of dietary saturated and trans-fatty acids on expression of genes associated with insulin sensitivity in rat adipose tissue. Eur. J. Endocrinol. 153, 159–165 (2005).

    Article  CAS  Google Scholar 

  58. Mozaffarian, D., Katan, M. B., Ascherio, A., Stampfer, M. J. & Willett, W. C. Trans fatty acids and cardiovascular disease. N. Engl. J. Med. 354, 1601–1613 (2006).

    Article  CAS  Google Scholar 

  59. Mensink, R. P., Zock, P. L., Kester, A. D. & Katan, M. B. 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 (2003).

    Article  CAS  Google Scholar 

  60. van Dam, R. M., Willett, W. C., Rimm, E. B., Stampfer, M. J. & Hu, F. B. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care 25, 417–424 (2002).

    Article  Google Scholar 

  61. Meyer, K. A., Kushi, L. H., Jacobs, D. R. Jr & Folsom, A. R. Dietary fat and incidence of type 2 diabetes in older Iowa women. Diabetes Care 24, 1528–1535 (2001).

    Article  CAS  Google Scholar 

  62. Hu, F. B. et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N. Engl. J. Med. 345, 790–797 (2001).

    Article  CAS  Google Scholar 

  63. Salmerón, J. et al. Dietary fat intake and risk of type 2 diabetes in women. Am. J. Clin. Nutr. 73, 1019–1026 (2001).

    Article  Google Scholar 

  64. Radesky, J. S. et al. Diet during early pregnancy and development of gestational diabetes. Paediatr. Perinat. Epidemiol. 22, 47–59 (2008).

    Article  Google Scholar 

  65. WHO. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organ Tech. Rep. Ser. 916, 1–49 (2003).

  66. Leth, T., Jensen, H. G., Mikkelsen, A. A. & Bysted, A. The effect of the regulation on trans fatty acid content in Danish food. Atheroscler. Suppl. 7, 53–56 (2006).

    Article  CAS  Google Scholar 

  67. New York City Department of Health and Mental Hygiene. Healthy heart—avoid trans fat. Cardiovascular Disease Prevention [online] (2009).

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Acknowledgements

The authors' research was supported by grants from the NIH, National Heart, Lung and Blood Institute (R01 HL 085710-01).

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  1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Renata Micha

  2. Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

    Dariush Mozaffarian

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Correspondence to Dariush Mozaffarian.

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Micha, R., Mozaffarian, D. Trans fatty acids: effects on metabolic syndrome, heart disease and diabetes. Nat Rev Endocrinol 5, 335–344 (2009). https://doi.org/10.1038/nrendo.2009.79

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