Trans fatty acids in adipose tissue and risk of myocardial infarction: A case-cohort study.

BACKGROUND: The risk of coronary heart disease associated with intake of individual trans fatty acids (TFAs) is not clear. Adipose tissue content of TFAs is a biomarker of TFA intake and metabolism. OBJECTIVE: We investigated the rate of myocardial infarction (MI) associated with the adipose tissue content of total 18:1t, isomers of 18:1t (18:1 Δ6-10t and 18:1 Δ11t) and 18:2 Δ9c, 11t. METHODS: A case-cohort study, nested within the Danish Diet, Cancer and Health cohort (n = 57,053), was conducted, which included a random sample (n = 3156) of the total cohort and all incident MI cases (n = 2148) during follow-up (14 years). Information on MI cases was obtained by linkage with nationwide registers and validated. Adipose tissue was taken from the participants buttocks and the fatty acid composition was determined by gas chromatography. RESULTS: Women with higher adipose tissue content of total 18:1t had a 57% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.57; 95% confidence interval, 1.12-2.20; P-trend = 0.011) and women with higher content of 18:1 Δ6-10t had a 76% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.76; 95% confidence interval, 1.23-2.51; P-trend = 0.002). No association between 18:1 Δ11t content and MI rate was observed. In men, no associations between adipose tissue content of total 18:1t and 18:1 Δ6-10t and MI rate were observed. However, men with higher content of 18:1 Δ11t had a 48% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.48; 95% confidence interval, 1.17-1.86; P-trend = 0.003). Adipose tissue content of 18:2 Δ9c, 11t was not associated with MI rate in women or men. CONCLUSIONS: Adipose tissue content of 18:2 Δ9c, 11t was not associated with MI rate in women or men, whereas higher contents of isomers of 18:1t were associated with higher MI rates but the associations for individual 18:1t isomers differed, however, in women and men.

[Eggs do not increase the risk of cardiovascular disease and can be safely consumed].

Eggs are nutrient dense, rich in essential amino- and fatty acids, and the most cholesterol containing food. Based on observational studies the consumption of eggs has since the 1970's been claimed to increase the risk of cardiovascular disease (CVD). Intervention studies on intake of eggs and plasma cholesterol do however not support causality. The higher incidence of CVD in egg eaters is more likely to be caused by the clustering of other CVD risk factors. Up to seven eggs per week can safely be consumed but in patients with CVD or diabetes only with special emphasis on a prudent diet and proper medical treatment.

Artificial trans fat in popular foods in 2012 and in 2014: a market basket investigation in six European countries.

OBJECTIVE: To minimise the intake of industrially produced trans fat (I-TF) and thereby decrease the risk of coronary heart disease (CHD), nearly all European countries rely on food producers to voluntarily reduce the I-TF content in food. The objective of this study was to monitor the change in presence of I-TF in biscuits/cakes/wafers in six countries in South-eastern Europe from 2012 to 2014, including two members of the European Union (Slovenia and Croatia). DESIGN: Three large supermarkets were visited in each of the six capitals in 2012. Pre-packaged biscuits/cakes/wafers were bought if the products contained more than 15 g of total fat per 100 g of product and if partially hydrogenated oil or a similar term was disclosed at the beginning of the ingredients list. These same supermarkets were revisited in 2014 and the same collection procedure was followed. All foods were subsequently analysed for total fat and trans fat in the same laboratory. RESULTS: The number of packages bought in the six countries taken together was 266 in 2012 and 643 in 2014. Some were identical, and therefore only 226 were analysed in 2012 and 434 in 2014. Packages with less than 2% of fat from I-TF went up from 69 to 235, while products with more than 2% (illegal in Denmark) doubled from an average of 33 to an average of 68 products for the six countries, with considerable variation across countries. The per cent of I-TF in total fat decreased slightly, from a mean (SD) of 22 (13) in 2012 to 18 (9) in 2014. CONCLUSIONS: The findings suggest that voluntary reduction of I-TF in foods with high amounts is an ineffective strategy in several European countries. Alternative strategies both within and outside the European Union are necessary to protect all subgroups of the populations against an increased risk of CHD.

n-3 PUFA esterified to glycerol or as ethyl esters reduce non-fasting plasma triacylglycerol in subjects with hypertriglyceridemia: a randomized trial.

To date, treatment of hypertriglyceridemia with long-chain n-3 polyunsaturated fatty acids (n-3 PUFA) has been investigated solely in fasting and postprandial subjects. However, non-fasting triacylglycerols are more strongly associated with risk of cardiovascular disease. The objective of this study was to investigate the effect of long-chain n-3 PUFA on non-fasting triacylglycerol levels and to compare the effects of n-3 PUFA formulated as acylglycerol (AG-PUFA) or ethyl esters (EE-PUFA). The study was a double-blinded randomized placebo-controlled interventional trial, and included 120 subjects with non-fasting plasma triacylglycerol levels of 1.7-5.65 mmol/L (150-500 mg/dL). The participants received approximately 3 g/day of AG-PUFA, EE-PUFA, or placebo for a period of eight weeks. The levels of non-fasting plasma triacylglycerols decreased 28% in the AG-PUFA group and 22% in the EE-PUFA group (P < 0.001 vs. placebo), with no significant difference between the two groups. The triacylglycerol lowering effect was evident after four weeks, and was inversely correlated with the omega-3 index (EPA + DHA content in erythrocyte membranes). The omega-3 index increased 63.2% in the AG-PUFA group and 58.5% in the EE-PUFA group (P < 0.001). Overall, the heart rate in the AG-PUFA group decreased by three beats per minute (P = 0.045). High-density lipoprotein (HDL) cholesterol increased in the AG-PUFA group (P < 0.001). Neither total nor non-HDL cholesterol changed in any group. Lipoprotein-associated phospholipase A2 (LpPLA2) decreased in the EE-PUFA group (P = 0.001). No serious adverse events were observed. Supplementation with long-chain n-3 PUFA lowered non-fasting triacylglycerol levels, suggestive of a reduction in cardiovascular risk. Regardless of the different effects on heart rate, HDL, and LpPLA2 that were observed, compared to placebo, AG-PUFA, and EE-PUFA are equally effective in reducing non-fasting triacylglycerol levels.

[Effect of fats on cardiovascular disease prevention in Denmark].

In Denmark death from cardiovascular disease (CVD) has decreased, mainly due to a 72% reduction since 1990 in death from ischaemic heart disease from reduced smoking, elimination of industrial trans fatty acids in the diet, and more effective medical treatment. Replacement of saturated fat by carbohydrate and/or n-6 polyunsaturated fat may increase CVD, but it is reduced by substitution with n-3 fats, monounsaturated fat, or low glycaemic index carbohydrates. Despite a high saturated fat content dark chocolate and cheese may reduce CVD and diabetes risk and eggs may be neutral, and less restrictive dietary recommendations are indicated.

Tracing artificial trans fat in popular foods in Europe: a market basket investigation.

OBJECTIVE: To minimise the intake of industrial artificial trans fat (I-TF), nearly all European countries rely on food producers to voluntarily reduce the I-TF content in food. The objective of this study was to investigate the effect of this strategy on I-TF content in prepackaged biscuits/cakes/wafers in 2012-2013 in 20 European countries. DESIGN: The I-TF content was assessed in a market basket investigation. Three large supermarkets were visited in each capital, and in some countries, three additional ethnic shops were included. RESULTS: A total of 598 samples of biscuits/cakes/wafers with 'partially hydrogenated vegetable fat' or a similar term high on the list of ingredients were analysed, 312 products had more than 2% of fat as I-TF, exceeding the legislatively determined I-TF limit in Austria and Denmark; the mean (SD) was 19 (7)%. In seven countries, no I-TF was found, whereas nine predominantly Eastern European countries had products with very high I-TF content, and the remaining four countries had intermediate levels. Of the five countries that were examined using the same procedure as in 2006, three had unchanged I-TF levels in 2013, and two had lower levels. The 18 small ethnic shops examined in six Western European countries sold 83 products. The mean (SD) was 23 (12)% of the fat as I-TF, all imported from countries in Balkan. In Sweden, this type of food imported from Balkan was also available in large supermarkets. CONCLUSIONS: The findings suggest that subgroups of the population in many countries in Europe still consume I-TF in amounts that increase their risk of coronary heart disease. Under current European Union (EU) legislation, the sale of products containing I-TF is legal but conflicts with the WHO recommendation to minimise the intake of I-TF. An EU-legislative limit on I-TF content in foods is expected to be an effective strategy to achieve this goal.

A trans European Union difference in the decline in trans fatty acids in popular foods: a market basket investigation.

OBJECTIVES: To minimise the intake of industrial trans fatty acids (I-TFA) some countries have introduced labelling, while others have introduced legislative limits on the content of I-TFA in food. However, most countries still rely on food producers to voluntarily reduce the I-TFA content in food. The objective of the present study was to investigate the efficiency of these strategies in the EU. DESIGN: The potential consumption of I-TFA was assessed in a market basket investigation by analysing the I-TFA content in popular foods. SETTING: A standardised purchase methodology was used in 16 EU countries in 2005 and again in 2009. SAMPLES: Seventy servings of French fries and chicken nuggets, 90 packages of microwave popcorn, and 442 samples of biscuits/cakes/wafers with 'partially hydrogenated vegetable fat' listed high on the list of ingredients were analysed. A high-trans menu was defined as a large serving of French fries and nuggets, 100 g of microwave popcorn and 100 g of biscuits/wafers/cakes. RESULTS: In 2005, a high-trans menu provided above 30 g of I-TFA in five EU countries in Eastern Europe and 20-30 g in eight EU countries in Western Europe. In 2009 the values in Hungary, Poland and the Czech Republic remained high between 10 and 20 g, whereas they were less than 2 g in Germany, France and the UK. CONCLUSIONS: In 2009 contents of I-TFA in popular foods in Western Europe appear low but, in spite of some reduction, still high in Eastern European EU countries. These findings suggest that millions of people in the EU still consume I-TFA in amounts that substantially increase their risk of coronary heart disease.

The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?

Current dietary recommendations advise reducing the intake of saturated fatty acids (SFAs) to reduce coronary heart disease (CHD) risk, but recent findings question the role of SFAs. This expert panel reviewed the evidence and reached the following conclusions: the evidence from epidemiologic, clinical, and mechanistic studies is consistent in finding that the risk of CHD is reduced when SFAs are replaced with polyunsaturated fatty acids (PUFAs). In populations who consume a Western diet, the replacement of 1% of energy from SFAs with PUFAs lowers LDL cholesterol and is likely to produce a reduction in CHD incidence of ≥2-3%. No clear benefit of substituting carbohydrates for SFAs has been shown, although there might be a benefit if the carbohydrate is unrefined and has a low glycemic index. Insufficient evidence exists to judge the effect on CHD risk of replacing SFAs with MUFAs. No clear association between SFA intake relative to refined carbohydrates and the risk of insulin resistance and diabetes has been shown. The effect of diet on a single biomarker is insufficient evidence to assess CHD risk. The combination of multiple biomarkers and the use of clinical endpoints could help substantiate the effects on CHD. Furthermore, the effect of particular foods on CHD cannot be predicted solely by their content of total SFAs because individual SFAs may have different cardiovascular effects and major SFA food sources contain other constituents that could influence CHD risk. Research is needed to clarify the role of SFAs compared with specific forms of carbohydrates in CHD risk and to compare specific foods with appropriate alternatives.

Ruminant and industrially produced trans fatty acids: health aspects.

Fatty acids of trans configuration in our food come from two different sources - industrially produced partially hydrogenated fat (IP-TFA) used in frying oils, margarines, spreads, and in bakery products, and ruminant fat in dairy and meat products (RP-TFA). The first source may contain up to 60% of the fatty acids in trans form compared to the content in ruminant fat which generally does not exceed 6%. In Western Europe, including Scandinavia, the average daily intake of IP-TFA has decreased during the recent decade due to societal pressure and a legislative ban, whereas the intake of RP-TFA has remained stable.In spite of this decrease we have found that in many countries consumption >20 g of IP-TFA in a one-meal menu consisting of some popular foods is possible, even though the average intake of IP-TFA in these countries is low. Subgroups of the populations may therefore, on average, consume >5 g IP-TFA per day. This level of consumption is generally not possible for RP-TFA. A daily intake of 5 g TFA (primarily IP-TFA) is associated with a 29% increased risk of coronary heart disease. Such an association is not found for RP-TFA up to a daily intake of 4 g.The high amount of IP-TFA in popular foods, the evidence of a more harmful effect on health by IP-TFA than by RP-TFA, and the feasibility of eliminating IP-TFA from foods without side effects for the population, suggest that a selective elimination of IP-TFA from our food is a 'low hanging fruit' in the quest for a more healthy diet for subgroups of the population.

Nutrition transition and its relationship to the development of obesity and related chronic diseases.

The prevalence of overweight and obesity has also increased substantially in the nutritional transition countries, and the health burden of obesity-related complications is growing. The introduction of fast-food chains and Westernized dietary habits providing meals with fast-food characteristics seems to be a marker of the increasing prevalence of obesity. The mechanisms involved are probably that the supply of foods is characterized by large portion sizes with a high energy density, and sugar-rich soft drinks. The high energy density of foods is partly brought about by a high dietary fat content, and it has been shown that even in a Chinese population the increase from about 15% to 20% in the proportion of calories from fat is sufficient to explain some weight gain in the population. In addition, fast food from major chains in most countries still contains unacceptably high levels of industrially produced trans fatty acids that have powerful biological effects, and contribute to type 2 diabetes and coronary artery disease. New evidence also suggests that a high intake of trans fat may produce abdominal obesity, an important factor in the metabolic syndrome, type 2 diabetes and cardiovascular disease. The optimal diet for the prevention of weight gain, obesity, metabolic syndrome and type 2 diabetes is fat-reduced, without any industrially produced trans fatty acids, fibre-rich, high in low energy density carbohydrates (fruit, vegetables and whole grain products) and with a restricted intake of energy-containing drinks.

Intake of ruminant trans fatty acids and risk of coronary heart disease.

BACKGROUND: Studies have shown a positive association between trans fatty acids (TFA) intake and risk of coronary heart disease (CHD), primarily accounted for by industrially produced TFA. Some of these studies indicate an inverse association between ruminant TFA (R-TFA) intake and CHD implying that R-TFA intake is innocuous or even protective against CHD. The aim of this study was to describe the association between R-TFA intake and risk of CHD evaluating both the absolute and the energy-adjusted intake. METHODS: The study was an 18-year follow-up study of 3686 Danes, aged 30-71 years, at baseline without previous CHD. RESULTS: There were no overall associations between absolute or energy-adjusted R-TFA intakes and risk of CHD. However, among women, indications of inverse associations between R-TFA intake and risk of CHD were found: hazard ratio (HR) per 0.5 g increase in absolute R-TFA intake = 0.84 [95% confidence interval (CI): 0.70, 1.01] and HR per 0.5 g increase in energy-adjusted R-TFA intake = 0.77 (95% CI: 0.55, 1.09). No associations between absolute or energy-adjusted R-TFA intakes and CHD were found among men. CONCLUSIONS: This study suggests that R-TFA intake is not associated with a higher risk of CHD. Whether R-TFA intake is even protective against CHD among women cannot be concluded from this study.

Traditional and modern Greenlandic food - dietary composition, nutrients and contaminants.

OBJECTIVES: High levels of n-3 fatty acids and other nutrients in traditional Inuit food appear to provide some protection against the typical diseases of affluent industrialized societies: cardiovascular diseases and type 2 diabetes. An increased intake of imported food among Inuits will probably increase their frequency of these diseases. However, since the 1970s it has become evident that the marine-based Inuit diet also contains high levels of potentially toxic lipophilic organic pollutants and heavy metals. Since these two food related opposing health effects appear to be inseparable, the phenomenon has been known as "The Arctic Dilemma". However, both the fatty acid composition and the contaminant levels vary in Greenlandic food items. Thus in principle it is possible to compose a diet where the benefits and risks are better balanced. Our objectives of this study were to compare traditional and modern meals in Greenland concerning the dietary composition, nutrients, and health indicators among the consumers. STUDY DESIGN: The present study was a cross-sectional dietary survey as part of the Arctic Monitoring and Assessment, Human Health Programme (AMAP). These results were compared with older dietary surveys in Greenland. METHODS: Dietary components, fatty acids, and nutrients in 90 local meals collected by duplicate portion method in Uummannaq town, north Greenland 2004 and in Narsaq, south Greenland 2006, were compared with 177 duplicate meals sampled in the village of Igdslorsuit, Uummannaq, district, 1976 and also compared with other dietary studies in Greenland 1953-1987. Anthropometric measures (weight, height, and body mass index, BMI) and blood lipids were measured as health indicators among the participants. RESULTS: Between the traditional foods sampled or analysed 30-50 years ago and the modern food from 2004 to 2006, significant differences were found in the dietary composition. The percentage of local food had decreased, to a present average of about 20% and with it the dietary content of n-3 fatty acids. Also, the intakes of many vitamins and minerals had decreased, and were below Nordic Nutrient Recommendations in 2004 and 2006. Vitamin A, B(1), (B(2)), B(12), iron, iodine, phosphorus, and selenium contents were correlated with n-3 content, whereas vitamin C, folate, and calcium contents were not and the same time very low. In the traditional food, especially from the villages, the intakes of vitamin A, vitamin D, and iron were extremely high and borderline toxic. The levels of contaminants such as organochlorins and heavy metals were also strongly correlated with the relative content of local food in the diet. The best balance between potentially beneficial and harmful substances was found for 20-30% local food, corresponding to a daily intake of 3-5 g of n-3 fatty acids. Body weight, height, body mass index (BMI), cholesterol, and S-triglycerides had increased significantly between 1976 and 2004. CONCLUSION: The dietary changes to a more western fare were found to be negative resulting in less adequate nutrient coverage but at the same time lower contaminant load. Thus, we recommend not to increase the consumption of local products beyond the present level but rather to improve the quality of the imported food.

[Fast food promotes weight gain]. / Fastfood fremmer fedme--sekundaerpublikation.

The total amounts of fat in a fast food menu consisting of French fries and fried Chicken Nuggets from McDonald's and KFC, respectively, bought in 35 different countries vary from 41 to 71 gram. In most countries the menu contained unacceptably high amounts of industrially-produced trans fat which contributes to an increased risk of ischaemic heart disease, weight gain, abdominal fat accumulation and type 2 diabetes. The quality of the ingredients in fast food ought to be better and the size of the portions smaller and less energy-dense so that frequent fast food meals do not increase the risk of obesity and diseases among customers.

[Antioxidants and health]. / Antioxidanter og helbred.

The Danish Fitness and Nutrition Council has evaluated the basis for recommendations on the intake of antioxidants and has found limited basis for increasing the recommended intake levels for the antioxidants vitamin C and E. Evidence was insufficient to support recommendations for polyphenol or carotenoid supplementation. Supplementation with high doses of vitamin E and beta-carotene may present a health risk. A high intake of fruit and vegetables is associated with a reduced risk of lifestyle diseases, but there is no evidence that this association is due to an antioxidant effect.

Dietary composition and contaminants in north Greenland, in the 1970s and 2004.

OBJECTIVES: The fatty acid composition and other nutrients in traditional Inuit food appear to provide some protection against diseases of affluent industrialized societies, such as cardiovascular diseases and type 2 diabetes. A transition towards increased amounts of imported food might increase the occurrence of these diseases among Inuit. However, since the 1970s it has become evident that the marine-based Inuit diet also contains high levels of potentially toxic lipophilic organic pollutants and heavy metals. Since these two opposing effects on health appear to be inseparable, the phenomenon has become known as "The Arctic Dilemma". However, both the fatty acid composition and the contaminant levels vary in Greenlandic food items. Thus, in theory, it is possible to compose a diet where the benefits outweigh the risks. Our objective was to compare traditional and modern meals in Greenland regarding dietary composition, content of n-3 fatty acids and contaminants. STUDY DESIGN: The present study was part of the Arctic Monitoring and Assessment Programme, AMAP, comparing the results of dietary composition and nutrients in 177 traditional meals collected in Uummannaq municipality, north Greenland in 1976 with 90 meals sampled in Uummannaq town in 2004 under similar conditions. Eleven pesticides, 14 PCB congeners, heavy metals, selenium, and fatty acids were analysed in meals and blood samples from the participants. Contaminant levels were compared between 1976 and 2004 after adjustment for n-3 fatty acids, indicating local food content. RESULTS: Between the traditional meals collected 30 years ago and the meals from 2004, dramatic and significant changes have occurred in the dietary composition. The percentage of local food has decreased, and with it the intake of n-3 fatty acids. Calculated as daily intake, all but three contaminants had decreased significantly. However, this could be explained by the lower intake of local food. After adjustment for n-3 fatty acid content in the food, significant declines of concentration in the local food were evident only for PCBs and lead, whereas for mercury, DDTs, and chlordanes the levels were unchanged, and for hexachlorobenzene, mirex, and toxaphenes, the levels had increased significantly. CONCLUSION: The consumption of locally produced food has decreased in Greenland during the last 30 years and this has led to a reduction in the daily intake of contaminants. However, the concentrations of contaminants in local food items have not decreased, except for PCB and Lead. Therefore, we recommend that the consumption of local products is not increased beyond the present level, until the level of contaminants is reduced to a safer level.

[High levels of industrially produced trans fatty acids in popular fast food - but not in Denmark--secondary publication]. / Højt indhold af industrielt producerede transfedtsyrer i populaere fødevarer--men ikke i Danmark--sekundaerpublikation

An intake of trans-fatty acids of 5 grams per day is associated with an increase of 25% in the risk of ischemic heart disease. In 2004 Denmark, as the first country in the world, introduced a limitation on the content of industrially produced trans-fatty acids in foods. The amount in a "high-trans menu" consisting of popular foods was, from 2001 to 2005, reduced in Denmark from 30 g to <1 g. The amount in the same menu bought in countries within and outside the European Union is 20-40 g. During a period of just a few years, Denmark has thus eliminated a risk factor for ischemic heart disease without noticeable side effects for consumers. This risk factor is, however, still present in many other countries.

A trans world journey.

A high intake of industrially produced trans fatty acids (IP-TFA) is associated with increased risk of coronary heart disease (CHD), and a daily intake as low as possible is required to minimize health risks. To achieve this at the individual level in Denmark, legislation limited IP-TFA in foods to a maximum of 2% of fat content from 2004. We assessed the potential exposure of consumers to IP-TFA by analysing popular foods in Denmark, and in 25 other countries. Fifty-five servings of French fries and chicken nuggets, 87 packages of microwave popcorn, and 393 samples of biscuits/cakes/wafers with "partially hydrogenated vegetable fat" listed high on the food label were bought between November 2004 and February 2006. The content of IP-TFA was analysed by standardized methodology. We defined a "high trans menu" as a large size serving of French fries and nuggets, 100 g of microwave popcorn, and 100 g of biscuits/wafers/cakes. The amounts of IP-TFA in a "high trans menu" was 30 g in 2001 in Denmark, but was reduced to less than 1g in 2005. By contrast, a "high trans menu" provided more than 20 g in 17 out of 18 countries, with Hungary, Czech Republic, Poland, Bulgaria, and USA, ranking highest with 42, 40, 38, 37, and 36 g, respectively. The legislation in Denmark has reduced the exposure of IP-TFA at the individual level without noticeable effect on availability, price, and quality of foods previously containing high amounts of IP-TFA. The findings of high concentrations of IP-TFA in popular foods outside Denmark suggest that millions of people inside and outside EU have intakes of IP-TFA that may increase their risk of CHD. The Danish experience demonstrates that this risk can be eliminated.

Intake of ruminant trans fatty acids and risk of coronary heart disease-an overview.

Epidemiological studies have shown a strong direct (positive) association between the intake of trans fatty acids (TFA) and the risk of coronary heart disease (CHD), primarily accounted for by industrially produced TFA (IP-TFA). However, comparisons between ruminant TFA (R-TFA) and IP-TFA and risk of CHD have been based on quintiles of intake, which implies that the associations between the two sources of TFA and the risk of CHD were described across different ranges of intake. Controlled metabolic studies of the effect of intake of total and specific R-TFA on CHD risk factors are warranted. Moreover, further epidemiological studies of intake of R-TFA and risk of CHD in populations with a high intake of R-TFA are warranted.