Trans fats in food

Why they should be eliminated

Alan Maryon-Davis FRCP FFPH

What exactly are trans fats?

Short for trans fatty acids (TFAs) trans refers
to their molecular structure
Non-essential. No known benefits to human
health
Small amounts occur naturally in milk and milk
products
Vast majority are man-made by partially
hydrogenating plant oils industrially produced
TFAs
Commercial advantages: increased bulk,
improved texture; longer shelf-life, semi-solid
consistency, rancid-resistant, cheaper

Industrially produced
trans fats

Clear
vegetable oils

Solid or
semi-solid fats

by hydrogenation

Trans fats made in cooking

Clear
cooking oil
Low TFAs

Repeated
re-heating

Cloudy
cooking oil
High TFAs

Trans fats are mainly consumed in

fried fast-food, biscuits, pastries,
cakes, pies and cooking fats

Impact of trans fats on the body

Push up the level of LDL (bad)
cholesterol
Decrease the level of HDL (good)
cholesterol
Increase the level of triglycerides
Increase vascular endothelial dysfunction
May increase insulin resistance

Risks to health
of higher trans fat intakes
Clear evidence of an increased risk of
coronary heart disease (CHD) angina,
heart attack, etc
Some evidence suggesting an increased
risk of type 2 diabetes
Possible increased risk of prostate cancer
Possible increased risk of breast cancer

Impact on population health

Meta-analysis of five large-scale
prospective population studies* found a
24% increase in CHD risk associated
with higher TFA intakes
Gram for gram, TFAs carry five times the
risk associated with saturated fats
*Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ,
Willett WC. Trans 2 fatty acids and cardiovascular
disease. N Engl J Med 2006;354: 1601-13.

Impact on population health

Every gram increase in the average intake
increases CHD deaths by 5%
According to a recent review by NICE* the
current UK consumption of TFAs causes
5000-15000 deaths every year.
These deaths are totally avoidable

* NICE 2009

COMA 1994
Recommended that TFAs should
contribute no more than 2% of food
energy (ie. calorie) intake across the
whole population*
*Expressed as the maximum
recommended contribution these nutrients
should make to the population average
diet.

Policy history
1994 COMA (later SACN) recommends population
maximum for TFAs of 2% of food energy intake
2003 WHO recommends a population intake of less
than 1% of total energy
2007 FSA endorses the COMA/SACN population
maximum and recommends no change
2009 a WHO review emphasised the need to
significantly reduce or virtually eliminate industrially
produced TFAs from the food supply

SACN review of trans fats

2007 recommendations
Improved monitoring of specific groups,
particularly young adults, at risk of low
nutritional status is required.
These population groups and people
(especially adults with children) in lower
socio-economic groups could benefit from
focused health initiatives.

Progress
SACN recommendation
(adults)

< 2% of food energy

1986/87

2.2%

2000/01

1.2%

2010

0.8%

Limitations of the NDNS

Small sample (<1000 households in the
first year)
43% non-response or inadequate
response
A common reason for non-response was
language difficulties
Around 20% of food intake is not reported

FSA review 2007

Reviewed the latest evidence
Only considered population average intakes
Concerned that further reductions in TFAs would
lead to compensatory increases in sat fats
Sat fat reduction programme considered to be a
higher priority
Recommended no change in COMA/SACN
population-wide limit of 2%
Recommended continuing the existing voluntary
approach rather than mandatory regulation

TFA consumption
and health inequalities
There is concern that children and young
people, and those on low incomes, are
consuming worryingly high levels of TFAs in
deep-fried takeaway foods
A recent study in Tower Hamlets suggests that
some individuals are consuming 6-12% of food
energy as TFAs
The high intakes among young people and
deprived populations was a key consideration in
the Denmark legislation

CHD mortality in Scotland, 35-64

TFAs in fast foods

One in six meals is eaten outside the home
The number of takeaway outlet is rising by about 8% a
year
Main customers are children and young people, and
those on lower incomes
Cooking practices vary greatly
Very high TFA levels can result from re-heating cooking
oil, even when initial levels are low
Deep-fat fryer in small takeaways of particular concern
Relatively little UK data on this (ad hoc studies, eg.
Tower Hamlets trading standards study)

Scope for action in UK

Reduce recommended maximum TFA intake (DRV) to
<0.5% of food energy across the population (Denmark
has achieved this)
Shift from voluntary to mandatory regulation
Ban IPTFAs in all manufactured foods
Mandatory TFA labelling for specific groups of foods
Improved guidance and tougher regulation for providers
of foods eaten outside the home
Improved monitoring of TFA intake in specific subgroups,
eg. children, low income groups, ethnic minorities
Regular mini-surveys of TFA content of fast-foods