Article

Consumption of trans fats and estimated effects on coronary heart disease in Iran

The Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
European Journal of Clinical Nutrition (Impact Factor: 2.95). 08/2007; 61(8):1004-10. DOI: 10.1038/sj.ejcn.1602608
Source: PubMed

ABSTRACT 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.
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.
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.
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.
National Heart, Lung and Blood Institute, National Institutes of Health, USA. National Nutrition & Food Technology Research Institute, Tehran, Iran.

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    • "But, the degree of exposure to TFA in most countries is unknown. Populations in low-and middle-income countries could be disproportionately exposed to foods with high TFA content because of the use of partially hydrogenated oils and mix of shortenings and different oils in the elaboration of traditional dishes (Mozaffarian et al. 2007; Ghafoorunissa 2008; Butt and Sultan 2009) and local snacks and baked goods (Uicich et al. 2006; Baylin et al. 2007; Valenzuela 2008; Butt and Sultan 2009; Vieitez et al. 2011). Voluntary industry efforts to reduce TFA intake have been slow and insufficient for the most part. "
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    ABSTRACT: The World Health Organization (WHO) has deemed that there is enough evidence to recommend the elimination of industrially produced trans-fatty acids (TFA) from the food supply. This article evaluates government-led public health strategies in countries in Latin America and the Caribbean (LAC), and factors perceived to affect following WHO's recommendation to eliminate industrially produced TFA. Descriptive, prospective multiple case studies integrated data from open-ended questionnaires to representatives of ministries of health, and systematic review of internal and publicly available documents in 13 LAC countries.Findings: Overall, government efforts to follow WHO recommendations have not been well co-ordinated throughout the region. Evidence for this includes the lack of standardization of TFA definitions. For example, some countries exclude naturally occurring TFA from the definitions, whereas others leave the option open to their inclusion. As a consequence, the criteria for trans-free nutrient claims and labelling requirements are inconsistent across the region. Government-led strategies varied from banning or limiting TFA content in the food supply to voluntary labelling of TFA. The identified challenges to the implementation of policies to reduce TFA include the shortage of information on TFA content of diets and foods, consumer unawareness of TFA and lack of monitoring and surveillance. The identified enabling factors were intersectoral collaboration with industry, mandatory labelling regulation and international and national visibility of the topic, which facilitated reduction of TFA content.Interpretation: A co-ordinated effort is required to achieve virtual elimination of all TFA in the region, as recommended by WHO. Standardization of the definition of TFA across the region would facilitate regulation, consumer education efforts and monitoring and surveillance efforts. Simultaneously, countries need to determine their level of exposure to TFA through the implementation of small surveys to assess blood TFA levels using blood spots, and the evaluation of TFA in fat sources that are commonly used.
    Health Policy and Planning 10/2013; 29(5). DOI:10.1093/heapol/czt034 · 3.00 Impact Factor
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    • "The average per-person home use of partially hydrogenated vegetable oils among Iranians is 4184 kJ (1000 kcal) (Mozaffarian et al., 2007). Based on reports, almost 33% of fatty acids in these products are TFAs (Asgary et al., 2009) which equals 4.2% of their energy, and is almost twice the amount in developed countries (Mozaffarian et al., 2007). Such dietary intakes might help to explain the high prevalence of cardiovascular risk "
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    ABSTRACT: Background To determine the association between fatty acid intake and the prevalence of risk factors for the metabolic syndrome. Methods In this population-based cross-sectional study, a sample of 2750 Tehranian subjects (44% men and 56% women) aged 20-74years, who completed a validated food frequency questionnaire, was studied. The metabolic syndrome (MetS) was defined in accordance with the modified guidelines of the National Cholesterol Education Program Adults Treatment Panel III, and waist circumference was coded according to the newly-introduced cut-off points for Iranian adults (95cm for both sexes). Metabolic risk factors across quartile categories of each type of dietary fat [total fat intake, total poly-unsaturated fatty acid (PUFA) intake, total MUFA intake, total saturated fatty acid (SFA) intake expressed as percentage of energy and quartiles of the ratio of polyunsaturated fat to saturated fat (P:S)] were compared. ResultsThe mean (SD) ages of participants were 40.8 (14.6) and 38.6 (12.9)years, respectively, for men and women. The mean contribution of fat to energy intake was approximately 26% in men and women. A positive trend over successive quartiles of SFA intake with low-density lipoprotein-cholesterol (LDL-C) and triglyceride, as well as P/S ratio intake with high-density lipoprotein-cholesterol (HDL-C), was found. An inverse association between HDL-C with SFA and PUFA intake and a positive association with MUFA and the P/S ratio was found. A significant association of fatty acid consumption and risk of the MetS in this population was observed, except for total PUFA intake. Conclusions Special dietary fatty acids are associated with metabolic risk factors among the Iranian population. Because of the high prevalence of cardiovascular disease and MetS, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention.
    Journal of Human Nutrition and Dietetics 06/2013; 27. DOI:10.1111/jhn.12117 · 2.07 Impact Factor
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    • "It has been reported that partially hydrogenated oils might contain 30-50% TFAs, resulting in significant TFA intake in many populations (Mozaffarian et al., 2007). Many studies have shown that TFA intake is associated with increased risk of CHD (Fernandez-San Juan, 2009; Lichtenstein, 2000; Mozaffarian et al., 2007). Moreover, several studies have recently shown that dietary TFA intake is associated with other health problems such as breast cancer, poor growth and development (Innis et al., 1999; Stender and Dyerberg, 2004). "
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    ABSTRACT: The underlying role of dietary Trans Fatty Acid (TFA) intake in the aetiology of Coronary Heart Diseases (CHD) and its influence on serum lipid levels is very well established. The present study was conducted to estimate the dietary intake of TFA among selected cases of CHD and healthy participants and to investigate the strength of the association between TFA intake and CHD risk in Jordan. Using a case-control design, 100 patients known to have CHD of either sex and 91 healthy controls of age <60 y were examined. Daily intake of TFA was estimated using a semi-quantitative Food Frequency Questionnaire (FFQ). Mean daily dietary intake of %TFA was significantly higher in cases (0.78±0.55) as compared to controls (0.62±0.28, p = 0.01). Daily TFA intake was significantly positively associated with CHD risk in cases as compared to controls [RR: 2.4 (1.1-4.9), p = 0.01]. The RR of CHD for TFA intake within the highest quartile as compared to the lowest was associated with increased risk of CHD by 4.9 fold (95% CI: 1.3-17.4, p = 0.01) in cases as compared to controls. Finally, the major food sources of TFA intake was contributed by fast food, meats and dairy products. Therefore, proper food labeling of TFA, especially on local foods would help to minimize TFA intake and therefore reduce the risk of CHD incidence in Jordan.
    Pakistan Journal of Nutrition 05/2012; 11:423-433. DOI:10.3923/pjn.2012.423.433
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