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: 2.71). 08/2007; 61(8):1004-10. DOI: 10.1038/sj.ejcn.1602608
Source: PubMed


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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    • "However, consumption of soft drinks has increased among Iranian adults [19]. Iranians primarily meet their daily energy requirements from simple and refined carbohydrates, and only 22% is derived from fat [20]. Therefore, in the present study, we assessed the relationship between two markers of dietary acid load on CVD factors, high-sensitivity C-reactive protein (hs-CRP), and kidney-related biomarkers in patients with DN. "
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    ABSTRACT: An association between dietary acid load and cardiovascular disease risk has been reported in epidemiologic studies; however, there are no reports to our knowledge of this association in patients with diabetic nephropathy (DN). Therefore, the aim of this study was to examine the association between dietary acid load, based on potential renal acid load (PRAL) and protein:potassium ratio (Pro:K) scores, and cardiovascular disease risk factors in individuals with DN. In this cross-sectional study, we randomly enrolled 547 patients with DN. Dietary intake was assessed using a validated food frequency questionnaire. Biochemical and anthropometric measures were assessed using standard methods. Participants had a mean age of 66.8 y and body mass index of 24 kg/m(2). After controlling for potential confounders, participants in the low PRAL group had lower hemoglobin (Hb)A1c (5.7% ± 0.5% versus 7.8% ± 0.5%; P = 0.01), triacylglycerols (246.9 ± 2.3 mg/dL versus 257.4 ± 2.3 mg/dL; P = 0.006), systolic blood pressure (103.6 ± 0.7 mm Hg versus 106.1 ± 0.7 mm Hg; P = 0.03), and lower creatinine and fasting blood sugar compared with the high PRAL group. Pro:K was positively related to HbA1c (5.8% ± 0.5% versus 7.6% ± 0.5%; P = 0.03), but inversely associated with low-density lipoprotein and waist circumference. We found that both PRAL and Pro:K were positively related to HbA1c in the setting of DN, whereas other biochemical and kidney-related markers varied with PRAL and Pro:K status. Future studies are warranted to clarify the clinical outcomes of dietary acid load in older populations as well as in patients with chronic kidney disease. Copyright © 2015 Elsevier Inc. All rights reserved.
    Nutrition 12/2014; 31(5). DOI:10.1016/j.nut.2014.11.012 · 2.93 Impact Factor
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    • "Regarding South Asia, it has been estimated that 39% of CHD events in Iran can be prevented by replacement of TFA with cis-unsaturated fats.7 Indian Government in an attempt to combat TFA related health problems plans to reduce TFA contents in vanaspati oil to 5% by the end of 2013.5 "
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    ABSTRACT: Trans fatty acids (TFA) are produced either by hydrogenation of unsaturated oils or by biohydrogenation in the stomach of ruminant animals. Vanaspati ghee and margarine have high contents of TFA. A number of studies have shown an association of TFA consumption and increased risk of cardiovascular disease (CVD). This increased risk is because TFA increase the ratio of LDL cholesterol to HDL cholesterol. Food and Agriculture Organization of the United Nations and World Health Organization have come up with the recommendation that the contents of TFA in human dietary fat should be reduced to less than 4%. There is high prevalence of CVD in Pakistan. High consumption of vanaspati ghee which contains 14.2-34.3% of TFA could be one of the factors for this increased burden of CVD in Pakistan. Consumption of dietary fat low in TFA would be helpful in reducing the risk of CVD in South Asia. Denmark by banning the sale of food items with TFA has brought down the number of deaths due to coronary heart disease by nearly 50% over a period of 20 years. Public awareness about the adverse effects of TFA on human health would be extremely important. Media can play a very effective role in educating the masses and advocating the policy for the sale of only low TFA food items. Literature sources: Google and US National Library of Medicine, National Institute of Health were the sources of papers cited in this review article.
    Pakistan Journal of Medical Sciences Online 03/2014; 30(1):194-197. DOI:10.12669/pjms.301.4525 · 0.23 Impact Factor
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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 · 3.47 Impact Factor
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