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A trans European Union difference in
the decline in trans fatty acids in
popular foods: a market basket
investigation
Steen Stender,
1
Arne Astrup,
2
Jørn Dyerberg
1
To cite: Stender S, Astrup A,
Dyerberg J. A trans European
Union difference in the
decline in trans fatty acids in
popular foods: a market
basket investigation.
BMJ Open 2012;2:e000859.
doi:10.1136/bmjopen-2012-
000859
▸Prepublication history for
this paper are available
online. To view these files
please visit the journal online
(http://dx.doi.org/10.1136/
bmjopen-2012-000859).
Received 23 May 2012
Accepted 31 July 2012
This final article is available
for use under the terms of
the Creative Commons
Attribution Non-Commercial
2.0 Licence; see
http://bmjopen.bmj.com
1
Department of Clinical
Biochemistry, Copenhagen
University Hospital, Gentofte,
Denmark
2
Department of Human
Nutrition, University of
Copenhagen, Copenhagen,
Denmark
Correspondence to
Dr Steen Stender;
stst@geh.regionh.dk
ABSTRACT
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.
INTRODUCTION
Tr a n s fatty acids (TFA) in food originate from
industrial hydrogenation of oils and from
ruminant sources. Compared to unhydroge-
nated oils, fats containing industrial TFA
(I-TFA) are solid at room temperature, have
some technical advantages in food processing,
and prolong the shelf life of food. However
I-TFA can constitute up to 60% of the fats in
certain foods, whereas ruminant fat contains
at most 6% TFA.
1
A meta-analysis of four large
prospective studies found that an intake of
TFA corresponding to 2% of the total energy
intake (E%) (approximately 5 g/day) was asso-
ciated with a 23% increase in the risk of coron-
ary heart disease.
2
Several public health
organisations have recommended that I-TFA
intake should be lowered as much as pos-
sible.
3–5
In 1976, the average intake of TFA in
Western Europe was 6 g/day. In 1996, this
intake had dropped to 2.6 g/day (range 1.2–
6.7 g/day), corresponding to 0.5–2.1 E%.
6
ARTICLE SUMMARY
Article focus
▪Are popular foods with high amounts of industrial
trans fatty acids (TFA) still available in EU countries
in 2009 to the same extent as it was in 2005.
▪Is there a difference in availability of such foods
between Western and Eastern EU countries.
Key messages
▪Industrial TFA in popular foods in Western EU
countries have declined considerably since 2005.In
Eastern Europe industrial TFA in some popular
foods are in spite of some decline still high.
▪A low-average intake of industrial TFA at the
population level does not preclude a high intake
among subgroups.
▪Most EU countries rely on food producers to volun-
tarily reduce the amounts of industrial TFA in foods
with variable results. An effective alternative is
legislation so far only used by a few EU countries.
Strengths and limitations of this study
▪A strength is the measurement of TFA in many
popular foods in several EU countries in 2005
and again in 2009.
▪A limitation is that the average daily intake of
TFA was not measured in subgroups of the
population, but instead inferred from the popu-
larity of fast food and from the presence of
popular foods with high amounts of industrial
TFA in large supermarkets.
Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859 1
Open Access Research
Approximately half of this intake was from ruminant TFA
and only about 1.3 g was from I-TFA, which constitutes a
78% decrease since 1976.
6
Despite a mean population
intake of approximately 1 g of I-TFA per day in Denmark
in 2001, it was still possible to consume 20–30 g of I-TFA in
a single high-trans menu by eating popular food products
such as wafers, microwave popcorn, nuggets and French
fries.
5
Among the 5 million Danes,10 000–50 000 people
consumed food from this type of menu several times each
week, and got a daily intake of more than 5 g I-TFA.
5
Generalising to the population in the EU, this corresponds
to 1–5 million people.
In 2003, Canada introduced the mandatory labelling
of the I-TFA content in pre-packaged food. In the same
year, Denmark introduced a legislative limit of 2% I-TFA
in fat used for foods. The EC initially opposed this legis-
lation but in March 2007 dropped its infringement pro-
ceedings against Denmark because of increased
scientific evidence on the dangers of trans fats.
7
The
USA introduced mandatory labelling of prepackaged
food in 2006, followed by legislative limits on I-TFA in
the food served in restaurants in New York City in 2008
and in 2010–2011 in the state of California. In 2009,
Austria and Switzerland and in 2011 Iceland introduced
a legislative ban similar to the Danish’to be followed
also by Sweden. It means that in 2012 only a minority,
that is, approximately 14 million people of the 500
million people in EU are protected by legislation against
foods with high amounts of I-TFA.
In 2005, we assessed by a market basket investigation
the availability of a high-trans menu (large servings of
French fries and nuggets, 100 g of microwave popcorn
and 100 g of biscuits/wafers/cakes) in 15 EU countries,
and found that, in spite of a low mean intake, high con-
centrations of I-TFA were still present in many popular
foods. Thus, subgroups of the populations could have an
intake that is considerably higher than the recom-
mended upper limit for intake of I-TFA.
8
I-TFA in foods
from international fast food providers was an important
contributor to the high intake in these subpopulations.
9
Still in 2009, EU countries (with the exception of
Austria and Denmark) rely on food producers to volun-
tarily reduce the amounts of I-TFA in foods. The present
study assesses the efficiency of that strategy in three
Eastern European countries, Hungary, Poland and the
Czech Republic, and in three Western European coun-
tries, Germany, France and the UK.
METHODS
Purchase of food products
Between November 2004 and January 2006, 542 items of
foods were purchased in 26 countries. The cities included
were partly determined by visits taken by the authors and
their colleagues for other purposes, and these visits were
supplemented by arranged visits by two of the authors
(SS and JD). The tourist office in the city was asked to
identify three large supermarkets in the vicinity,
preferably chain supermarkets with many large shops in
the capital and across the country. A written procedure
was followed that included details about which products
to select and instructions for storage methods until the
food could be returned to the laboratory. Fast-food items
(chicken nuggets and French fries) were obtained from
McDonald’s and KFC outlets. Microwave oven popcorn
and biscuits/cakes/wafers were bought if ‘partially hydro-
genated fat’or a similar term was listed among the first
three ingredients and if the food label indicated that the
fat content exceeded 15 g of fat per 100 g.
In July 2009 to September 2009, the capitals of
Poland, the Czech Republic, Hungary, Germany, France
and the UK were revisited and the same procedures for
the purchase of food items were followed. If possible,
the same stores were revisited and the same brands were
bought. Altogether, 602 samples of food in EU countries
were purchased.
Analysis for TFA
The microwave popcorn was popped before processing.
The foods were homogenised, and the fatty acid content
was analysed by gas chromatography (GC) on a 100 m
highly polar capillary column. Thin layer chromatog-
raphy on silver nitrate-impregnated silica with renewed
GC verified the results.
10
The method is accredited by
the Danish Accreditation Authorities (DANAK) accord-
ing to ISO 17025.
Calculation
For comparison, the amounts of I-TFA in the French
fries and the chicken nuggets were expressed as the
amounts in a serving size equivalent to a large serving
from McDonald’s in the USA. The serving sizes were
171 g of French fries and 160 g of chicken nuggets.
The potential consumption of I-TFA in a given
country was defined as the sum of the I-TFA contents
provided by a high-trans menu that consisted of products
with the highest identified amount of I-TFA.
RESULTS
Biscuits, cakes and wafers
Figure 1 presents data from the products bought in the six
EU countries in 2005 and 2009. The products are ranked
according to I-TFA content and the combined values for
the three Eastern EU countries and for the three Western
EU countries are given separately. The highest I-TFA con-
tents (10–15 g) in single 100 g servings in 2005 were
found in Hungary, Poland and the Czech Republic. In
France, Germany and the UK, the I-TFA contents were
lower but still with many above 2 g in 100 g product.
In 2009, biscuits, cakes and wafers in the three Eastern
EU countries contained a smaller, but still substantial,
amount of I-TFA. In contrast, the I-TFA content in pro-
ducts in the three Western EU countries was minimal
(<1 g). The same pattern was observed in each of the
countries.
2Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859
Industrial TFA in popular foods in Western and Eastern Europe
Only in few cases was the same brand of biscuits, cakes
and wafers from the 2005 purchase included in the 2009
purchase either because it had disappeared from the
shop or because it did no longer have the term partially
hydrogenated fat on the list of ingredients. When the
same brand was included in the purchases the amount
of I-TFA in that brand has declined from 2005 to 2009,
but other brands with higher amounts have appeared on
the shelves.
The values in figure 1 are given in table 1 for each
food item from each country.
Fast food
In 2005, the I-TFA content of the McDonald’s servings
in EU varied from less than 1 g in Copenhagen to 7 g in
London, UK. For KFC servings, there were even larger
differences between the countries, ranging from less
than 1 g in Germany to 24 g in Hungary. Only 15% of
the 54 fast food servings contained more than 10 g per
serving, and 50% contained between 5 and 10 g.
9
In 2009, each of the 12 fast food menus, which were
collected in France, Germany and the UK in the same
locations as in 2005, contained less than 1 g of I-TFA per
serving (figures 2 and 3).
Popcorn
The highest I-TFA content in a single 100 g serving of
microwave oven popcorn bought in each country is pre-
sented in the data given for the I-TFA content in the
high-trans menu for that country (figure 2 and table 2).
In 2009, the microwave oven popcorn samples with
the highest amounts of I-TFA, which were from
Hungary, Poland and the Czech Republic, contained the
same amounts of I-TFA as the popcorn that we analysed
in 2005. In contrast, the I-TFA in popcorn from
Germany, France and the UK was negligible (figure 3
and table 3).
The brand of microwave oven popcorn with the
highest concentration of I-TFA (11.6 g I-TFA per 100 g
product) found in the Czech Republic in 2005 did not
contain I-TFA in 2009. However, the same brand had the
highest concentration (7.6 g I-TFA per 100 g product)
among the microwave oven popcorn bought in Hungary
in 2009 (table 3).
A high-trans menu
In 2001, the potential consumption of I-TFA by eating a
high-trans menu was 37 g in Denmark, but by 2005, this
potential consumption level was reduced to less than 1 g
(figure 2). In 2005, in contrast, the potential
Figure 1 Amounts of industrial trans fatty acids (TFA) in 100 g of biscuits/cakes/wafers bought in six EU countries in 2005 and
in 2009. For both groups of countries (three Eastern EU countries and three Western EU countries), the products are ranked
according to the concentrations of industrially produced TFA. Products were only bought if ‘partially hydrogenated fat’or a similar
term was listed among the first three ingredients and if the food label indicated that the fat content exceeded 15 g of fat per
100 g. Fewer products in Western EU countries fulfilled the inclusion criteria compared with products in Eastern EU countries.
Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859 3
Industrial TFA in popular foods in Western and Eastern Europe
Table 1 Trans fatty acids (TFA) in biscuits, cakes and wafers bought in 2005 and 2009 in large supermarkets in the capital of the country
2005 2009 2005 2009 2005 2009
Item
no.
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Hungary 10 10.4 93 5.6 Poland 43 12.5 111 6.0 Czech
Republic
25 15.3 57 2.3
19 4.2 88 5.0 2 11.9 85 5.5 11 14.3 64 2.0
26 3.7 98 2.2 26 11.7 92 5.4 35 14.0 69 2.0
24 2.1 85 2.2 44 10.8 107 5.5 20 12.9 71 1.9
33 1.4 97 0.4 1 8.1 91 5.0 36 12.8 66 1.9
29 1.1 96 <0.2 40 7.4 89 4.3 24 12.7 56 1.6
32 0.9 91 <0.2 5 6.3 97 3.5 5 11.7 54 0.9
15 0.9 86 <0.2 24 6.3 114 2.6 21 8.5 55 0.7
35 0.8 90 <0.2 35 5.7 87 2.6 29 8.2 58 0.5
34 0.5 83 <0.2 42 5.5 113 2.1 41 7.8 73 0.4
36 0.5 84 <0.2 33 4.4 109 2.0 31 7.1 76 0.3
23 0.3 89 <0.2 22 4.3 104 1.7 38 6.3 74 0.3
8 <0.2 92 <0.2 6 4.0 105 1.4 34 5.3 78 0.3
9 <0.2 99 <0.2 21 3.9 95 0.9 23 3.8 77 <0.2
16 <0.2 95 <0.2 23 3.4 110 0.8 40 3.7 70 <0.2
28 <0.2 87 <0.2 29 2.9 112 0.7 43 1.7 72 <0.2
30 <0.2 94 <0.2 45 2.8 115 0.5 22 1.6 59 <0.2
5 <0.2 82 <0.2 36 <0.2 108 <0.2 42 1.4 63 <0.2
6 <0.2 34 <0.2 106 <0.2 27 1.2 80 <0.2
11 <0.2 4 <0.2 96 <0.2 28 0.4 53 <0.2
12 <0.2 37 <0.2 88 <0.2 12 <0.2 75 <0.2
13 <0.2 25 <0.2 103 <0.2 13 <0.2 68 <0.2
18 <0.2 38 <0.2 90 <0.2 26 <0.2 79 <0.2
7 <0.2 94 <0.2 30 <0.2 81 <0.2
13 <0.2 93 <0.2 32 <0.2 65 <0.2
3 <0.2 86 <0.2 37 <0.2 60 <0.2
20 <0.2 39 <0.2 61 <0.2
27 <0.2 44 <0.2 62 <0.2
28 <0.2
30 <0.2
31 <0.2
39 <0.2
Total
number
of items
23 18 32 26 28 28
Continued
4Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859
Industrial TFA in popular foods in Western and Eastern Europe
Table 1 Continued
2005 2009 2005 2009 2005 2009
Item
no.
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
Item
number
Gram of
TFA in
100 g
product
France 1b 4.8 12 0.7 Germany 8b 6.9 42 0.3 UK 28a 4.5 58 0.2
22a 4.2 20 0.5 17b 2.6 51 <0.2 4a 1.3 52 0.2
24a 3.6 13 0.5 4a 1.4 43 <0.2 16a 1.0 56 <0.2
4a 3.5 15 0.3 13a 11 40 <0.2 17a 1.0 54 <0.2
2a 1.8 16 0.2 4b 0.8 41 <0.2 15a 0.9 51 <0.2
26a 1.5 17 0.2 3a 0.6 50 <0.2 36a 0.9 57 <0.2
13a 0.7 21 <0.2 13b 0.4 46 <0.2 7b 0.7 55 <0.2
3a 0.7 19 <0.2 5a 0.3 48 <0.2 2b 0.7 53 <0.2
3b 0.7 22 <0.2 12b 0.3 44 <0.2 10a 0.4
15a 0.5 23 <0.2 8a <0.2 47 <0.2 33a 0.4
12a 0.3 18 <0.2 15a <0.2 49 <0.2 32a 0.3
5a <0.2 14 <0.2 1b <0.2 34a 0.3
18a <0.2 3b <0.2 3b 0.2
2b <0.2 16b <0.2 31a <0.2
3c <0.2 6a <0.2 13a <0.2
17a <0.2 7a <0.2 1a <0.2
23a <0.2 14a <0.2 39a <0.2
1a <0.2 17a <0.2 5b <0.2
16a <0.2 6b <0.2 6b <0.2
21a <0.2 21b <0.2 8b <0.2
25a <0.2 16a <0.2 9b <0.2
2c <0.2 29a <0.2
20a <0.2 23a <0.2
14a <0.2 11a <0.2
19a <0.2 12a <0.2
1c <0.2 2a <0.2
4b <0.2 38a <0.2
40a <0.2
4b <0.2
5a <0.2
8a <0.2
35a <0.2
Total
number
of items
27 12 21 11 33 8
Products were only bought if ‘partially hydrogenated fat’or a similar term was listed among the first three ingredients and if the food label indicated that the fat content exceeded 15 g of fat per
100 g product.
Item number is an internal identification number for each package of biscuits, cakes and wafers bought in a given country.
Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859 5
Industrial TFA in popular foods in Western and Eastern Europe
consumption level via a high-trans menu exceeded 20 g
in 13 of the 16 EU countries, from which foods were
investigated. Hungary, the Czech Republic and Poland
ranked among the highest, with values around 40 g per
menu. A considerable amount of the I-TFA in the
menus was derived from the fast-food meal.
Figure 3 demonstrates the time trends for I-TFA in the
high-trans menu in Hungary, the Czech Republic,
Poland, Germany, France and the UK. In all the coun-
tries, the contribution values obtained from McDonald’s
and KFC meals (nuggets and fries) in 2009 were negli-
gible compared to the values obtained in 2005.
In 2009, biscuits, cakes, wafers and microwave oven
popcorn were still high in I-TFA in Eastern EU countries.
In contrast, only small amounts of I-TFA in these same
products obtained in Western EU countries were found.
DISCUSSION
The data from 2005 show that, despite a mean daily
intake of around 1 g I-TFA for the entire population (as
it was in Denmark in 2001), it was still possible to
consume 30–40 g I-TFA in a high-trans menu composed
of popular foods. Consequently, a low-average intake at
the population level does not preclude a very high
intake among some subgroups.
8
Following Denmark’s
2003 legislation, the I-TFA content of the same menu
was reduced to less than 1 g.
910
In addition, the data
demonstrate that in 2005 it was possible to eat a menu
of popular foods with more than 20 g of I-TFA in 13 of
16 EU countries and up to 40 g in Hungary ( figure 2).
So far, EU countries (with the exception of Austria and
Denmark) rely on food producers to voluntarily reduce
the amounts of I-TFA in foods. The present study
demonstrates the difference between Eastern and
Western Europe in the efficiency of this strategy. The
overall picture regarding the I-TFA content in fast food,
biscuit/wafers/cookies and microwave oven popcorn in
the EU indicates that I-TFA has disappeared from
American-based fast food, such as that from McDonald’s
and KFC, mainly due to societal pressure.
911
The same
decline for biscuits and snacks in Western EU countries
were observed. In Eastern EU countries, however, the
amount of I-TFA in these products is still high. We even
observed this difference in products bought at the same
retailers in the Eastern and Western EU countries (eg,
Carrefour).
Limitations of the study
The average daily intake of I-TFA was not measured in
subgroups of the population, but instead inferred from
the popularity of fast food from McDonald’s and KFC
and from the presence of popular foods with high
amounts of I-TFA in large supermarkets. The assump-
tions are: (1) the analysed brands of biscuits, cakes,
wafers and microwave oven popcorn were stocked at the
supermarkets because they are sold in considerable
amounts; (2) the majority of these foods are regularly
bought and consumed by the same subgroups of consu-
mers and (3) the findings in the supermarkets in each
capital are representative of the entire country and of
adjacent countries in the Eastern and Western Europe.
Another weakness is that only foods were bought in
large supermarkets and from two international fast food
providers (McDonald’s and KFC). The I-TFA content in
foods sold by small, privately owned shops or street
vendors was not examined. Fats with high amounts of
Figure 2 Amounts of industrial
trans fatty acids (TFA) in a
high-trans menu bought in
various countries in 2005. For
each country, the product with the
highest concentration of industrial
TFA in each of the three food
categories is shown.
6Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859
Industrial TFA in popular foods in Western and Eastern Europe
I-TFA prolong the shelf life of foods, and it is reasonable
to assume that this factor is of even higher importance
for small, privately owned shops than it is for larger
supermarkets. The selective pattern of purchasing may
thus have led to an underestimation of the amounts of
I-TFA consumed by subgroups of the population.
Implications
An intake of above 5 g of TFA daily is associated with a
health risk that can be eliminated more easily than
many other diet-associated health risks. This issue is par-
ticularly relevant to low socioeconomic groups, such as
truck and taxi drivers and manual labourers, who, due
to other lifestyle factors, already have an increased risk
of coronary heart disease partly due to high prevalence
of smoking and poor diet, including a high intake of
I-TFA and metabolic syndrome.
12
In 2012, EU countries, with the exception of Austria
and Denmark, legally allow foods with the maximum
concentration of I-TFA in the fat (ie, 60%) to be sold
without any notice as long as the food is unpackaged (as
is the case for restaurants and fast food outlets). If the
food is prepackaged, then the law requires the presence
of I-TFA to be noted only by the term ‘partially hydroge-
nated fat’in the list of ingredients.
13
Most consumers do
not appreciate the hazard concealed therein.
Societal pressure on food producers has undoubtedly
resulted in a reduction in the population-level mean
intake of I-TFA from 2005 to 2009, especially in Western
EU countries.
11
However, this study demonstrated that a high intake of
I-TFA is still possible in Eastern EU countries. This
problem will continue as long as popular foods with a
high concentration of I-TFA are available. Even though
Figure 3 Time trends for the
amounts of industrial trans fatty
acids in a high-trans menu bought
in three Eastern EU countries in
2005 and 2009 and in three
Western EU countries in 2005
and 2009.
Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859 7
Industrial TFA in popular foods in Western and Eastern Europe
labelling foods with I-TFA contents may further reduce
the mean intake of I-TFA, such labelling still allows the
intake of high amounts of these fatty acids, first because
fast food is not labelled and second because consumers
might not pay attention to or understand the
labelling.
14 15
A further advantage of a legislative limit on I-TFA
content is that it does not require the population to
learn about the health risks of I-TFA or to pay attention
to the labelling of food products. It is also much easier
and cheaper to monitor the presence of I-TFA in foods
than it is to monitor the actual intake of I-TFA in at-risk
population subgroups.
In EU Austria and Denmark have shown that the
health risk that a high intake of I-TFA causes, can be
eliminated for the entire population without any notice-
able side effects for consumers. This has the added
advantage of creating a ‘level playing field’for suppliers.
All are equally challenged. All can profitfromexperience
of successful and rapid adaptation as in Denmark. It
remains to be investigated to what extent the difference
of availability of I-TFA in popular foods between and
Eastern and Western EU countries contributes to the
much higher mortality of coronary heart disease in
Eastern, than in Western EU countries (table 4 and
figure 4).
16
Table 2 Amounts of industrial trans fatty acids (TFA) in a high-trans menu bought in the various countries in 2005
Gram of TFA in a large
serving* of nuggets and
French fries
Gram of TFA in 100 g
biscuits, cakes and
wafers
Gram of TFA in 100 g
microwave popcorn
Gram of TFA in a
high-trans menu
Czech Republic 2005 16.8 15.3 11.6 43.7
Poland 2005 19.8 12.5 10.7 42.3
Hungary 2005 24.1 10.4 7.6 42.1
Bulgaria 2005 22.5 7.9 7.7 38.1
Romania 2005 15.3 3.5 11.8 30.6
France 2005 6.2 4.8 13.8 24.8
Germany 2005 4.9 6.9 12.4 24.2
Portugal 2005 4.0 5.5 13.9 23.4
Spain 2005 5.0 4.6 13.8 23.4
UK 2005 8.2 4.5 10.4 23.1
The Netherlands 2005 5.0 6.7 11.0 22.7
Austria 2005 4.2 8.4 9.4 22.0
Italy 2005 6.0 3.3 11.9 21.2
Sweden 2005 4.8 6.0 5.9 16.7
Finland 2005 5.9 4.6 0.1 10.6
Denmark 2001 10.0 17.0 10.0 37.0
Denmark 2005 0.3 0.3 0.3 0.9
*A large serving was 171 g of French fries or wedges and 160 g of nuggets or hot wings.
Table 3 Amounts of industrial trans fatty acids (TFA) in various foods bought in three Eastern EU countries in 2005 and
2009 and in three Western EU countries in 2005 and 2009
Gram of TFA in a large
serving of nuggets and
French fries
Gram of TFA in
100 g biscuits/
cakes/wafers
Gram of TFA in 100 g
microwave popcorn
Gram of TFA in a
high-trans menu
Hungary 2005 24.1 10.4 7.6 42.1
Czech Republic 2005 14.1 15.3 11.6 41
Poland 2005 19.1 12.5 6.7 38.3
Hungary 2009 <1 5.6 6.9 12.5
Czech Republic 2009 <1 2.3 16.8 19.1
Poland 2009 <1 6 7.6 13.6
France 2005 62 4.8 13.8 24.8
Germany 2005 53 6.9 12.4 24.6
UK 2005 83 4.5 10.4 23.2
France 2009 <1 <1 <1 <1
Germany 2009 <1 <1 <1 <1
UK 2009 <1 <1 <1 <1
8Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859
Industrial TFA in popular foods in Western and Eastern Europe
Acknowledgements We acknowledge the support from Jenny Vissings
Foundation, University of Copenhagen and the Department of Clinical
Biochemistry, Gentofte University Hospital.
Contributors SS and JD were both responsible for the concept design of the
study, for collection of food items, registration and labelling. SS and JD
produced the first draft of the study and SS, JD and AA were responsible for
critical revision of the manuscript. SS is a guarantor for the study.
Funding University of Copenhagen, Jenny Vissings Foundation.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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Table 4 Trends in ischaemic heart disease death rates,
selected OECD countries, 1980–2006
Denmark Hungary OECD
1980 261.2 217 171.8
1981 258.4 231.5 170.3
1982 241.3 230.7 166.8
1983 237.9 231 165.2
1984 235.4 223.9 162.0
1985 232.1 225 162.6
1986 226.5 227.5 157.5
1987 221.9 221.5 154.3
1988 211.6 223.5 150.5
1989 204.4 222.8 147.6
1990 201.6 226.6 144.3
1991 187.8 230.2 141.4
1992 181.9 234.6 138.3
1993 180.2 244.2 137.0
1994 158.0 233.1 130.3
1995 157.4 235.4 128.9
1996 136.6 237.8 123.6
1997 130.5 232.2 118.7
1998 120.5 234.2 115.4
1999 117.4 240.9 114.6
2000 106.0 225.4 107.9
2001 106.4 212.9 103.2
2002 93.7 209.3 100.7
2003 87.9 219.7 98.1
2004 80.4 220.6 92.5
2005 73.9 247.5 89.7
2006 67.8 228.5 86.9
Deaths per 100 000.
Source: OECD Health Data 2009.
Figure 4 Trends in coronary heart disease death rates,
selected OECD countries, 1980–2006. Source: OECD Health
Data 2009. The raw mortality data are extracted from the
WHO Mortality Database, and age-standardised to the 1980
OECD population. For 2006–2009 the yearly mortality for
Hungary is 228, 215, 205 and 204. The corresponding values
for Denmark and for OECD mean have not yet appeared in
the OECD Health data 2011.
Stender S, Astrup A, Dyerberg J. BMJ Open 2012;2:e000859. doi:10.1136/bmjopen-2012-000859 9
Industrial TFA in popular foods in Western and Eastern Europe
