Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs

Rubinstein, Adolfo; Elorriaga, Natalia; Garay, Osvaldo Ulises; Poggio, Rosana; Caporale, Joaquín; Matta, María G.; Augustovski, Federico; Pichón-Riviere, Andrés; Mozaffarian, Dariush

doi:10.2471/blt.14.150516

Cited by 32 publications

(36 citation statements)

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“…After removing 723 duplicates, we screened 1084 publications by title and abstract, after which 70 full-text papers were assessed for eligibility. A total of 23 papers met the inclusion criteria (12 empirical studies 20 – 31 and 11 modelling studies; 32 – 42 Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of dietary trans-fat reduction interventions

Hyseni

Bromley

Kypridemos

et al. 2017

Bull. World Health Organ.

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ObjectiveTo systematically review published studies of interventions to reduce people’s intake of dietary trans-fatty acids (TFAs).MethodsWe searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes.ResultsAfter screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day.ConclusionMulticomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.

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Section: Resultsmentioning

confidence: 99%

“…Based on changes in lipid profile, the combined intervention was projected to avert 301 deaths, 1066 acute coronary heart disease events, 5237 DALYs and 17 million United States dollars in health-care costs annually in the adult population. 42 …”

Section: Resultsmentioning

confidence: 99%

Systematic review of dietary trans-fat reduction interventions

Hyseni

Bromley

Kypridemos

et al. 2017

Bull. World Health Organ.

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“…However, the European Union model found that a mandatory TFA-labeling policy would not be cost-effective unless initial TFA intakes were quite high ( 43 ). For those studies that examined savings per year, health care savings ranged from US$17 million/y ( 44 ) to £230 million/y ( 39 ). Two studies ( 38 , 42 ) examined the effects of different TFA policy scenarios on different socioeconomic groups.…”

Section: Resultsmentioning

confidence: 99%

“…Two modeling studies, one in Argentina ( 44 ) and another in Denmark ( 45 ), modeled the impact of the countries' actual TFA policies, both showing positive impacts in terms of reducing CHD and CVD rates. Over the course of a 10-y period between 2004 and 2014, Argentina went from having a voluntary TFA-labeling policy to having mandatory TFA limits in foods.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Policies to Reduce trans Fat Consumption: A Systematic Review of the Evidence

Downs

Bloem

Zheng

et al. 2017

Current Developments in Nutrition

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Background: The consumption of industrially produced trans fatty acids (TFAs) has been associated with an increased risk of heart disease. In recognition of this, countries, states, and cities worldwide have implemented TFA policies aimed at reducing their availability in the food supply. Objective: This article aims to provide an update of the evidence of the effectiveness of policies aimed at reducing TFAs in the food supply. Methods: A systematic review of the literature from 2013 onward was conducted, building on a previously published review that examined the evidence of the impact of TFA policies worldwide from 2000 to 2012. Studies that were 1) empirical, 2) examined a TFA policy, and 3) examined the effect of the policy on TFA amounts and availability pre– and post–policy intervention were included. Modeling studies examining the impact of TFA policies on cardiovascular, equity, and economic outcomes were also included. Results: A total of 18 articles from the updated search were combined with 14 articles from the previous review (total = 32 articles). All types of TFA policies led to their reduction; however, trans fat bans had a larger impact (TFAs virtually eliminated) than did voluntary (range: 20–38% reduction in TFA intakes) or labeling (range: 30–74% reduction in TFA intakes, plasma serum, or breast-milk concentrations) approaches to reducing TFA amounts in the food supply. Product reformulation to reduce TFAs had variable effects on saturated fatty acid (SFA) contents in these foods; however, the combined amount of TFAs and SFAs declined in most products. Overall, the modeling studies indicated that TFA bans would reduce heart disease risk, benefit socioeconomically disadvantaged populations the most, and be cost-saving. Conclusions: Policies aimed at reducing TFAs in the food supply are effective and will likely reduce the burden of diet-related disease, particularly among the most vulnerable socioeconomic groups. Although all policy approaches lead to reductions in TFAs in foods, TFA bans are likely the most effective, economical, and equitable policy approach to reducing TFAs in the food supply.

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“…In our study, the biggest contributors of TFA were meat, poultry, and fish recipes (12.47% at baseline vs. 18.75% at one year), followed by breads, rolls, biscuits, and other related products (10.75% at baseline vs. 10.70% at one year) (data not shown in table). In the United States, nutritional labelling of TFA content became mandatory in 2006 [ 37 ]. In 2007, New York City (NYC) became the first in the United States to pass a regulatory restriction on PHO use, targeting restaurants.…”

Section: Discussionmentioning

confidence: 99%

Substantial Increase in Compliance with Saturated Fatty Acid Intake Recommendations after One Year Following the American Heart Association Diet

et al. 2018

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The American Heart Association (AHA) dietary guidelines recommend 30–35% of energy intake (%E) be from total fat, <7%E from saturated fatty acids (SFA), and <1%E from trans fatty acid (TFA). This study evaluates the effect of AHA dietary counselling on fat intake. Between 2009 and 2014, 119 obese adults with metabolic syndrome (MetS), (71% women, average 52.5 years of age, and 34.9 kg/m2 of body mass index), received individual and group counselling on the AHA diet, over a one-year study period. Each participant attended 2 individual sessions (months 1 and 12) and 12 group sessions, at one-month intervals. At baseline and one-year, we collected three random 24-h diet recalls (two weekdays and one weekend day). Fat intake patterns over time were analyzed using paired-t test and linear mixed-effect models. There was significant variation on SFA and TFA intake per meal, being highest at dinner, in restaurants, and on weekends. Over the one-year study period, daily intake of total fat, SFA, and TFA decreased by 27%, 37% and 41%, respectively (p-value < 0.01, each). Correspondingly, the percentage of participants complying with AHA’s recommendations, increased from 25.2% to 40.2% for total fat (p-value = 0.02); from 2.5% to 20.7% for SFA (p-value < 0.01); and from 45.4% to 62% for TFA (p-value = 0.02). Additionally, SFA intake for all meal types at home decreased significantly (p-value < 0.05, each). AHA dietary counselling significantly increased the compliance with AHA dietary guidelines, with an eightfold increase in compliance in SFA intake. Nonetheless, ~80% of our participants still exceeded the recommended SFA intake. Substantial efforts are needed to encourage low-SFA and low-TFA food preparation at home, with strong public health policies to decrease SFA and TFA in restaurants and prepared foods.

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Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs

Cited by 32 publications

References 29 publications

Systematic review of dietary trans-fat reduction interventions

Systematic review of dietary trans-fat reduction interventions

The Impact of Policies to Reduce trans Fat Consumption: A Systematic Review of the Evidence

Substantial Increase in Compliance with Saturated Fatty Acid Intake Recommendations after One Year Following the American Heart Association Diet

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