Restricting trans Fatty Acids in the Food Supply

In the spirit of the American Public Health Association’s (APHA’s) dedication to supporting the Dietary Guidelines for America, this resolution supports 1 of its key recommendations: to limit trans fatty acids in the American diet.¹

Trans fats (also know as trans fatty acids) are unsaturated fatty acids with at least 1 double bond in the trans configuration. Although a small amount of trans fat occurs naturally in meat, milk, and other foods from ruminants, most of the trans fats in the US diet are industrially produced from vegetable oils that are partially hydrogenated.² The hydrogenation process converts the polyunsaturated fats into monounsaturated trans fatty acids that are solid at room temperature. These fats are used mainly in frying oils and shortenings. The Food and Drug Administration (FDA) now requires the nutrition facts label on consumer products to list trans fats; however, there is no such requirement for institutional food packaging. Thus, restaurants, schools, hospitals, cafeterias, and other quantity food purchasers are unable to assess or compare these commercial food products for trans fat content.

Early scientific studies on the relation between trans fatty acids and ischemic heart disease (IHD) showed inconclusive results.^3,4 However, more recent studies have shown a strong association between the intake of trans fatty acids and IHD.5–7 Studies have also shown that trans fats increase low-density lipoprotein (LDL), decrease high-density lipoprotein (HDL), and increase the LDL/HDL ratio, all of which are strong risk factors for coronary heart disease (CHD).8 Further, it has been reported that compared with saturated fat (gram for gram), trans fat is more harmful and produces a significantly greater risk (2.5- to 10-fold) for IHD.^2,9

Harvard School of Public Health researchers estimated that industrially produced trans fats in the diet cause 72,000 to 228,000 heart attacks, with 30,000 to 100,000 of these being fatal, every year.¹⁰ Trans fatty acids may also increase the risk of type 2 diabetes and breast and colon cancers, although findings have been mixed.^2,8

The National Academy of Science’s Institute of Medicine concluded that “Because they are not essential and provide no known health benefit, there is no safe level of trans fatty acids and people should eat as little of them as possible while consuming a nutritionally adequate diet.”¹¹, p 423 The 2005 Dietary Guidelines for Americans recommends to “keep trans fatty acid consumption as low as possible,”¹, p 10 and the American Heart Association has recommended that trans fats comprise 1% or less of a person’s caloric intake.¹²

On the basis of recent findings, the American Heart Association and others have recommended that the food industry replace saturated and trans fats in prepared foods with liquid vegetable oils that are low in saturated fat and trans fat.¹² Further, several major European food processors and restaurant chains have eliminated partially hydrogenated oils and trans fats from their foods without apparent problem.¹³

In 2004, Denmark mandated that all oils and fats in domestic or imported foods, including those of major US restaurants and food processors that do business in Denmark, contain less than 2% industrially produced trans fat.^2,8 In 2006, Health Canada’s trans Fat Task Force recommended that the trans fat content of soft margarines and vegetable oils be limited to 2% of total fat and be limited to 5% of the total fat of other foods (with no limit for foods made entirely from ruminants).¹⁴

To date, 2 metropolitan US cities, New York and Philadelphia, have instituted bans on industrial-produced artificial trans fats in restaurant-prepared foods, and several others cities and states are following suit, pushing to ban artificial trans fats. A New York City Health Code, passed December 2006, calls on restaurants and other food service establishments to cease using oils, margarines, or shortenings that contain more than 0.5 g of trans fat per serving by July 2007 and totally eliminate all foods that contain more than 0.5 g per serving of trans fats by July 2008, with the exception of foods that are served in the manufactures’ packaging that would display the trans fat content.¹⁵ The Philadelphia code, like the New York City code, started with a partial phase out in September 2007 and requires that all artificial trans fat (≥ 0.5 g/serving) be eliminated from menu items in restaurants and other food establishments by September 2008, with the exception of manufactures’ prepackaged foods.¹⁶

Although there are widespread calls for banning industrially produced artificial trans fat in the food supply, there is also some concern that in the haste to ban artificial trans fat in food, there may be a risk of replacing these fats with an even more harmful fat source. However, proven technology currently is being used to produce fat products that are low in saturated fat as well as trans fat,¹⁷ and other countries have demonstrated that these changes can be made without an increase in the cost of food or a decrease in quality.^9,13,18p

Although the FDA’s mandated listing of the trans fat content in processed food on the nutrition facts label is thought to decrease consumption if consumers read the labels, other sources of trans fat, such as that in restaurant-prepared foods, will not be as apparent. Therefore, when people are dining out, nutrition labeling may not be as effective in controlling trans fat intake as requiring restaurants and other food establishments to reduce industry-produced trans fat in food. Consequently, in addition to banning artificial trans fat, information on saturated fat and trans fat should be provided on menus, as called for in APHA Policy Statement 2004-^14.19 Evidence shows that if people are provided nutrition information, they are likely to use it.^20,21 The Danish government’s efforts to decrease the intake of trans fat from 6 g per day to 1 g per day over a 20-year period is thought to be related to a 50% decrease in IHD deaths.²

Given the well-documented impact that trans fat intake has on health, APHA recommends efforts to protect the public from the harmful effects of trans fat and takes the following steps to reduce the trans fat content of Americans’ diets:

1. Urges Congress and state and local governments to require nutrition facts labeling of trans fats on all commercial food products.
2. Urges federal, state, and local governments to ban and monitor the use of trans fat–laden partially hydrogenated oils in restaurants or require restaurants to have menu labeling that would prominently disclose all amounts of trans fat greater than 0.1 g/serving. Further, foods with greater than 0.2 g/serving must include a warning stating that trans fats have been shown to increase the risk of heart disease. 
3. As an initial step, urges federal, state, and local government to develop initiatives that would bar the sale or availability of foods that contain significant amounts (> 2%) of industrially produced trans fat in public facilities (e.g., office buildings, prisons), Head Starts; day care and child care facilities, Kindergarten through 12 schools, colleges, and universities. 
4. Urges the US Department of Health and Human Services and the FDA to begin rulemaking to revoke the “generally recognized safe” and “prior sanction” status of trans fat containing partially hydrogenated oils and support regulations that would limit the trans fat content of vegetable oils, shortenings, margarines, and processed foods to safe levels, as Denmark has done. 
5. Urges federal, state, and local governments to undertake monitoring, surveillance, and oversight of trans fat food content and dietary intake levels.
6. Urges public and private support for nutrition and health education on the issue of trans fat in the US diet.

References

1. US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans. 2005. Available at: www.health.gov/dietaryguidelines/dga2005/document. Accessed December 10, 2007.
2. Stender S, Dyerberg J. Influence of trans fatty acids on health. Ann Nutr Metab. 2004;48:61–66.
3. Aro A, Kardinaal AF, Salminen I, et al. Adipose tissue isometric trans-fatty acids and risk of myocardial infarction in nine countries: The EURAMIC study. Lancet. 1995;345:273–278. 
4. Aro A. Epidemiology of trans-fatty acids and coronary heart disease in Europe. Nutr Metab Cardiovasc Dis. 1998;8:402–407. 
5. Ascherio A, Rimm EB, Giovannucci EL, Spiegelman D, Stampfer M, Willet WC. Dietary fat and risk of coronary heart disease in men: cohort follow-up study in the United States. BMJ. 1996;31:84–90. 
6. Pietimen P, Ascherio A, Korhonen P, et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men: the Alpha-Tocopherol, Beta Carotene Cancer Prevention Study. Am J Epidemiol. 1997;145:876–887. 
7. Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat and the risk of coronary heart disease in women. N Engl J Med. 1997;337:1491–1499. 
8. Mozaffarian D, Katan MB, Ascherio A, et al. Medical progress: trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354:1601–1613. 
9. Nutrition Subcommittee of the Food Advisory Committee, Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FSA) summary minutes. April 27–28, 2004. Available at: www.fda.gov/ohrms/dockets/ac/04/minutes/2004-4035m1-summary.pdf. Accessed November 3, 2006.
10. Willett WC, Ascherio A. Trans fatty acids: are the effects only marginal? Am J Public Health. 1994;85:722–724. 
11. Institute of Medicine of the National Academies. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press, 2005.
12. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82–96. 
13. Katan MB. Regulation of trans fats: The gap, the Polder, and McDonald’s French Fries. Atheroscler Suppl. 2006;7(2):63–66.
14. Health Canada. Transforming the food supply. 2006. Available at: www.hc-sc.gc.ca/fn-an/nutrition/gras-trans-fats/tf-ge/tf-gt_rep-rap_e.html#ea. Accessed October 15, 2006. 
15. New York City Department of Health and Mental Hygiene. Board of Health votes to phase out artificial trans fat from New York City’s restaurants [press release #114-06, December 5, 2006]. Available at: www.nyc.gov/html/doh/html/pr2006/pr114-06.shtml. Accessed December 10, 2007. 
16. Philadelphia City Council (2007-10-10). Amending Section 6-307 of The Philadelphia Code, entitled “Foods Containing Artificial Trans Fats,” by exempting certain bakeries from the provisions prohibiting the use of artificial trans fats, under certain terms and conditions. Press release. Available at: http://webapps.phila.gov/council/detailreport/?key=7421. Accessed November 10, 2007
17. Upritchard JE, Zeelenberg MJ, Huizinga H, Verschuren PM, Trautwein EA. Modern fat technology: what is the potential for heart health? Proc Nutr Soc. 2005;4:379–386. 
18. Clark R, Lewington S. Trans fatty acids and coronary heart disease. BJM. 2006;333:214. 
19. American Public Health Association. APHA Policy Statement 2004-14. Support for Nutrition Labeling in Fast-Food and Other Chain Restaurants. Washington, DC: American Public Health Association; 2004. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1300. Accessed December 10, 2007.
20. Global Strategy Group. Nationally representative poll commissioned by the Center for Science in the Public Interest. Washington, DC: Center for Science in the Public Interest; 2003.
21. Harvard Forums on Health. Obesity as a Public Health Issue: A Look at Solutions. National poll by Lake Snell Perry & Associates; 2003. Available at: www.phsi.harvard.edu/health_reform/poll_results.pdf Accessed February 16, 2008.

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